Materiały źródłowe

• #1 Cavernous malformations – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cavernous-malformations/care-at-mayo-clinic/mac-20360944

  Mayo Clinic doctors consult with each other about a person with cavernous malformations. […] Each year, doctors at Mayo Clinic treat more than 3,400 people with vascular malformations, including cerebral cavernous malformations (CCMs). […] Your specialists work together as an integrated team to provide you with comprehensive care, whether your condition needs to be closely watched or you need medicines or surgery. […] At Mayo Clinic, several disciplines and a wealth of specialized expertise come together for diagnosis and treatment, whether your needs over time call for observation or surgery. […] Mayo Clinic doctors trained in brain and nervous system conditions (neurologists), brain and nervous system surgery (neurosurgeons), brain imaging (neuroradiologists), and other specialties have experience diagnosing and treating people with CCMs and other brain and blood vessel conditions (cerebrovascular conditions).

• #2 Cavernoma | Duke Health

  https://www.dukehealth.org/treatments/cavernoma

  Research shows that hospitals and surgeons who perform more surgeries tend to have better outcomes. […] Your care team consists of specially trained neurosurgeons, neurologists, neuroradiologists, medical genetics specialists, epileptologists, and others who work together to consider every aspect of your condition. […] Our nurse navigator becomes your one-stop shop for scheduling appointments, coordinating visits, communicating your results, and planning surgery. […] We are committed to improving care for people with cavernomas.

• #3 Cavernomas – Symptoms & Treatment | Mount Sinai – New York

  https://www.mountsinai.org/locations/cerebrovascular-center/conditions/vascular-malformations/cavernomas

  At Mount Sinai, we have experts who specialize in cavernomas (also called cavernous angiomas or cavernous malformations). […] Our doctors develop treatment plans for people with cavernomas based on several factors: […] Depending on thorough assessment of the above factors, treatment plans include: […] Surgery: This is the only cure for cavernomas. We typically perform surgery on cavernous angiomas with a recent hemorrhage and those that are growing or causing seizures. […] We surgically remove cavernomas by making a small opening in the skull to expose the brain (a craniotomy), usually under general anesthesia. We use the latest, safest, and most effective techniques available for removing cavernomas with as little disruption to the brain as possible, including microsurgery and computer image-guided surgical navigation. […] Most patients leave the hospital within two days after the procedure. If you have experienced neurological loss because of the cavernomas, we may recommend post-surgical rehabilitation.

• #4 Tailored Treatment Options for Cerebral Cavernous Malformations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9147523/

  The diagnosis and treatment of cerebral cavernous malformations (CCMs), or cavernomas, continues to evolve as more data and treatment modalities become available. Intervention is necessary when a lesion causes symptomatic neurologic deficits, seizures, or has high risk of continued hemorrhage. Future medical treatment directions may specifically target the pathogenesis of these lesions. This review highlights the importance of individualized treatment plans based on specific CCM characteristics. […] Surgical intervention is the first treatment option for accessible supratentorial lesions causing uncontrolled seizures or symptomatic lesions due to recurrent hemorrhage or mass effect. Resection mitigates any further risk of hemorrhage and permanent neurologic deficits in addition to seizure improvement in 80% of cases.

• #5 Cavernous malformations – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cavernous-malformations/diagnosis-treatment/drc-20360942

  Cerebral cavernous malformations (CCMs) are treated by specialists. They may include: […] Your healthcare team reviews your symptoms and imaging tests to decide on a treatment plan. The care team may recommend closely watching the cavernous malformation is recommended. Or your care team may recommend removing or treating the cavernous malformation. Several options exist for treating a cavernous malformation surgically. And research is looking into medicines that can reduce bleeding risk. […] If your treatment plan includes surgery, more-advanced imaging technologies may be useful. You may have a functional MRI, which measures blood flow in the active parts of the brain. Another option is tractography, which creates a map of the brain to make surgery as safe as possible. […] Several medicines are being tested in clinical trials to see if specific medicines rather than surgery could reduce the chance of further bleeding. Talk to your healthcare professional about which clinical trials may be available to you.

• #6 Cavernoma | Duke Health

  https://www.dukehealth.org/treatments/cavernoma

  Cavernomas, also known as cavernous malformations or cavernous angiomas, are tangled bundles of small, thin-walled blood vessels that can leak or hemorrhage. […] Dukes team of specialists uses advanced technology to diagnose and treat your cavernoma. We provide high-quality, integrated care so you experience the best quality of life. […] Your doctors will recommend a treatment plan based on the number of cavernomas you have, their size, their location, and other factors. […] Your doctor may advise that your best course of action is to closely monitor your cavernoma with regular imaging studies. […] Medicines can help treat symptoms like seizures and headaches. Duke is involved in research studying medications that could help strengthen the affected blood vessels and stop cavernomas from forming.

