# Cavernous Malformations of the Central Nervous System: A Comprehensive Review of Pathophysiology, Diagnosis, and Management

## TL;DR

This review summarizes the causes, diagnosis, and treatment of cavernous malformations in the brain and spinal cord, emphasizing recent advances and clinical best practices.

## Contribution

The paper provides a comprehensive synthesis of current evidence and emerging approaches for managing cavernous malformations in the CNS.

## Key findings

- MRI has significantly improved the diagnosis and differentiation of cavernous malformations from other vascular lesions.
- Surgical resection or radiosurgery is recommended for symptomatic or recurrent hemorrhagic cases.
- Hereditary cases of CMs are linked to specific genetic and molecular mechanisms.

## Abstract

Cavernous malformations (CMs) of the central nervous system (CNS) are vascular anomalies characterized by clusters of dilated, thin-walled blood vessels prone to leakage and hemorrhage. These malformations can occur throughout the CNS, including the brain and spinal cord, and present with a wide range of clinical manifestations, from asymptomatic cases to severe neurological deficits. Advances in neuroimaging, particularly magnetic resonance imaging (MRI), have greatly improved the diagnosis and understanding of CMs, enabling more precise differentiation from other vascular lesions. The management of CMs has evolved alongside advancements in surgical and radiosurgical techniques, offering various therapeutic options depending on the lesion’s characteristics and patient symptoms. While conservative management is often appropriate for asymptomatic or minimally symptomatic lesions, surgical resection or stereotactic radiosurgery may be indicated in cases with recurrent hemorrhage or significant neurological impairment. This comprehensive review explores the pathophysiology, clinical presentation, diagnosis, and management of CMs, highlighting current evidence-based practices and emerging therapeutic approaches. The review also addresses the genetic and molecular underpinnings of CMs, particularly in hereditary cases, and discusses potential future directions in research and treatment. By synthesizing the latest knowledge in the field, this review aims to enhance clinical decision-making and promote further investigation into the optimal management of CMs in the CNS.