title: Cerebral cavernous malformations: natural history and clinical management.
abstract: Cavernous malformations (CMs) are angiographically-occult clusters of dilated sinusoidal channels that may present clinically with seizures, focal neurological deficits and/or hemorrhage. Across natural history studies, the annual hemorrhage rate ranged from 1.6-3.1% per patient-year, decreasing to 0.08-0.2% per patient-year for incidental CMs and to 0.3-0.6% for the collective group of unruptured CMs. Prior hemorrhage is a significant risk factor for subsequent CM hemorrhage. Hemorrhage clustering, particularly within the first 2 years, is an established phenomenon that may confound results of natural history studies evaluating the rate of rehemorrhage. Indeed, rehemorrhage rates for hemorrhagic CMs range from 4.5-22.9% in the literature. Surgical resection is the gold standard treatment for surgically-accessible, symptomatic CMs. Incidental CMs or minimally symptomatic, surgically inaccessible eloquent lesions may be considered for observation. Stereotactic radiosurgery is a controversial treatment approach of consideration only for cases of highly aggressive, surgically inaccessible CMs.
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Gross
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D000818:Animals; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019468:Disease Management; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D012307:Risk Factors
keywords: brainstem; cavernoma; cavernous malformation; hemorrhage; natural history; radiosurgery; surgery