What’s a cavernoma and why do I care?

20 Jun



  • Occur with equal frequency in males and females, usually between age of 30-40
  • Supratentorial cavernomas present with hemorrhage, seizures, and progressive neuro deficits
  • Infratentorial cavernomas commonly present with hemorrhage and progressive neurological deficits

Natural History:

  • Asymptomatic patients (around 50% of patients with cavernomas) have hemorrhage rates much lower than those with symptoms
  • Supratentorial lesions have a hemorrhage rate of 0.25-1.1% annually
  • Infratentorial lesions have a hemorrhage rate of 2-3% per year, and recur in 17-21% of patients


  • In asymptomatic patients, the lesions should be monitored and no surgical intervention is necessary
  • Surgical resection recommended for progressive neuro deficits, refractory seizures, or hemorrhage
  • Anti-epileptic medications are often used to prevent further seizures.  A recent Meta-analysis showed that Phenytoin and Keppra are equally effective in preventing seizures in post-traumatic hemorrhages.  There are few RCT’s regarding which AED to use and data about the use of AED’s in patients with cavernomas is sparse.

Submitted by W. Brooks.

Reference(s): UpToDate, Natural history of the cavernous angioma; Robinson JR,AwadIA, Little JR; J Neurosurg. 1991;75(5):709; Natural history of intracranial cavernous malformations; Aiba T, Tanaka R, Koike T, Kameyama S, Takeda N, Komata T; J Neurosurg. 1995;83(1):56; Phenytoin versus Leviteracetam for Seizure Prophylaxis after Brain Injury – AMetaAnalysis; BMC Neurology; 2012 May 29;12(1):30; picture


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