• #7 Cavernous Malformations | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurosurgery/cerebrovascular-and-stroke-surgery/cavernous-malformations

  Direct removal of the cavernous malformation with surgery is the only known cure. Surgery is often recommended for cavernous malformations that are causing symptoms, grow on repeat imaging, bleed and are easily accessible by traditional neurosurgical methods with low risk of harming the surrounding brain. […] Medications cannot treat the cavernous malformations directly but can help with symptoms such as seizures, headache and difficulties with attention. […] Generally, cavernous malformations that are small, not causing symptoms or located in critical brain areas are not treated immediately but rather monitored. Most such patients are „followed” by repeat MRI scan every year for several years, then if there is no growth, the MRIs are spaced out every two to five years after that. Treatment may be needed if the lesion grows or causes new symptoms.

• #8 Cavernous Malformation | Barrow Neurological InstituteSecond Opinion IconGroup 49

  https://www.barrowneuro.org/condition/cavernous-malformation/

  If you are diagnosed but not experiencing symptoms, your doctor may recommend observing the malformation over time with regular MRI scans. […] Medications, such as anti-epileptic drugs, may be prescribed to control your seizures or other symptoms. […] If your symptoms are not responding to medication or there is repeated bleeding in the brain, removal via neurosurgery may be recommended. […] Not all cerebral cavernous malformations need to be removed surgically. If it has not bled before, then there is approximately a 1-4% chance each year that it will hemorrhage. […] Conversely, cavernomas that have bled before have a higher chance of bleeding again in a given year. A cavernous malformation that shows behavior suggesting it is more likely to continue to bleed and cause harm should be removed. If a lesion is quiet and behaving well, then it is sometimes best left alone. […] Cavernous malformations can be cured by complete surgical removal.

• #9 Cavernous Malformation – Taylor Family Department of Neurosurgery

  https://neurosurgery.wustl.edu/items/cavernous-malformation/

  Washington University cerebrovascular surgeons work as part of a multidisciplinary team to offer treatment for cavernous malformations at the Barnes-Jewish Hospital Stroke and Cerebrovascular Center, which is the only center in the region with an introperative MRi to assist with the removal of cavernous malformations. […] Cavernous malformations are treated on a case-by-case basis. The treatment selected depends on the location of the cavernous malformation, the severity and nature of symptoms, the patients age and health status, and the risk involved in treatment. Treatment options include observation and surgery. […] Often an appropriate choice for patients who are symptom-free, observation may also be appropriate for certain patients with symptomatic cavernous malformations who are older, have multiple medical problems or have a complex or difficult-to-reach cavernous malformation where treatment carries a high risk.

• #10 Cavernous Malformation Treatment | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/cavernous-malformation/treatment/overview

  Cavernous malformations will not shrink or go away on their own. Treatment options are different for every person and depend on several factors, such as the size, location, symptoms, and bleeding status of the cavernous malformation, as well as your overall health. The various options available are observation, medical management, and/or surgery. […] Each of these treatment methods has its own pros and cons, and each has a specific situation in which it is preferred. Your neurosurgeon will walk you through these choices and explain the risks and benefits of each option so that you can make an informed decision. The experience of the neurosurgeon is important regarding the surgical outcome. […] Medical management is especially useful for a cavernous malformation that is seated deep within the brain, making it very difficult to remove surgically. Medical management is also useful for those with a cavernous malformation that has not bled or bled just once and is not causing any other symptoms.

• #11 Cavernous Malformation Medical Management | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/cavernous-malformation/treatment/medications

  There are several treatment options available for cavernous malformations, and the best approach will depend on a variety of factors, including the size and location of the malformation, previous occurrence of bleeds, as well as your current symptoms and overall health. The treatment of cavernous malformation includes primarily, observation, medications, and/or surgery. […] If the malformation is causing symptoms, however, treatment may be necessary. Medications can be prescribed to manage symptoms such as seizures or headaches. Anti-seizure medications can help prevent seizures, while pain killers can help manage headaches. […] Surgery is another treatment option. If the malformation is in a location where it can be safely removed without causing damage to surrounding brain tissue, surgery may be recommended. Surgery is the only method to provide a cure via removal of the cavernous malformation.

• #12 Cavernous Malformation Medical Management | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/cavernous-malformation/treatment/medications

  Medications control only the symptoms of a cavernous malformation. While antiepileptic drugs are usually effective at preventing seizures, they are not a cure for a cavernous malformation. If you suffer from drug-resistant seizures, meaning the seizures are not controlled by antiepileptic drugs, or experience worsening of your underlying symptoms, you may need surgery to remove the cavernous malformation. […] The management of a cavernous malformation depends on the size, location, and previous bleeding, as well as your overall health. Surgery is usually recommended when the cavernous malformation is in a part of the brain that is easy to access or when repeated bleeding has caused difficulty in moving your arms or legs, vision problems, or seizures. Surgery may also be advised if you have drug-resistant seizures. […] Medical management is not a cure for a cavernous malformation; rather, it provides relief from symptoms. […] If seizures are not controlled with medications or your symptoms worsen, surgery may be recommended.

