Treatments for Brain Cavernous Malformation in Children

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Many people with cavernous malformations (CMs) never notice any ill effects and do fine with a "wait-and-see" approach. If the cavernous malformation has begun to bleed, we are more likely to recommend surgery. Surgery is a good option if there is a single cavernous malformation that is clearly the cause of the child's symptoms, and if it is located in a part of the brain that can be accessed and operated on without causing neurologic problems.

Most children have excellent outcomes from surgery. Neurosurgeons at Boston Children's Hospital use computerized guidance techniques to help locate cavernous malformations that are very small or deep within the brain.

When a child has multiple cavernous malformations, the decision to perform surgery can require more detailed evaluation. It is sometimes hard to determine which particular malformation is causing the symptoms and whether the operation will reduce them. In this situation, it is sometimes safest to observe the child for a period of time and reevaluate if symptoms recur. After treatment, we follow each child every six months or annually with magnetic resonance imaging.

While some centers use stereotactic radiosurgery to treat cavernous malformations, our team has found that this technique may not completely obliterate the cavernous malformation, and symptoms may persist years after the treatment. Additionally, radiosurgery may lead to brain swelling that can be dangerous. For this reason, we use radiosurgery only as a last resort, when traditional surgery is too dangerous and symptoms become intractable.

In addition to treating the cavernous malformation itself, we bring together a team to address any neurologic problems it may have caused, including neurologists, physical/occupational therapists or speech-language therapists as needed.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

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