An Alternative Approach to Surgery or Radiosurgery for Treating Cerebral Cavernous Malformations? A Case Report with Literature Review.

Abstract

Introduction: Cerebral cavernous malformation (CCM) is a vascular abnormality in capillaries. CCMs can lead to different complaints depending on their location. Their size can range from microscopic up to several centimeters in diameter. In CCM, the walls of the capillaries are thinner than normal and less elastic. The blood vessel walls in cavernomas are weak and thin and can leak blood into the surrounding brain or spinal cord tissue. This leak can damage surrounding brain tissue and cause neurological problems. CCMs are dynamic lesions that may regress, progress in size, or even develop through de novo formation. The most feared side effect is intracerebral hemorrhage which may cause focal neurological symptoms such as headache and epileptic seizures.

Case study: Our patient was a 44-year-old male with an Eastern Cooperative Oncology Group (ECOG) performance status of 1-2. He had recently experienced a brain hemorrhage 15 days ago. Additionally, he had mild vision loss and headaches. An MRI revealed a cavernoma located 2 cm deep in the occipital lobe with a diameter of 1 cm. The standard therapy for a cavernoma typically includes surgery or radiotherapy. However, a conservative treatment approach may also be considered, depending on the patient's symptoms and overall condition. It is prudent to consider conservative medical treatment for CCMs, especially when weighing the potential side effects of more invasive procedures like microsurgery or stereotactic radiosurgery (SRS). Adverse effects include neurological damage, infection, and radiation-induced complications. In this case, we reviewed the literature to evaluate the appropriate treatment modality for our patient.

Conclusion: Conservative management typically involves monitoring the patients with regular imaging and medication. Each treatment option has its risks and benefits, and the decision should be tailored to the individual patient's condition, location and size of the CCM, and overall health.