A cavernous hemangioma is a type of mass that arises from a cluster of malformed vessels in the blood. This condition is typically present from birth and is known by many other names. These include cavernous malformation, and cavernous angioma. Each term refers to the same underlying issue of irregularly formed blood vessels that create the mass.
What is it?
A cavernous hemangioma is a kind of vascular malformation, which refers to masses formed from clusters of atypical blood vessels. These malformations are estimated to happen in approximately 1 percent of individuals from birth and can be divided based on their specific characteristics.
Cavernous deformities are a particular kind of vascular malformation characterized by widened vessels of blood that create cavernous spaces through which blood flows very gradually. Their appearance is often likened to a raspberry. These malformations are non-cancerous and do not have the potential to develop into cancer.
While cavernomas most commonly develop in the brain, they can also appear in other parts of the body, including the spinal cord, retina, skin, adrenal glands, liver, and gastrointestinal tract. They can vary in number and size over time, ranging from a few millimeters to many centimeters. To give some perspective, a millimeter is roughly the credit card thickness, and a centimeter is around the staple length.
Symptoms
The symptoms can vary widely depending on the location of the malformation. Remarkably, up to 40 out of 100 individuals with cavernomas in their brains may never experience noticeable signs or get a diagnosis. Many individuals in this group have a malformation, without a family history of the condition, and no genetic mutations.
For those with a family history of cavernomas, the likelihood of developing multiple malformations and experiencing symptoms is higher.
When cavernomas occur in the brain, seizures are one of the most common symptoms. Other potential symptoms include bleeding, headaches, slurred speech, hemorrhagic stroke, balance problems, double vision, tremors, memory issues, poor concentration, and limb numbness or weakness.
In the spinal cord, cavernomas can lead to symptoms like limb weakness, numbness, paralysis, burning, tingling, and itching. Additionally, they may cause bowel control or loss of bladder.
For cavernous malformations affecting the eye, symptoms may include declining eyelids, eye pain, double vision, and vision issues due to optic nerve compression. Typically, these symptoms are reversible following surgical elimination of the malformation.
Complications
Most individuals with cavernous hemangiomas do not experience any issues. However, if a malformation occurs in the brain and it starts to bleed, it can lead to neurological symptoms and complications. The severity of these issues depends on the particular area of the brain impacted by the bleeding.
Cavernomas commonly form in the brain’s outer layer, known as the cortex. They may also develop in regions that control subconscious functions, like the brainstem or cerebellum. If these malformations bleed, they can cause a hemorrhagic stroke, which can be very serious and potentially life-threatening. According to the National Health Service, the chance of bleeding is about 2.4 percent per year. If the malformation has never bled before, the risk is between 0.3 and 2.8 percent annually. However, if it has bled previously, the risk increases significantly, ranging from 6.3 and 32.2 percent per year.
Cavernomas can also occur in the spinal cord, where they might lead to neurological symptoms due to compression of the spine. In rare cases, if a malformation forms in the eye, it can result in loss of vision. Cavernomas in the eye are quite uncommon, affecting fewer than 1 percent of individuals with cavernous hemangiomas of the brain
Diagnosis
Diagnosing a cavernous hemangioma requires special imaging or, in rare cases, an autopsy. The most common and effective method for diagnosing these malformations is Magnetic Resonance Imaging. MRIs are very good at showing the details of the malformation. On the other hand, an angiography or computed tomography scan might not detect the malformation unless it has recently bled.
If there is a family history of cavernous malformations, doctors may recommend genetic testing to check for inherited conditions that could increase the risk.
Interestingly, around 25 out of 100 individuals diagnosed with cavernomas are children.
Treatment
Cavernous hemangiomas can be treated in different ways depending on the symptoms and location of the malformation. Medicines may be suggested to manage specific symptoms like headaches or seizures.
If the malformation has recently bled, your healthcare provider might suggest surgery. For brain malformations, the traditional approach is a craniotomy, where an area of the skull is eliminated to access and remove the malformation. Another method is radiosurgery, which uses very focused beams of radiation to target the malformation. However, radiosurgery is still a debated option and is usually considered for cases where traditional procedure isn’t possible.
A 2020 study found that among 12 children with multiple brain malformations and bleeding, half needed further surgery within two and half years. In contrast, none of the nine children without these risk elements required further surgery.
If the cavernomas are located in other areas like the spinal cord or eye and are causing issues, surgery may also be recommended to address those problems.
Outlook
The outlook for someone with a cavernous hemangioma is generally positive. Many individuals with cavernomas in their brains do not experience any symptoms, and their condition tends to have a good prognosis. However, if the malformation is large, there is a higher chance of developing symptoms.
When cavernomas occur in other areas of the body, the outlook is also usually favorable. For instance, surgery to remove a malformation from the spinal cord generally has a good outcome, although complete recovery might not always be possible in every case.
If the malformation is in the eye, symptoms typically improve or resolve completely after surgery.
Summary
A cavernous hemangioma is a benign malformation of malformed blood vessels, often present from birth. While many individuals do not experience symptoms, if a malformation bleeds, it can cause significant issues depending on its location, such as seizures in the brain or vision problems in the eye. Diagnosis is primarily through MRI, and treatment may involve medications or surgery. The outlook is generally positive, with many not developing symptoms, and surgeries often lead to favorable results. However, if the malformation has bled or is in a challenging location, complications and further treatments may be necessary.
