What is a brain cavernoma?
A cavernoma is a mulberry like abnormality of the blood vessels of the brain.
How common are brain cavernomas and how do they present?
Brain cavernomas are common and about 1 out of 200 people have one. They are seen most commonly in patients in their 40’s and 50’s.
Cavernomas are normally diagnosed because a person has had a brain scan (often for a reason such as headache or tinnitus) for something unrelated. In about half of patients they are diagnosed because it causes symptoms. Patients with a cavernoma can present with a seizure or epilepsy and also with a brain haemorrhage.. The reason why brain cavernomas occur is not known.
What is the risk of a haemorrhage from a brain cavernoma?
The overall risk of a first-ever haemorrhage related to a cavernoma is low (0.4-0.6% per year). Once a haemorrhage has occurred, risk of a subsequent haemorrhage is much higher (3.8-23% per year), although this risk decreases over time after the haemorrhage.
What is the risk of epilepsy after diagnosis of a cavernoma?
About 25% of patients with a cavernoma present with either a single or multiple seizures or fits. Of patients that have a first seizure from a cavernoma most patients will go on to develop epilepsy. In about half of these patients seizures may be persistent despite medication.
How are brain cavernoma diagnosed?
Most brain cavernomas are identified on a CT scan or an MRI scan. Cavernomas have a classical appearance on a brain scan and can appear as 'popcorn'-like lesions. Sometime specific scan techniques (gradient echo sequences) are required to confirm the diagnosis.
How is a cavernoma treated?
In general, a cavernoma may be considered for treatment if it has bled, and if it is in an area of the brain that can be easily treated. There is no clinical trial evidence to suggests when and how this is best done and treatment decisions are made on an individual patient basis.
All clinical scenarios and imaging are normally discussed with a panel of doctors that have experience in treating a brain cavernoma (multi-disciplinary team (MDT) discussion).
The various methods of treating brain cavernomas are outlined below:
- Conservative management. In almost all brain cavernomas that have been found incidentally on a brain scan, conservative management is likely to be recommended.
- Surgery. If a cavernoma has bled and/or is in an area that can be easily operated upon, then surgical removal may be recommended. The patient is put to sleep with anaesthesia, a portion of the skull is removed, and the abnormality is surgically removed. When the cavernoma is completely taken out, the possibility of any further bleeding should be eliminated.
- Stereotactic radiosurgery. Cavernomas can also be treated by radiotherapy. This is normally reserved for patients with cavernomas that are difficult to get to by an open operation. The aim of treatment is to prevent re-haemorrhage by causing thrombosis of the blood vessels in the cavernoma.