• #13 Cavernous Malformation (Cavernoma): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21594-cavernous-hemangioma

  A cavernous malformation, also known as cavernoma or cavernous hemangioma, is an abnormal tangle of blood vessels. Treatments include observation, medications and surgery. […] Cavernous malformation treatment varies based on its location and whether or not its bleeding or causing symptoms. […] Your provider may recommend the following treatment options for a bleeding cavernous malformation: Medications to manage seizures or headaches. Surgery to remove it. […] Your provider may consider surgery if: You had one or more symptomatic bleeding episodes. The bleeding caused neurologic problems (like weakness or vision problems) and the problems are getting worse. You have seizures that dont get better with medication. Surgery is a safe option for you. […] Cavernous malformations are best treated with surgery to remove the hemangioma.

• #14 Tailored Treatment Options for Cerebral Cavernous Malformations

  https://www.mdpi.com/2075-4426/12/5/831

  Seizures are a common presentation of CCMs as a result of cortical irritation. While not aimed at eliminating or reducing the size of CCMs, antiepileptic medications, such as levetiracetam or lacosamide, are a good initial treatment for seizures caused by CCMs. Adequate seizure control can be achieved in as many as 60% of patients with medication alone. Surgical intervention is often an excellent option if seizures continue despite medical treatment, and for patients who do not want to be on lifelong seizure medications as up to 80% of patients achieve seizure control following resection. […] […] To date, no targeted therapies focusing on the genetic mutations responsible for familial CCM syndromes are available. However, future genetic treatments could capitalize on the role of these genes to repair the vasculogenesis pathway and potentially prevent the development and progression of CCMs. Gene therapy is proposed as a viable option to replace dysfunctional vascular proteins seen in the familial forms of CCMs. […]

• #15 Cavernoma | Duke Health

  https://www.dukehealth.org/treatments/cavernoma

  In general, your doctors may recommend surgery if you’re experiencing symptoms and if your cavernoma is unstable or has already hemorrhaged. […] We offer the full range of surgical treatment options, including: […] This option is the most invasive, but it is also the most effective. […] During this minimally invasive surgery, doctors use a small laser to destroy the cavernoma through a tiny incision in the skull. […] Also known as gamma knife, this noninvasive radiation therapy may be an option for people whose cavernoma is difficult to reach using other methods. […] The Alliance to Cure Cavernous Malformations recognizes Duke University Hospital as a Center of Excellence — the only one in North Carolina. […] This ensures you receive the most comprehensive care and more treatment options.

• #16 Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4300037/

  Cavernous malformations are dynamic lesions that may exhibit enlargement, regression, or even de novo formation. They are resected after patients have experienced multiple hemorrhages in eloquent areas, or a single hemorrhage in a noneloquent area that is associated with deteriorating neurological deficits. In addition, experiencing severe symptoms, such as cardiac or respiratory instability, and the presence of a CM lesion within 2mm from the pial surface are important indications for surgery. Patients are treated with steroids for 1 to 2 weeks prior to the surgery in order to limit the edema and allow for the CM resection. If there is a DVA associated with the CM lesion, its resection should be avoided because removing the DVA entails a high risk of venous infarction. Moreover, upon excision of the CM lesion, gliosis, calcification, and hyaline degeneration often take place and may complicate the procedure.

• #17 Cavernous Malformations – AANS

  http://www.aans.org/patients/conditions-treatments/cavernous-malformations/

  Surgery should be considered for seizure control if: 1.) Seizures cannot be controlled through medication; 2.) The cavernous malformation is in a low risk, easily accessible area of the brain; and 3.) It has been determined that the lesion is causing the seizures. […] In general, although seizures may indeed be cured by successful microsurgical removal, the primary goal of surgery is to prevent future bleeding and problems, such as seizures that may be associated. […] Surgery may be indicated in patients who have experienced one neurologically symptomatic hemorrhage from a lesion in a low risk, easily accessible area. […] Surgical removal should be considered in patients with progressive neurological deficits, but such neurological deficits can worsen after surgery.

