Cerebral Cavernous Malformation

A cerebral cavernous malformation (CCM), or cavernoma, is a raspberry-like cluster of abnormal, thin-walled blood vessels in the brain or spinal cord. Because these vessels are fragile, they can leak blood into surrounding tissues, causing seizures, neurological deficits or hemorrhagic stroke.

What Is Cerebral Cavernous Malformation?

A cerebral cavernous malformation (CCM) is a vascular abnormality consisting of blood-filled "caverns" separated by single layers of endothelial cells, without normal intervening brain tissue. Unlike AVMs, cavernomas are low-flow lesions. They can occur sporadically or as part of a familial genetic syndrome. While many remain silent, symptomatic lesions require careful evaluation for potential microsurgical resection.

At a Glance

Cavernomas are low-flow clusters of abnormal capillaries resembling a raspberry
Can be sporadic (single lesion) or familial (multiple lesions due to genetic mutations in CCM1, CCM2, or CCM3)
Seizures and focal neurological deficits are the most common presentations
MRI is the gold standard for diagnosis; cavernomas often appear with a classic "popcorn" appearance
Microsurgical resection is the definitive treatment for accessible, symptomatic lesions

Symptoms

Diagnosis

MRI of the brain — the gold standard; classically shows a "popcorn" or "berry" appearance with a rim of hemosiderin (dark ring on T2/gradient echo sequences) indicating past bleeding.
CT scan — may show a calcified lesion but is less sensitive than MRI.
Genetic testing — recommended for patients with multiple cavernomas or a family history to check for CCM1, CCM2, and CCM3 mutations.

Types

Treatment

Observation — for asymptomatic cavernomas or those in highly eloquent/deep areas (like the brainstem) where surgery poses a high risk. Includes serial MRI monitoring.
Microsurgical resection — the primary surgical treatment for symptomatic, accessible cavernomas. Complete removal eliminates the risk of future bleeding from that lesion and can improve seizure control.
Stereotactic radiosurgery (SRS) — occasionally considered for deep, surgically inaccessible lesions with a history of hemorrhage, though its efficacy and safety profile for cavernomas are debated compared to AVMs.

Outcomes

Treatment	Efficacy	Notes
Microsurgical resection	Curative for the removed lesion	High success rate in stopping recurrent bleeding; ~70-80% seizure freedom if resected early
Observation	Variable	Annual hemorrhage risk is ~0.6-1.1% for incidental lesions, but higher (~4.5%) if prior hemorrhage

References

Our Specialists

Issam A. Awad, MD

Neurosurgery

Sean P. Polster, MD

Neurosurgery

Omer Doron, MD, PhD

Neurosurgery

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