Cavernous Malformations of the Brain: Natural History and Surgical Outcomes

Cerebral cavernous malformations (CCM) are rare, benign vascular anomalies of the central nervous system with a prevalence of 0.5-0.8%. While often discovered incidentally, they may present with seizures, headaches, focal neurological deficits, or intracranial haemorrhage. Sporadic cases typically involve solitary lesions, whereas familial forms are associated with multiple lesions and genetic mutations such as PDCD10. Supratentorial locations predominate, but brainstem, cerebellar, and spinal involvement are also observed. Management depends on symptomatology and lesion site. Asymptomatic cases are generally observed with serial imaging, while symptomatic lesions may require intervention. Microsurgical resection remains the treatment of choice for patients with medically refractory seizures or recurrent haemorrhage, offering favourable long-term outcomes and high seizure control rates. Radiosurgery may be considered for deep or eloquent lesions where open surgery carries a higher risk, though its benefits are delayed. An individualized approach is essential to optimize neurological and functional outcomes in CCM.