• #18 Surgery for a Cavernous Malformation | Neurological Surgery

  https://neurosurgery.weillcornell.org/condition/cavernous-malformations/surgery-cavernous-malformation

  In a patient who is suffering from ongoing or worsening symptoms, recurring hemorrhages, or uncontrolled seizures, surgery may be the best option for treating a cavernous malformation. […] The neurosurgeon will evaluate each patient individually and make a recommendation on a treatment plan based on the patients age and overall health, the size and location of the cav-mal, and the severity of the symptoms. […] In some cases, surgery is performed on an emergency basis after a significant hemorrhage. […] In other cases, the patient and surgeon will have time to discuss the options and make an informed decision about the best way to proceed for that individual patient. […] Microsurgical Resection is open surgery performed under general anesthesia and consists of the resection (removal) of the cavernous malformation.

• #19 Surgery for a Cavernous Malformation | Neurological Surgery

  https://neurosurgery.weillcornell.org/condition/cavernous-malformations/surgery-cavernous-malformation

  When performed by a highly experienced neurosurgeon at a major medical center, a microsurgical resection is an excellent option the surgeon can completely remove the cavernous malformation with no damage to surrounding brain tissue. […] Relief from symptoms is usually immediate. […] An Awake Craniotomy may be appropriate when the surgery will take place in a part of the brain that is eloquent (meaning critical to one of the senses). […] The use of functional MRI (fMRI) before surgery is extremely helpful in planning for surgery for cavernous malformations. […] Some institutions may offer stereotactic radiosurgery as a treatment option, but there is insufficient data to support the use of SRS for cavernous malformations. […] After surgery your medical team will monitor your progress and conduct tests to evaluate the success of your treatment. […] Cavernous malformations should be treated at major medical centers by experts in cerebrovascular disorders.

• #20 Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4300037/

  Complete removal of the lesion is required in order to prevent recurring hemorrhagic events, but that depends on the neurosurgeon’s experience. Resection of the hemosiderin ring must also be accomplished if seizure surgery is performed. Rebleeding has been shown to occur in 40% of cavernoma remnants after surgery, which is why a postoperative MRI within 72 hours is strongly recommended. If remnants are found, surgical intervention is needed as early as possible. […] The complication risks associated with surgical intervention vary with the location of the CM lesion. Surgical resection of symptomatic CM lesions located in noneloquent areas is always recommended, as it has been shown to be safe as well as effective in treating epilepsy and preventing future hemorrhages. However, deciding on whether to resect a CM becomes more complicated when the lesion is located in an eloquent area of the brain and is barely symptomatic or completely asymptomatic. The use of frameless stereotaxy and intraoperative fMR imaging significantly reduces the risk of complications and establishes microsurgical resection as a favorable treatment method for most supratentorial CM lesions.

• #21 Cavernous Malformations | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/cavernous-malformations

  Currently, the treatments available for cavernous malformations include observation and surgery. […] Surgery is often recommended for the treatment of cavernous malformations. Because these malformations are so distinct from the surrounding brain tissue, they can at times be completely removed and cure associated seizures. It is very important to remove the entire malformation because it can grow back if a small piece is left behind. The risk of the operation depends on the size and location of the cavernous malformation and your general health.

• #22 Clinical Features and Treatment of Pediatric Cerebral Cavernous Malformations

  https://www.jkns.or.kr/journal/view.php?number=7705

  Cerebral cavernous malformation (CCM) is a vascular anomaly commonly found in children and young adults. […] Surgical resection remains the mainstay of treatment for pediatric CCMs. […] Stereotactic radiosurgery is an alternative treatment, especially for deepseated CCMs, but its true efficacy needs to be verified in a clinical trial. […] Treatment of CCM is typically recommended when symptoms related to CCM develop and persist. […] Surgical removal of CCM is the mainstay of treatments. […] For patients with CCM-related epilepsy, the seizure-free rate after surgery is 75-85%. […] Several studies have reported that excision of the hemosiderin-stained rim along with CCM itself leads to better seizure outcome than removal of only the CCM, but these studies are small-sized and retrospective.

• #23 Tailored Treatment Options for Cerebral Cavernous Malformations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9147523/

  Surgical intervention in the acute hemorrhagic period is not advised. […] Despite the risks associated with resection, surgery remains the best option in select cases of symptomatic brainstem CCMs given the high risk of further permanent disability and death with recurrent hemorrhagic events without surgery. […] Stereotactic radiation remains a controversial topic for CCMs that carry unacceptable surgical risk, such as brainstem CCMs that do not come to the surface or lesions in exquisitely eloquent brain tissue. […] Overall, SRS has been shown to decrease rates of hemorrhage after a period of 2 years. […] Surgical intervention is often an excellent option if seizures continue despite medical treatment, and for patients who do not want to be on lifelong seizure medications as up to 80% of patients achieve seizure control following resection.

