Experts at the Center for Endovascular Surgery specialize in cavernomas (also called cavernous angiomas or cavernous malformations). Cavernomas, or cavernous angiomas are abnormal clusters of vessels with small bubbles (or caverns) filled with blood that make them look like a berry. Cavernomas can range from microscopic up to several inches in diameter. Unlike arteriovenous malformations or AVM, blood flow in cavernomas is low. Since the walls of cavernomas are weak, blood can slowly leak out. Cavernomas can occur in the brain and on the spinal cord. While a cavernous angioma may not affect function, it can cause seizures, stroke symptoms, hemorrhages and headache.

Who Is At Risk For Cavernomas, Cavernous Angiomas?
Approximately one in 200 people has a cavernous angiomas. Anyone may have a cavernoma, or a cavernous angioma (again, also sometimes referred to as a cavernous malformation), and the majority diagnosed report no family history. However, those with more than one cavernoma are suspected to have an inherited factor.

Each child of someone with the inherited form of cavernomas, or cavernous angiomas, has a 50% chance of inheriting the illness. In inherited cavernomas, current research points to a mutation in any one of three particular genes. The Center for Endovascular Surgery can coordinate genetic counseling for families who would like to evaluate their risk.

While many uninherited cavernomas are present at birth, some develop later in life, often as a result of other endovascular abnormalities such as a venous malformation.

What Are The Symptoms Of Cavernomas, Cavernous Angiomas?
Cavernomas, or cavernous angiomas, are usually only diagnosed after a seizure, a loss of function or from a surprise finding when an MRI is performed for another reason.

Cavernomas may have no symptoms, but more than 30% of those with cavernous angiomas eventually will develop symptoms. Often these symptoms occur when patients are 20 to 40 years old.

The type, frequency and severity of symptoms often depend on the location of the cavernomas. Typical symptoms include:

• Headache
• Epileptic seizure
• Neurological loss such as limb weakness, vision or balance problems, or problems with memory and attention
• A brain hemorrhage, which can be small, but sometimes massive, leading to stroke-like symptoms.
• Spinal cord injury

How Do Doctors Diagnose Cavernomas, Cavernous Angiomas?
Due to their low blood flow, cavernomas are not visible on angiograms. Cavernomas, however, very clearly show on MRIs and are easily distinguished from tumors. Imaging experts at the Center for Endovascular Surgery specialize in diagnosing cavernomas, or cavernous angiomas (cavernous malformations).

What Are The Treatment Options For Cavernomas, Cavernous Angiomas?
Physicians at the Center for Endovascular Surgery evaluate how to treat cavernomas depending on:

• How the cavernomas are bleeding. Cavernous angiomas might bleed slowly, requiring little intervention since the body will reabsorb it. Cavernomas that are bleeding more profusely, however, can put dangerous pressure on the surrounding brain tissue and/or cause an obvious hemorrhage. Cavernous angiomas that have already bled are more likely to bleed again, especially within two years of their first bleed. Frequency is evaluated too; even if the cavernoma is only causing very small hemorrhages, continuous bleeding can affect function over time.
• If there are multiple cavernomas. The higher the number of cavernomas, the greater the chance of one or more hemorrhages occurring.
• Where the cavernomas are located. For instance, surgery on cavernomas in the brainstem (where the brain connects to the spinal cord), or located in the cerebral cortex (the outer layer of the brain responsible for speech, motor and visual abilities), or the spinal cord is considered risky. On the other hand, cavernomas in these areas can cause more damage when they do bleed than cavernomas located elsewhere. The risk versus benefit is weighed carefully when deciding on treatment.
• The presence of other endovascular abnormalities. Up to 40% of cavernomas occur near a venous malformation, which can make surgical treatment more difficult.

Depending on thorough assessment of the above factors, the Center for Endovascular Surgery can offer:

• Watching and waiting. Many cavernomas are observed for changes, recent hemorrhage or worsening symptoms.
• Medications, which cannot directly treat the cavernomas, but can be effective in treating symptoms such as seizures and headaches caused by cavernomas.
• Surgery, which is the only curative approach to cavernomas and is advocated for cavernous angiomas with recent hemorrhage, those that are expanding in size, and sometimes those that are causing seizures.

Surgeons at the Center for Endovascular Surgery remove cavernomas by opening the skull (a craniotomy). This is usually performed under general anesthesia, except in rare cases where mapping of the brain while awake is needed. Most patients leave the hospital within a few days and resume normal life within a few weeks. Patients who suffered from neurological loss caused by the cavernomas may require post-surgical rehabilitation, which is coordinated by the Center for Endovascular Surgery.

The surgeons at the Center for Endovascular Surgery use the latest, safest and most effective techniques for removing cavernomas with as little disruption to the brain as possible. These techniques include microsurgery and computer-image guided surgical navigation.