The impact that a cavernous malformation makes on a person varies greatly.
A neurosurgeon will take many factors into consideration before deciding on an approach to treatment, including:
- The patient's age
- The location of the malformation. Some malformations are easier to reach surgically. Removing them carries less risk and fewer complications than a malformation that is deep within the brain.
- The size of the malformation. Cavernous malformations can range in size from less than a quarter of an inch to the size of a tangerine. The larger the malformation is the more likely it is to cause problems for the patient.
- Whether the malformation shows signs of bleeding. Bleeding may cause symptoms similar to those of a stroke. It also causes a cavernous malformation to get larger. The blood itself can irritate the tissues of the brain and cause seizures.
- The symptoms that it is causing. A cavernous malformation that is stable and not bleeding may cause no symptoms. All that may be needed is regular observation.
- How fast the cavernous malformation is growing. A malformation that has had bleeding is more likely to bleed again. If the malformation is growing at a fairly rapid rate, it may be necessary to remove it.
Surgical Removal of Cavernous Malformations
If the cavernous malformation is causing symptoms or is growing, doing surgery to remove the malformation may be recommended.
Surgery can be very effective if the malformation is located in an accessible part of the brain. The entire cavernous malformation must be removed. If any part is left behind, it may start growing again.
A newer approach to treating cavernous malformations is stereotactic radiosurgery. This approach is useful when cavernous malformations are repeatedly bleeding and are located in parts of the brain that aren't otherwise accessible by surgery because they are deep within the brain.
Stereotactic radiosurgery uses precisely focused radiation to treat cavernous malformations. Three-dimensional, computer-generated images guide the oncologists and surgeons in aiming radiation from several sources at the malformation.
The may be used for treatments in the brain. The doses of radiation given are very high. But because they are precisely aimed, there is little risk to the surrounding tissue.
Stereotactic radiosurgery doesn't require the patient to have general anesthesia. No incision is made in the body. As a result, there is no need to shave the patient's head or body. Radiosurgery takes about one to four hours. A patient is able to go home the same day and return to normal activities the following day. Sometimes more than one treatment is needed.
(Radiosurgery is different than radiation therapy that is sometimes given to cancer patients. Radiation therapy gives the patient radiation in low doses over a series of sessions. It is less precisely targeted.)