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Update on the natural history of cavernous malformations and factors predicting aggressive clinical presentation

Chad W. Washington, M.D., Kathleen E. McCoy, B.S., and Gregory J. Zipfel, M.D.

Neurosurgical FOCUS 29:3:E7

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Cavernous malformations (CMs) are angiographically occult, low-pressure neurovascular lesions with distinct imaging and clinical characteristics. They present with seizure, neurological compromise due to lesion hemorrhage or expansion, or as incidental findings on neuroimaging studies. Treatment options include conservative therapy, medical management of seizures, surgical intervention for lesion resection, and in select cases stereotactic radiosurgery. Optimal management requires a thorough understanding of the natural history of CMs including consideration of issues such as mode of presentation, lesion location, and genetics that may impact the associated neurological risk. Over the past 2 decades, multiple studies have been published, shedding valuable light on the clinical characteristics and natural history of these malformations. The purpose of this review is to provide the reader with a concise consolidation of this published material such that they may better understand the risks associated with CMs and their implications on patient treatment.

Address correspondence to: Gregory J. Zipfel, M.D., Washington University School of Medicine, Department of Neurological Surgery, 660 S. Euclid Avenue, Campus Box 8057, St. Louis, Missouri 63110. email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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