• #24 Cavernous Malformation Treatment

  https://www.rwjbh.org/treatment-care/neuroscience/neurosurgery/conditions-treated/cavernous-malformations/

  Cavernous malformation treatment is crucial for patients experiencing symptoms. […] Surgery may be the best option for patients who have experienced symptoms. […] Those patients who do experience symptoms, such as seizures, may be prescribed medication or be good candidates for surgical removal of their CCM. […] Most patients who have surgical treatment for CCM leave the hospital just a few days following surgery and resume their normal activities within a few weeks.

• #25 Cavernous Malformations | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cavernous-malformations.html

  The impact that a cavernous malformation makes on a person varies greatly. […] A neurosurgeon will take many factors into consideration before deciding on an approach to treatment, including: […] If the cavernous malformation is causing symptoms or is growing, doing surgery to remove the malformation may be recommended. […] Surgery can be very effective if the malformation is located in an accessible part of the brain. The entire cavernous malformation must be removed. If any part is left behind, it may start growing again. […] A newer approach to treating cavernous malformations is stereotactic radiosurgery. This approach is useful when cavernous malformations are repeatedly bleeding and are located in parts of the brain that aren’t otherwise accessible by surgery because they are deep within the brain.

• #26 Cavernoma

  https://www.nhs.uk/conditions/cavernoma/

  The recommended treatment for cavernoma will vary depending on a person’s circumstances and factors such as size, location and number of cavernoma. […] Some cavernoma symptoms, such as headaches and seizures, can be controlled with medication. […] But more invasive treatment may sometimes be offered to reduce the risk of future haemorrhages. […] The decision to have such treatment is made on a case-by-case basis in discussion with your doctor. […] Types of treatment offered in the UK to reduce the risk of haemorrhages include: neurosurgery carried out under general anaesthetic to remove the cavernoma, stereotactic radiosurgery where a single concentrated dose of radiation is aimed directly at the cavernoma, causing it to become thickened and scarred. […] In most cases, neurosurgery is preferred to stereotactic radiosurgery because the effectiveness of radiosurgery in preventing haemorrhages is unknown.

• #27

  https://link.springer.com/article/10.1007/s11940-025-00842-w

  SRS is a treatment approach with applicability for CCMs extrapolated from its use in the management of arteriovenous malformations. […] The Angioma Alliance guidelines recommend however that SRS may be considered for solitary CCMs, with previous symptomatic hemorrhage, if the CCM lies in eloquent cortical areas and its surgical resection carries an unacceptably high surgical risk […] The lack of effective non-surgical treatments for CCM remains an important clinical challenge. […] Multiple preclinical studies, both in vitro and experimental in vivo studies have pointed towards a possible role of betablockers in reducing various complications of CCMs, such as hemorrhage, FNS or the occurrence of new lesions in genetic or sporadic forms of CCM. […] Another potential therapeutic target for CCMs is the Rho kinase (RhoA/ROCK) pathway.

• #28 Cavernous Malformation Treatment | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/cavernous-malformation/treatment/overview

  Surgery for a cavernous malformation is usually advised when it is located in an easily accessible part of the brain and is causing significant symptoms such as medically non-responsive seizures or neurological problems. […] Discuss the risks and benefits of surgery with your neurosurgeon. Choosing a neurosurgeon who is experienced in handling a surgery as technically difficult as cavernous malformation removal is very important. […] Stereotactic radiosurgery (SRS) is a technique used to direct radiation beams to a desired part of the brain with high levels of accuracy and precision. SRS is a noninvasive method of treatment, so you will not have any incisions or be left with visible scars. […] SRS treatment is a noninvasive and relatively quick option and is particularly suitable for people who are not able to undergo general anesthesia. It is also useful for cavernous malformations that are deep within the brain (such as the brainstem). However, the long-term relief from symptoms may not be as effective as with conventional surgery, and the cavernous malformation might take longer to shrink. […] Be sure to discuss personalized treatment strategies with your neurosurgeon. […] Surgery is usually advised for those with a cavernous malformation that is easily accessible and is causing significant symptoms.

• #29 Cavernous Malformations | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cavernous-malformations.html

  Stereotactic radiosurgery uses precisely focused radiation to treat cavernous malformations. […] Stereotactic radiosurgery doesn’t require the patient to have general anesthesia. No incision is made in the body. As a result, there is no need to shave the patient’s head or body. Radiosurgery takes about one to four hours. A patient is able to go home the same day and return to normal activities the following day. Sometimes more than one treatment is needed.

• #30 Gamma Knife radiosurgery for cerebral cavernous malformation | Scientific Reports

  https://www.nature.com/articles/s41598-019-56119-1

  The radiobiological effects of GKS on CMs remains uncertain; however, gradual endothelial cell proliferation and hyalinization yielding luminal closure are two possible mechanisms. […] The data presented in our study adds to the mounting evidence that GKS decreases the risk of hemorrhage in CCMs. Therefore, GKS may be an option for patients with eloquently located CCMs.

