Thalamic Cavernomas: A Systematic Review of Clinical Manifestations, Diagnostic Challenges, and Surgical Outcomes

Thalamic cavernomas represent rare vascular malformations that embody important challenges in the clinical and surgical point of view because of their eloquent location and hemorrhagic propensity. This systematic review focuses on summarizing evidence with respect to their clinical presentation, diagnostic approach, management strategy, and outcome. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included studies from PubMed and Scopus databases. Articles were screened for relevance using predefined inclusion criteria, and data were extracted and synthesized narratively. Quality assessment was performed using the Joanna Briggs Institute checklist. A total of 15 studies involving 219 patients were included. The patients' ages ranged from newborn to 56 years, with a slight predominance of females (N = 121, 55%). Common presentations included hemorrhage (N = 171, 78.1%) and headaches (N = 123, 56.2%). Surgical resection was the most common intervention used; transcallosal approach (N = 40, 18.3%) was the most frequent. Results from pooled analyses revealed distinct trends in surgical decision-making. Approximately 28% of patients were managed conservatively (95% confidence interval [CI]: 0.12-0.43), while 72% underwent surgery (95% CI: 56.2-88.5). Preventative surgeries accounted for 30% of cases (95% CI: 0.15-0.46), whereas surgeries following a first hemorrhagic event were more common (47%; 95% CI: 0.34-0.60). Interestingly, only 5% underwent surgery after recurrent bleeding (95% CI: 0.02-0.08), suggesting a shift toward earlier intervention. Publication bias was largely absent, and findings remained robust across models. These insights highlight evolving trends in surgical timing and underscore the importance of tailored, evidence-based management for thalamic cavernomas.