Medicines for Cavernoma

What it is

A cavernoma is a cluster of abnormal blood vessels, usually found in the brain or spinal cord. The abnormal vessels form a well-defined, mulberry-like cluster, and the blood flow through them is abnormal and the vessel walls are prone to leaking small amounts of blood. Cavernomas are relatively common, and many people who have one (or more) never have any symptoms from it — cavernomas are often discovered by chance on a brain scan done for another reason. When cavernomas do cause symptoms, this is usually because they bleed (haemorrhage), often in small amounts, or affect the surrounding brain tissue; the symptoms depend on the size and, importantly, the location of the cavernoma (which part of the brain or spinal cord it is in). Possible symptoms can include: seizures (fits), which are one of the more common ways a brain cavernoma causes symptoms; headaches; neurological symptoms such as weakness, numbness, problems with vision, balance, speech, or memory, depending on the location; and, if a cavernoma bleeds significantly, more sudden or pronounced symptoms. Most cavernomas are single, but some people have multiple cavernomas, which can run in families (a genetic form). The risk that a cavernoma will bleed, and cause symptoms or problems, varies and depends on factors such as its location and whether it has bled before. Because many cavernomas cause no symptoms and have a relatively low risk of causing problems, and because treatment (particularly surgery in the brain) carries its own risks, the management of a cavernoma is carefully individualised. Many are simply monitored, particularly if they are not causing symptoms; treatment (such as surgery to remove the cavernoma, or, in some situations, other approaches) is considered in certain cases — for example, if the cavernoma is causing troublesome symptoms (such as seizures that are hard to control), has bled, or is in a location where the risks favour treatment — and this is weighed carefully with a specialist. The key messages are that a cavernoma is a cluster of abnormal blood vessels (usually in the brain or spinal cord) that often causes no symptoms but can cause seizures or bleeding, and that it is managed by monitoring, with treatment considered in certain cases.

How it is treated

Cavernomas are managed with careful, individualised decisions — often monitoring, with treatment considered in certain cases — based on whether the cavernoma is causing symptoms, its location, and the risks; specialist assessment guides management. Cavernomas are often found incidentally on a brain scan, or diagnosed when they cause symptoms; imaging (particularly MRI, which shows cavernomas well) confirms the diagnosis, and assesses the size, location, number, and any evidence of bleeding. Because the risk of a cavernoma causing problems varies and is often relatively low, and because treatment (especially brain surgery) carries its own risks, decisions about management are made carefully and individually, weighing the risks of the cavernoma against the risks of treatment, with a specialist (such as a neurologist and neurosurgeon). For many cavernomas — particularly those not causing symptoms, or in locations where treatment would be risky — the approach is monitoring (observation), which may include periodic scans and being alert to any new symptoms, without active treatment; many such cavernomas remain stable and cause no problems. Managing symptoms is an important part of care where a cavernoma is causing them — for example, seizures caused by a brain cavernoma are treated with anti-seizure medicines, which control seizures well in many people; and other symptoms are managed as appropriate. Treatment to remove or treat the cavernoma is considered in certain situations — for example, if it is causing troublesome symptoms (such as seizures that are difficult to control with medicines), has bled (particularly if more than once, or with significant effects), or is in a location where the balance of risks favours treatment; the main treatment is surgery to remove the cavernoma, which is considered when it is accessible and the benefits outweigh the risks, and, in some specific situations, other approaches (such as stereotactic radiosurgery) may be considered. The decision is highly individual and made with the specialist team, weighing the potential benefits against the risks of the procedure (which depend heavily on the cavernoma’s location). For the genetic (familial) form with multiple cavernomas, care and monitoring take this into account, and genetic counselling may be relevant. Being aware of and promptly reporting new or worsening symptoms (such as new seizures, or new neurological symptoms) is important, so they can be assessed. The reassuring messages are that many cavernomas cause no symptoms and have a relatively low risk of causing problems, that management is carefully individualised (often monitoring, with symptom treatment such as anti-seizure medicines where needed), and that treatment (usually surgery) is considered in certain cases where the balance of risks favours it; so specialist assessment and individualised decisions are the keys to managing a cavernoma.