Hemispherical Cavernomas in Non-Eloquent and Eloquent Areas

Cerebral cavernoma are the most common clinically symptomatic vascular anomaly and constitute approximately 10%–15% of all vascular malformations. While the location of CCMs is quite variable, 70%–80% of CCMs have a supratentorial origin. With the increasing availability of MR imaging, the frequency of diagnosis of CM has risen significantly.Treatment options for patients with CCM include observation, microsurgical resection, and at times stereotactic radiosurgery. Because of the differing risk profile for ICH, the risks associated with microsurgical excision need to be weighed against that of natural history when considering treatment.Some patients with CCMs should be followed conservatively, especially asymptomatic lesions located in eloquent, deep, or brainstem areas. Surgical resection is also not recommended in cases with multiple asymptomatic CCMs. For patients who are observed, some form of regular sequential imaging and clinical follow up is recommended, such as yearly MRIs.The currently accepted indications for surgical resection of CCMs in the cerebral hemispheres include recurrent hemorrhage, progressive neurologic deterioration, and intractable epilepsy. For some younger patients with asymptomatic lesions, the intrinsic psychological burden may outweigh the risk of surgical morbidity. For easily accessible lesions, surgical resection presents an opportunity for a cure and obviates the need for long-term follow-up. The exact management plan for these patients will need to be individually tailored with thorough discussion of risks and benefits, while taking into account patient preferences.