• #31 Management of incidental cavernous malformations: a review in: Neurosurgical Focus Volume 31 Issue 6 (2011) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/31/6/2011.9.focus11211.xml

  Cavernomas can be managed conservatively with neuroimaging studies, surgically with lesion removal, or with radiosurgery. […] Considering recent studies examining the CM’s natural history, imaging techniques, and possible therapeutic interventions, the authors provide a concise review of the literature and discuss the optimal management of incidental CMs. […] Many surgical series on CMs have demonstrated good results with operative management, with minimal surgical morbidity or mortality among patients with lesions in the cerebral hemispheres. […] Several studies have reported favorable results, that is, complete freedom from seizures, after complete resection of CMs in patients who had presented with seizures. […] In several series radiosurgery has been advocated as a treatment option for CMs; however, its efficacy has been heavily debated.

• #32 Cavernoma

  https://www.nhs.uk/conditions/cavernoma/

  Stereotactic radiosurgery is usually only considered if the position of the cavernoma makes neurosurgery too difficult or dangerous. […] Risks of invasive treatment include stroke and death, although the exact risks depend on the location of the cavernoma. […] You should discuss the possible risks of treatment with your doctor beforehand.

• #33 Tailored Treatment Options for Cerebral Cavernous Malformations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9147523/

  There are a number of experimental pharmacologic treatments that aim to address the development and growth of CCMs. […] Future genetic treatments could capitalize on the role of these genes to repair the vasculogenesis pathway and potentially prevent the development and progression of CCMs. […] Future directions in management of CCMs will likely include less invasive surgical techniques such as laser ablation as well as pharmacologic and genetic therapies aimed at repairing the underlying mechanisms responsible for CCM formation.

• #34 Cavernous Malformations – Seattle Children’s

  https://www.seattlechildrens.org/conditions/cavernous-malformations/

  Deciding the best treatment for your child starts with a full evaluation that considers many factors, including: […] Experts in our Pediatric Vascular Neurology Program will talk with you in detail about what they recommend for your child and why. […] There is no medicine to get rid of CCMs, but medicines may help with symptoms, such as headaches or seizures. […] Your child’s doctor may recommend surgery to remove a CCM to: […] Our neurosurgeons have special expertise in removing CCMs and using the brain-mapping tools like fMRI (functional magnetic resonance imaging) that make this surgery as safe as possible. […] We offer both minimally invasive laser ablation surgery and open surgery that removes part of the skull (craniotomy) to reach the problem area. […] For some children, laser ablation (LAY-zer ab-LAY-shun) surgery is an option with fewer side effects than traditional (open) surgery.

• #35 Cavernous Malformations – Seattle Children’s

  https://www.seattlechildrens.org/conditions/cavernous-malformations/

  Seattle Children’s is among a handful of pediatric hospitals in the country and the only in our region to offer laser ablation surgery for epilepsy. […] Seattle Children’s provides ongoing care for children with CCMs, including long-term follow-up and rehabilitation for those who need it. […] If your child’s CCM caused seizures, surgery to remove it may stop their seizures or reduce the number. […] Our team is experienced in helping children return to school and other important activities after brain surgery or other treatment. […] Each year Seattle Children’s treats many babies, children and young adults with CCMs. […] Our doctors are expert at finding if your child’s CCM needs treatment and deciding which treatment is best. […] If your child needs neurosurgery, Dr. Jeffrey G. Ojemann and Dr. Hannah Goldstein are skilled and experienced in performing procedures for CCMs. […] Pediatric experts in Neurosurgery and Neurology will care for your child. […] Identifying the precise genetic cause of your child’s CCM may expand their treatment options.

• #36 Cerebral Cavernous Malformations – Focused Ultrasound Foundation

  https://www.fusfoundation.org/diseases-and-conditions/cerebral-cavernous-malformations/

  Focused ultrasound research is in the laboratory phase and is not yet available for patients. […] Focused ultrasound for this condition is being researched in clinical trials. […] Focused ultrasound is approved to treat this condition outside the US. Patients can seek commercial treatment at participating international sites. […] The US Food and Drug Administration has approved focus ultrasound for this condition. Patients can seek commercial treatment at participating sites. […] Focused ultrasound is a noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with cerebral cavernous malformations (CCMs), which are also called cavernomas. […] Where the beams converge, focused ultrasound produces precise ablation (thermal destruction of tissue), which may enable CCMs to be treated without surgery.

• #37 Cerebral Cavernous Malformations – Focused Ultrasound Foundation

  https://www.fusfoundation.org/diseases-and-conditions/cerebral-cavernous-malformations/

  The primary options for treatment of CCMs include surgery or observation. However, for deep brain CCMs, surgery is likely to result in neural injury due to the retraction required to access the CCM. […] For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications such as surgical wound healing or infection at a lower cost. It can also be repeated, if necessary. […] Focused ultrasound treatment for CCM treatment is not yet approved by regulatory bodies or covered by medical insurance companies.

