Intracranial cavernous malformations: lesion behavior and management strategies

Area of Science:

• Neurology
• Vascular Biology
• Medical Genetics

Background:

• Intracranial cavernous malformations (ICMs) are vascular anomalies affecting 0.45-0.9% of the population.
• ICMs present with seizures, hemorrhage, or neurological deficits, and can exhibit dynamic changes like new lesion formation and growth.
• Lesion behavior and associated risks are influenced by factors including location, age, gender, reproductive cycle, and prior hemorrhage.

Purpose of the Study:

• To review the current understanding of intracranial cavernous malformations.
• To highlight the dynamic nature and variable clinical presentation of these lesions.
• To propose outcome parameters for guiding clinical decisions and future research.

Main Methods:

• Literature review and synthesis of existing reports on ICMs.
• Analysis of clinical and radiological characteristics of ICMs.
• Discussion of management strategies and research needs.

Main Results:

• ICMs are characterized by endothelium-lined caverns with variable thrombosis and organization.
• Dynamic lesion behavior, including de novo genesis and hemorrhage, is frequently observed.
• Hemorrhagic risk and neurological disability are multifactorial, influenced by lesion characteristics and patient-specific factors.

Conclusions:

• Management strategies vary from expectant follow-up to surgical excision or radiosurgery based on lesion characteristics and symptoms.
• Further prospective, hypothesis-driven studies are essential to identify factors influencing ICM aggressiveness.
• Biological investigations are needed to develop strategies for predicting and modifying ICM behavior.