Cavernomas: to treat or not to treat?

Cerebral cavernous malformations (CCMs), also referred to as cavernomas or cavernous angiomas, can occur sporadically or as an inherited trait. CCMs can be asymptomatic and incidental findings on brain imaging or symptomatic because of haemorrhage, seizures, or headaches. Haemorrhage risk for CCMs vary according to whether they are incidentally detected and unruptured or have previously bled. The re-haemorrhage rate for CCMs is between 4.5 and 22.9% annually if there has been a single haemorrhage event, or up to 33% if there have been multiple previous events. Currently, there is no consensus on acute or longer term management of CCMs. In this month’s journal club, we explore three recent studies investigating interventions to reduce future haemorrhage risk and that propose future management strategies for symptomatic CCMs. The first paper is a retrospective analysis of the efficacy of gamma knife stereotactic radiosurgery (GKSRS) for symptomatic CCMs from a single centre, and the second reports on the use and outcomes of stereotactic radiosurgery (SRS) in symptomatic CCMs from a series of international centres. The third paper reports on a clinical trial examining the use of propranolol in the treatment of familial symptomatic CCMs