title: Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel.
abstract: BACKGROUND
  Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies.
  
  
  OBJECTIVE
  To develop guidelines for CCM management.
  
  
  METHODS
  The Angioma Alliance ( www.angioma.org ), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol.
  
  
  RESULTS
  Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%).
  
  
  CONCLUSIONS
  Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was similarly peer reviewed and is available on line www.angioma.org/CCMGuidelines .
authors.affiliation: Angioma Alliance Norfolk, Virginia.
authors.forename: Amy
authors.initials: A
authors.lastname: Akers
authors.affiliation: Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Rustam
authors.initials: R
authors.lastname: Al-Shahi Salman
authors.affiliation: Neurovascular Surgery Program, Section of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
authors.forename: Issam
authors.initials: I
authors.lastname: A Awad
authors.affiliation: Angioma Alliance Norfolk, Virginia.
authors.forename: Kristen
authors.initials: K
authors.lastname: Dahlem
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kelly
authors.initials: K
authors.lastname: Flemming
authors.affiliation: Department of Radiology, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Blaine
authors.initials: B
authors.lastname: Hart
authors.affiliation: Department of Anesthesia and Perioperative Care, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
authors.forename: Helen
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Jusue-Torres
authors.affiliation: Departments of Neurosurgery and Radiation Oncology, NYU Langone Medical Center, New York City, New York.
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.affiliation: Angioma Alliance Norfolk, Virginia.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lee
authors.affiliation: Departments of Neurology and Pediatrics, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Leslie
authors.initials: L
authors.lastname: Morrison
authors.affiliation: Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
authors.affiliation: Neurovascular Surgery Program, Section of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
authors.forename: Tania
authors.initials: T
authors.lastname: Rebeiz
authors.affiliation: Department of Genetics, INSERM UMR 1161, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Tournier-Lasserve
authors.affiliation: Department of Human Genetics and Pediatrics, University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
authors.forename: Darrel
authors.initials: D
authors.lastname: Waggoner
authors.affiliation: Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Kevin
authors.initials: K
authors.lastname: Whitehead
mesh_terms: D026683:Advisory Committees / Q000592:standards*; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D032921:Consensus; D019468:Disease Management; D005104:Expert Testimony / Q000592:standards*; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D026741:Physical Therapy Modalities / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
keywords: Angioma; Cavernous; Guidelines; Malformation; Recommendations