Cavernous angioma overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, DMD, MD

Cavernous angioma, also known as cerebral cavernous malformation (CCM) or cavernoma, is a rare disease that involves the capillaries of the central nervous system. CCMs have dilated endothelial-lined sinusoidal capillaries which lack intervening neural tissue. This is the only characteristic that can distinguish these lesions from capillary telangiectasia.

CCMs can be classified as sporadic or familial, which has an autosomal dominant form of inheritance. The majority of CCMs are recent and remote hemorrhages. These lesions range in size from millimeters to almost less than 3 centimeters in diameter.

Cavernous angioma, also known as cavernous hemangioma, cavernoma, and cerebral cavernous malformation, is a vascular malformation with still an unclear history of its first clinical discovery.

Developmental venous anomaly (DVA) can cause a chronic increase in intracranial pressure which can form microhemorrhages around DVA, leading to the development and growth of cavernous angioma. There are two patterns of cavernous angioma, the sporadic and the familial pattern.

There are no established causes for cavernous angioma.

Cavernous angioma appears very similar on magnetic resonance with calcified neoplastic and hemorrhagic lesions, most especially renal cell carcinoma, melanoma, pleomorphic xanthoastrocytomas, and oligodendrogliomas.

Cavernous angioma is the second most common form of intravascular malformation next to the developmental venous anomaly (DVA). The incidence in the general population is between 0.1–0.5%, and symptoms usually manifest in the third to fifth decade of life. Once thought to be strictly congenital, these vascular lesions have been found to occur de novo.

Family history increases the risk of having cavernous angioma. Genetic testing is recommended for the pathogenic variants of cavernous angioma (KRIT1, MGC4607, and PDCD10).

Cavernous angioma is usually a benign course since it is a low-flow and low-pressure lesion. Patients with cavernous angioma have variable signs and symptoms, with seizure as the most predominant symptom, followed by hemorrhage and focal neurologic deficit.

CCMs have varying presentations and these can be in the form of hemorrhagic stroke, focal neurological deficits, recurrent headaches, and seizures. Howevever, CCMs can be asymptomatic sometimes.

Cavernous angioma, also known as cavernous hemangioma, can affect several organs. Diagnosing this condition should be correlated with imaging findings.

CT scan is not usually used as a primary modality to diagnose cavernous angiomas due to the inability to detect smaller lesions despite the ability to detect lesions complicated by calcification or hemorrhage.

Diagnosis can be made through incidental findings from magnetic resonance imaging (MRI) screening. A gradient-echo sequence should be utilized to unmask punctate lesions which can go undetected. These lesions are more visible on FLAIR imaging than on T2 weighing. As compared to T2 weighing, FLAIR imaging has more suppression of free-flowing fluid signals.

A cerebral angiogram or magnetic resonance angiogram (MRA) is usually requested as lesions can go undetected in MRI. If a lesion is discernible via angiogram in the same location as in the MRI, then an arteriovenous malformation (AVM) becomes the primary concern.

There are no other imaging findings associated with cavernous angioma.

Diagnostic biomarkers can be utilized too in conjunction with imaging tools to identify cavernous angioma.

Surgery is the mainstay treatment for cavernous angioma. Complete surgical resection should be done to prevent seizures and hemorrhage due to remnant tissue.

Since cavernous angioma can be treated via medical or surgical option, therapy for this condition is relatively cost-effective.

Several insights on development of cavernous angioma exist. Some drugs have been identified to be able to reduce risk of hemorrhage, and possible development of new lesions. Advances in biomarkers are now being studied more.