In a patient who is suffering from ongoing or worsening symptoms, recurring hemorrhages, or uncontrolled seizures, surgery may be the best option for treating a cavernous malformation. The neurosurgeon will evaluate each patient individually and make a recommendation on a treatment plan based on the patient’s age and overall health, the size and location of the cav-mal, and the severity of the symptoms.
In some cases, surgery is performed on an emergency basis after a significant hemorrhage. In other cases, the patient and surgeon will have time to discuss the options and make an informed decision about the best way to proceed for that individual patient.
Microsurgical Resection is open surgery performed under general anesthesia and consists of the resection (removal) of the cavernous malformation. When performed by a highly experienced neurosurgeon at a major medical center, a microsurgical resection is an excellent option — the surgeon can completely remove the cavernous malformation with no damage to surrounding brain tissue. Relief from symptoms is usually immediate.
An Awake Craniotomy may be appropriate when the surgery will take place in a part of the brain that is “eloquent” (meaning critical to one of the senses). In an awake craniotomy the patient is under anesthesia while we make the incision and remove the bone, then is awakened during the surgery itself. Engaging the patient in conversation, brain mapping, and real-time testing allow neurosurgeons to monitor the effect of each tiny move they make. (See the blog post What to Talk About During Brain Surgery and the first-person account of an awake craniotomy I Was Awake During My Brain Surgery.)
The use of functional MRI (fMRI) before surgery is extremely helpful in planning for surgery for cavernous malformations.
Some institutions may offer stereotactic radiosurgery as a treatment option, but there is insufficient data to support the use of SRS for cavernous malformations. The Weill Cornell Medicine Brain and Spine Center has a robust Stereotactic Radiosurgery Program for use when its effectiveness is supported by the evidence.
After surgery your medical team will monitor your progress and conduct tests to evaluate the success of your treatment.
Cavernous malformations should be treated at major medical centers by experts in cerebrovascular disorders. Use our online form to request an appointment for a consultation or a second opinion.
Reviewed by Philip E. Stieg, PhD, MD
Last reviewed/last updated: October 2023
Illustration by Thom Graves, CMI