A Review of Current Advances in the Treatment of Cerebral Cavernous Malformations

BackgroundCerebral cavernous malformations (CCMs) are vascular anomalies consisting of clusters of thin walled blood vessels, missing intervening brain parenchima, the pathogenesis of which leads to repeated episodes of hemorrhage and thrombosis. This in turn may have a clinical impact, resulting in acute intraparenchymal hemorrhage (IPH), seizures, headaches, and focal neurological signs (FNS), but they can also be discovered purely incidentally.ObjectiveTo review current treatment modalities for CCMs and evaluate the potential of emerging pathogenic-targeted therapies. Methods: A comprehensive review was conducted to summarize existing therapeutic strategies for CCMs, broadly separated in conservative measures with clinical and imaging monitoring, microsurgical resection (MRS), and stereotactic radiosurgery (SRS). The influence of clinical presentation, lesion location (eloquent vs. non-eloquent brain areas), and patient-specific factors (age and comorbidities) on treatment decisions is discussed.ResultsThe clinical presentation and location of the CCM (eloquent or non-eloquent brain area), its association with a developmental venous anomaly (DVA), and the patient's age and comorbidities are cornerstones in choosing an optimal strategy, but controversy remains regarding specific criteria involved in decision-making tailored for each patient.ConclusionsThis review focuses on advantages and limitations of each current practice, the importance of a careful balance between clinical and anatomical considerations, while also presenting pathogenic treatment options currently under investigation, such as beta blockers, Rho-kinase (ROCK) inhibitors, and superoxide dismutase (SOD) mimetics.