Cavernous Hemangioma
Cavernous hemangiomas or "cavernomas" are benign blood vessel tumors which are characterized by slow flow of blood through them. They can occur in any organ system: the liver, the kidney, the skin ... and the brain.
They appear to be large dilated veins which have partially clotted blood within them. Occasionally they bleed into the surrounding brain tissue. Brain scar (glial scar) then surrounds the hemorrhage and may be why they appear to grow with repeated hemorrhages.
Cavernomas are readily visible on MRI studies.The surrounding hemosiderin left behind after the hemorrhage is characteristic of the lesion. MRIs are exquisitely sensitive in detecting these lesions.
Not all cavernomas have to be removed. Sometimes they are multiple. Surgery is indicated only when they bleed into the brain or cause seizures which are difficult to control medically. In some instances repeated hemorrhages result in progressive growth of the cavernoma and it eventually exerts pressure on the surrounding brain which results in neurologic deficit.
The best treatment for a cavernous hemangioma is surgical removal. New computer-assisted minimally invasive surgical techniques make the risk of surgery for these lesions exceedingly low. The role of radiosurgery is controversial and a very poor substitute for surgical removal.
A small cavernoma may not cause symptoms and may not require treatment. Surgery is indicated if it produces medically intractible seizures or it bleeds more than twice.
