The neurosurgeons at Houston Methodist Hospital Neurological Institute Cerebrovascular Center diagnose and treat many kinds of cerebrovascular conditions, including cavernous malformations of the brain and spinal cord. Dr. Gavin Britz, co-director of Houston Methodist Neurological Institute, and Dr. Jonathan Zhang, have special expertise in treating cavernous malformations.
Cavernous malformations of the brain and spinal cord are a type of vascular malformation that have clusters of abnormal, fragile blood vessels. These dilated blood vessels have multiple pockets (caverns), through which blood passes slowly. They often look like small mulberries. Cavernous malformations are also called cavernomas, cavernous angiomas, cavernous hemangiomas, and intracranial vascular malformations.
Cerebral cavernous malformations (CCMs) occur in the brain’s cortex. They do not have brain tissue within the malformation and usually don’t have defined borders. They can change in size and number over time, and tend to leak blood.
Many people will not have any symptoms of a cavernous malformation. At least 30% of people with brain and spinal cavernous malformations will develop symptoms. Specific symptoms often depend where the cavernoma is located and whether it is leaking blood. Symptoms may include:
Most cavernous malformations are not diagnosed unless they cause symptoms. If you or a loved one has symptoms that might indicate a cavernous malformation, your doctor may order imaging scans to detect dilated blood vessels.
Cavernous malformations don’t show up on angiograms because the blood flow is so slow. Magnetic resonance imaging (MRI) with gradient echo sequences is the most reliable way to diagnose cavernomas. Sometimes computed tomography (CT) scans with contrast dye is also used.
If a cavernous malformation isn’t causing symptoms, your doctor may monitor your condition with periodic testing to watch for any changes. If the cavernoma is bleeding, or if symptoms progress, you may need surgery to remove the cavernoma. Surgery for cavernous malformations is much safer today than in the past because of advances in microsurgery and computer-assisted image guided navigation.
Unlike other vascular malformations such as arteriovenous malformations (AVM), cavernous malformations don’t respond to radiation treatment. In fact, radiation treatment, including Gamma Knife Surgery, Cyberknife Surgery, or LINAC, for cavernous malformations can frequently result in complications.
Cerebral cavernous malformations are removed in a surgery called a craniotomy. During a craniotomy, part of the skull bone is removed so the surgeon can access the brain. This section of skull (called the bone flap) is replaced at the end of surgery. A craniotomy is usually performed under general anesthesia, unless the doctor needs to map brain function while the patient is awake.
Cavernous malformations of the spine are removed during a laminectomy. In this procedure, the back part of the vertebra that covers the spinal canal (the lamina) is removed.
Most patients only spend a few days in the hospital after surgery, and return to their normal activities within a few weeks. Many patients can be cured without neurological deficits. Patients who have neurological deficits are usually able to return to their baseline (their condition at the time of surgery) with therapy, and may even show continued improvement. Patients who have neurological deficits may need a longer period of rehabilitation.
The rebleeding rate of cavernous malformations varies. Some patients’ symptoms never recur, while others experience frequent rebleeding.