• #38 Finding Better Treatments for Cerebral Cavernous Malformations

  https://uvaphysicianresource.com/treatments-cerebral-cavernous-malformations/

  With a strong clinical research program for cerebral cavernous malformations (CCMs), UVA Health is working to find ways to improve care for this condition. […] Additionally, researchers are studying therapies for CCMs using focused ultrasound. […] We manipulate mouse cavernomas with focused ultrasound to halt the progression of these lesions, using several different paradigms, says Tvrdik. We believe this pre-clinical research has the potential to inspire and inform clinical practice. […] Each patient requires thorough evaluation to determine whether they need observation and medical management or meet the strict requirements for surgery. UVA Health also offers genetic counseling and testing for patients with a family history of CCMs.

• #39 Finding Better Treatments for Cerebral Cavernous Malformations

  https://www.uvaphysicianresource.com/treatments-cerebral-cavernous-malformations/

  With a strong clinical research program for cerebral cavernous malformations (CCMs), UVA Health is working to find ways to improve care for this condition. […] Additionally, researchers are studying therapies for CCMs using focused ultrasound. […] We manipulate mouse cavernomas with focused ultrasound to halt the progression of these lesions, using several different paradigms, says Tvrdik. We believe this pre-clinical research has the potential to inspire and inform clinical practice. […] UVA Health became an Alliance to Cure Cavernous Malformation Center of Excellence in 2021. Its now among 12 such centers in the country and only three in the southeast. The alliance is an international organization dedicated to improving treatment for CCMs. […] Each patient requires thorough evaluation to determine whether they need observation and medical management or meet the strict requirements for surgery. UVA Health also offers genetic counseling and testing for patients with a family history of CCMs.

• #40 Propranolol therapy for cerebral cavernous malformations

  https://www.spandidos-publications.com/10.3892/wasj.2022.158

  Propranolol therapy was commenced at the dose of 0.16 mg/kg/day and titrated to a maximum of 20 mg three times a day (0.8 mg/kg/day). […] Propranolol administration in patients with CCM, although not commonly prescribed, has effectively been used in children and appears to play a protective role in the prevention of CCM-derived hemorrhaging in adults. […] The present study demonstrates that propranolol impairs angiogenesis in vitro and may thus be a useful tool for the clinical management of CCM. […] The findings of the present study reinforce the use of propranolol in the clinical management of CCM and points out the monitorization levels of monocytes (CD14+/CD31+) and VEGF in PB as useful tools which may be used to predict treatment efficacy.

• #41 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20210223/Propranolol-can-be-used-to-treat-cerebral-cavernous-malformations.aspx

  Propranolol, a drug that is efficacious against infantile haemangiomas („strawberry naevi”, resembling birthmarks), can also be used to treat cerebral cavernous malformations, a condition characterized by misshapen blood vessels in the brain and elsewhere. […] Today, an operation to remove these lesions is the only possible treatment. However, surgical interventions in the brain are highly risky. Since the vascular malformations, moreover, recur in the hereditary form of the condition, drug treatment for CCMs is urgently required instead. […] The results show that propranolol can be used to shrink and stabilize vascular lesions, and maybe a potential medicine for treating CCMs. […] What makes the study especially interesting is that right now, in Italy, a clinical study is underway in which CCM patients are to get two years’ treatment with propranolol. During this period, they’re being monitored by means of magnetic resonance imaging of the blood vessels, to see how the malformations are developing.

• #42 Clinical Features and Treatment of Pediatric Cerebral Cavernous Malformations

  https://www.jkns.or.kr/journal/view.php?number=7705

  A meta-analysis indicated that extended lesionectomy, involving cortical resection beyond the boundary of CCMs either with or without electrocorticography, does not contribute to better seizure control than lesionectomy alone. […] In such cases, SRS, particularly gamma knife radiosurgery (GKRS), can be considered as an alternative option for preventing subsequent hemorrhages and neurological decline. […] Medical treatment aims to prevent the de novo formation of CCMs, prevent CCM hemorrhage, and reduce the size of existing CCMs. […] However, no drug has been conclusively proven to achieve these goals in CCM treatment. […] The discovery of familial CCM-related genes, including CCM1, CCM2, and CCM3, has opened the door to the possibility of molecular target drugs for CCMs. […] Currently, a human randomized placebo-controlled trial is underway to evaluate the clinical impact of atorvastatin on CCMs.

