Cavernomas are clusters of abnormal blood vessels mainly found in the brain and spinal cord. They are sometimes known as cavernous angiomas, cavernous hemangiomas or cerebral cavernous malformations. A typical cavernoma looks a bit like a blackberry.
A cavernoma or cavernous malformation is a vascular abnormality of the central nervous system. It consists of a cluster of abnormal, dilated vessels. Pathologically, it is red to purple in colour, appearing as a raspberry. Cavernomas contain blood products at various stages of evolution and are usually less than 3 centimetres in size.
Cavernomas 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; however, more than 30 percent 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 cavernoma.
Typical symptoms include:
- Epileptic seizure
- Neurological loss, such as limb weakness, vision or balance problems, or problems with memory and attention
- Brain hemorrhage, which can be small, but sometimes massive, leading to stroke-like symptoms
- Spinal cord injury
- Brain aneurysms are caused by a weakness in the walls of blood vessels in the brain. There are several reasons why this may happen, although an exact cause isn't always clear.
- The brain requires a large supply of blood delivered via four main blood vessels that run up the neck and into the brain.
- These blood vessels divide into smaller and smaller vessels in the same way the trunk of a tree divides into branches and twigs.
- Most aneurysms develop at the points where the blood vessels divide and branch off, as these areas are often weaker.
Approximately one in 200 people have a cavernous angioma. Anyone may have a cavernoma, 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 has a 50 percent chance of inheriting the condition. In inherited cavernomas, current research points to a mutation in any one of three particular genes. The Cerebrovascular Center can coordinate genetic counseling for families who would like to evaluate their risk.
While many uninherited cavernomas are present at birth, and some develop later in life, often associated with other endovascular abnormalities, such as a venous malformation.
There are two main tests that are used to diagnose cavernomas. These are:
- Computerized Axial Tomography (CAT Scan)
- Magnetic Resonance Imaging (MRI)
MRI has provided the ability to image and localize otherwise hidden lesions of the brain and provide accuracy of diagnosis preoperatively. Both the MRI and CAT scans produce images of slices through the brain. These tests help the doctors to see exactly where the cavernoma is located. Cavernomas cannot be seen on a cerebral angiogram.
The following are indications to consider treatment of a cavernous malformation:
- Neurological dysfunction
- An episode of bleeding
- Intolerable symptoms
- Uncontrolled seizures
Physicians at the Cerebrovascular Center 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. However, cavernomas that are bleeding more profusely 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 the 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), 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 percent of cavernomas occur near a venous malformation, which can make surgical treatment more difficult.
We encourage you to educate yourself about Intracranial Cavernoma Surgery in India, and also the benefits from the right kind of Surgery before making a choice.
You can be rest assured that with Surgicure International's expertise, we bring in a wonderful experience of Surgery in India, which we have been doing so for almost a decade now.