How are Cavernoma Treated?
Cavernomas are clusters of abnormal blood vessels in the brain or spine. Not all cavernomas require treatment - the best approach depends on where the cavernoma is, whether it causes symptoms and each person’s overall health.
Treatment for cavernoma will vary depending on a person’s circumstances and factors such as: size, location, and the number of cavernomas.
This page explains the main approaches: medical management, surgery and stereotactic radiosurgery, as well as rehabilitation and supportive therapies.
Observation
Many people with cavernomas do not need immediate treatment, particularly if the cavernoma is small and not causing symptoms. This approach is often referred to as wait and see.
What it involves:
‣ Regular check-ups with your doctor or specialist
‣ MRI scans where clinically appropriate to monitor for changes
‣ Medication to manage symptoms such as seizures or headaches
MRI scans may not be needed routinely in every case. They are usually arranged if there is uncertainty about the diagnosis or if new or worsening symptoms develop.
If symptoms such as seizures occur, medication can often help control them. Your doctor may adjust treatment over time to achieve the best balance between effectiveness and side effects.
When this approach is considered
‣ The cavernoma is not causing significant symptoms
‣ The risks of surgery outweigh potential benefits
‣ Symptoms are manageable with medication
Living with a cavernoma without active treatment can feel unsettling. Support from healthcare professionals, counselling services or peer support groups may help people manage anxiety and uncertainty.
Neurosurgery
Surgery may be recommended when a cavernoma:
‣ Has caused repeated bleeding,
‣ Is causing severe or worsening neurological symptoms
‣ Is located in an area that can be accessed safely
What surgery involves:
For brain cavernomas, surgery usually involves a craniotomy, which is an operation to open the skull to remove the cavernoma.
For spinal cavernomas, surgery involves accessing the spine. This may include a procedure called a laminectomy, where a small section of bone is removed to allow access to the spinal cord. Surgeons use specialised microsurgical techniques to remove the cavernoma as safely as possible.
Points to consider
All surgery carries risks, including infection, bleeding or possible damage to surrounding tissue. The potential benefits and risks vary depending on the location of the cavernoma and a person’s overall health.
Your neurosurgeon will discuss:
‣ The potential benefits
‣ The possible risks
‣ Expected recovery time
‣ Whether rehabilitation may be required afterwards
Stereotactic Radiosurgery
In some cases, traditional surgery may be too risky because of the cavernoma’s location. Stereotactic radiosurgery (such as Gamma Knife or CyberKnife) is a non-invasive treatment that uses focused radiation to stabilise the cavernoma, which may cause it to thicken and scar over time.
This treatment does not involve an open surgical operation. It is usually carried out as a planned procedure and does not require a hospital stay in most cases.
Radiosurgery is not suitable for everyone, and its benefits and risks should be discussed with a specialist.
Rehabilitation and Supportive Therapies
Some people may benefit from rehabilitation, particularly after a bleed or surgery.
This may include:
‣ Physiotherapy - improves strength, mobility, balance and coordination
‣ Occupational therapy - to support independence in daily activities
‣ Speech and language therapy - if communication or swallowing is affected
‣ Psychological support or counselling - to help cope with emotional impact
Rehabilitation plans are tailored to each individual’s needs.
Making Decisions About Treatment
Treatment decisions are made on an individual basis in discussion with a neurologist or neurosurgeon. Factors considered include:
‣ The location of the cavernoma
‣ Previous bleeding events
‣ Severity of symptoms
‣ General health
‣ Personal preferences
It can be helpful to prepare questions before appointments and to discuss both short-term and long-term considerations.
2025 International Care Guidelines:
Updated international care guidelines for brain and spinal cavernoma have been published by the Alliance to Cure Cavernous Malformation. These evidence-based recommendations are designed to support clinicians in delivering consistent care. Patients may wish to share these guidelines with their medical team.
https://www.alliancetocure.org/home/for-patients/newly-diagnosed/ccm-care-guidelines
Important
Cavernoma Ireland does not recommend or endorse specific treatments. Decisions about care should always be made in consultation with a qualified healthcare professional.