At the University of Virgnia, the treatment of AVMs is individualized on the clinical and radiologic characteristics of the single case and incorporates all of these treatment modalities alone or in various combinations. B. Cavernous Malformations Cavernous malformations are benign tumors of blood vessels and represent a lobulated collection of dilated endothelial-lined sinusoidal spaces. A familial tendency has been noted in certain instances. Seizures are the most common manifestation of supratentorial cavernous malformations. Surrounding hemosiderin and gliosis is thought to account for the epileptogenicity.
Symptomatic hemorrhage is the next most common presenting scenario followed by headaches.
Additionally, cavernous malformations are frequent incidental findings on radiographic studies for other indications. Cavernous malformations are angiographically occult lesions and are best seen with MR imaging. Microsurgical resection is indicated for supratentorial lesions that present with hemorrhage or that are associated with medically intractable epilepsy or headaches. Brainstem cavernous malformations are considered for surgical resection when there is repeat hemorrhage, progressive neurological deficit and superficial location. Surprisingly and inexplicably, these do not appear to be amenable to radiosurgery and such treatment is frequently complicated by a high incidence of radionecrosis.