Vascular Malformations of the Brain
The main treatment options for cavernous malformations are long-term observation or surgery. Many people with this condition can go their whole lives without noticing any ill effects, so it may make perfect sense to simply wait and see. If your child's CM has begun to bleed, it is more likely that surgery will be recommended. Surgery for a cavernous malformation is relatively easy for the neurosurgeon since these malformations can usually be separated from the surrounding brain and since bleeding from the malformations is relatively easy to manage during the operation. If the lesions are small or deep within the brain, computerized guidance techniques can help to locate them accurately.
The neurosurgeons at Boston Children's Hospital generally will remove a single, symptomatic lesion if it is easily accessible to the surgeon, if it is located in an area of the brain where the surgery itself will not cause or provoke neurological deficits, and if the lesion can clearly be identified as the cause of the patient's symptoms. When multiple cavernous angiomas show up in the course of an evaluation, the decision becomes more difficult. It can be hard to determine which CM is causing symptoms and surgeons are reluctant to operate on multiple malformations without evidence that it will improve the patient's symptoms. A course of observation and re-evaluation if symptoms recur sometimes is the safest policy to undertake in this situation.
Some researchers report average "rebleeding" rates -- that is how often a patient might experience a second bleed. Neurosurgeons at Children's Hospital have noticed that this rate varies widely from one person to the next, so they will sometimes counsel patience to see if your child is one of the lucky ones with a low likelihood of rebleeding, especially if the lesion is deep and risky to treat.