• #43 Diagnosing and Treating a Cavernous Malformation | Neurological Surgery

  https://neurosurgery.weillcornell.org/condition/cavernous-malformations/diagnosing-and-treating-cavernous-malformation

  There are two imaging techniques that are commonly used for an individual who has the symptoms of a cavernous malformation: […] A cavernous malformation that causes seizures may be treated with anti-seizure medication. If the seizures cannot be controlled with medication, or if the cav-mal causes other neurological symptoms or presents a high risk for hemorrhaging, it may need to be surgically removed. Because a cav-mal is typically self-contained, and not integrated into other brain structures, it often can be removed successfully with microsurgical techniques. […] Always consult a cerebrovascular neurosurgeon to determine the optimal treatment for a cavernous malformation. […] Cavernous malformations are complicated and should be evaluated and treated at major medical centers by an expert in cerebrovascular disorders.

• #44 Cavernous malformations – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cavernous-malformations/care-at-mayo-clinic/mac-20360944

  Mayo Clinic in Minnesota has been named a Center of Excellence for treating cavernous malformations by the Alliance to Cure Cavernous Malformation. […] Mayo Clinic doctors typically see thousands of people with vascular malformations, including CCMs, every year. […] Mayo Clinic neurologists, neuroradiologists and neurosurgeons work together to diagnose and treat CCMs. […] Mayo Clinic researchers are working to learn more about how CCMs occur and which cavernous malformations might cause future problems.

• #45

  https://umiamihealth.org/en/treatments-and-services/neurosurgery/cerebral-cavernous-malformations

  Cavernous malformations may be treated surgically to remove these risks. […] The University of Miami Health System is designated a Center of Excellence in Cerebral Cavernous Malformation (CCM) by the Alliance to Cure Cavernous Malformation. […] We have a number of clinical trials enrolling and following CCM patients to better assess outcomes according to specific patient and disease characteristics. Additionally, we are collecting blood and CCMs from the operating room to help develop better molecular tests to determine which CCM may bleed. Research on the collected CCMs is working to develop novel medical therapies, imaging, and minimally invasive treatment options. […] At UHealth, cavernoma patients receive care from a collaborative team of highly experienced doctors including cerebrovascular neurosurgeons, neurologists, radiologists, epileptologists, clinical geneticists, and a team of clinical and basic science researchers who work to discover and translate novel cavernoma therapies into the clinic. […] A multidisciplinary team of experts. At UHealth, you have access to the best neurosurgeons in the region. You will be taken care of by a passionate and knowledgeable multidisciplinary team of medical professionals who make sure that you receive the right treatment for your unique condition.

• #46 Cerebral Cavernous Malformations Program Treats Most Complex Cases | Duke Health Referring Physicians

  https://physicians.dukehealth.org/articles/cerebral-cavernous-malformations-program-treats-most-complex-cases

  Since earning the prestigious Center of Excellence designation from the Alliance to Cure Cavernous Malformation over a year ago, Dukes cerebral cavernous malformation (CCM) program has elevated its expertise in treating the most complex CCM cases. […] We have the resources to diagnose and tackle nearly any cavernoma, including those affecting children, adults, pregnant women, and many other unique cases, says Hasan. […] The stability of the cavernoma determines the course of treatment, Hasan explains. […] Cavernomas actively bleeding, causing neurological deficits, or in higher-risk locations need treatment. […] We are also exploring new approaches for treating CCM using minimally invasive laser and thermal therapy techniques, says Hasan. […] Additional research efforts focus on initiating an early-phase clinical trial to test high-intensity focused ultrasound treatment, which could benefit patients with cavernomas in challenging or high-risk locations like the eloquent cortex. […] Aspirins are contraindicated in cavernoma treatment due to perceived bleeding risk, but we have some evidence to believe that they might prevent bleeding, says Hasan.

• #47 Tailored Treatment Options for Cerebral Cavernous Malformations

  https://www.mdpi.com/2075-4426/12/5/831

  Cavernous malformation management must be tailored to each unique patient’s situation with consideration of the context of each lesion including potential hemorrhagic risk, operative morbidity, and conservative management options. In general, cavernous malformations that are asymptomatic do not require intervention. If symptoms or recurrent bleeding occurs, surgical resection can be curative for lesions with acceptable perioperative risk. Supratentorial lesions are more likely to cause seizures and can be resected surgically if seizures or hemorrhagic symptoms are not controlled with medication. Infratentorial lesions are more likely to have recurrent and devastating bleeding events. The risk of surgical resection may be warranted, especially in brainstem CCMs that demonstrate recurrent hemorrhage. There is some evidence for SRS as an option for non-operable lesions. However, it remains to be seen whether radiation is a curative treatment option for CCMs. Future directions in management of CCMs will likely include less invasive surgical techniques such as laser ablation as well as pharmacologic and genetic therapies aimed at repairing the underlying mechanisms responsible for CCM formation.

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