Decision to operate on brain cavernoma can be difficult. Leading neurosurgeon explains factors in treatment or observation of cerebral cavernous malformations. Treatment of Cerebral cavernous malformations, CCMs. Cavernous angiomas, they are also known as cavernomas. Dr. Anton Titov, MD. There are multiple treatment options for cavernous angiomas of the brain. It is not that easy to decide sometimes if the patient needs to be observed or actively treated. Dr. Mika Niemela, MD. True! You have a particular interest in brain cavernoma diagnosis. Dr. Anton Titov, MD. You treat many patients with cavernous angioma. Yes! How do you decide on the best treatment options for patients with cavernoma? Cavernoma treatment depends whether it has bled or not. Treatment of cerebral cavernous malformations also depends on how big is the bleeding. Sometimes brain cavernous angioma has bled. Then we are more active in treating it. Dr. Mika Niemela, MD. A brain cavernous angioma could be symptomatic. It could be a large cerebral hemorrhage due to cavernous angioma rupture. Sometimes cavernoma has a tiny bleed. This happens more often. You then can see hemosiderin around a brain cavernoma in MRI. Dr. Anton Titov, MD. Brain cavernous angioma treatment depends on the location, age of the patient, and symptoms. Sometimes cavernoma has a larger bleed. Then surgical treatment is indicated for cavernous angioma. Dr. Mika Niemela, MD. Even a smaller cavernoma bleeding in the brain stem area may indicate a need for treatment. But brain cavernoma could bleed on the surface of the brain. Hemorrhage could be very small. There could be no signs of active bleeding. The patient could have no symptoms. Then there is no need for active treatment of cerebral cavernous angioma. The bleeding could be internal to the cavernoma. Hemorrhage could also be external. Dr. Anton Titov, MD. The significance of two types of cavernoma bleeding could be very different for the patient. Exactly! A very small bleeding in cavernoma doesn't necessarily cause anything else other than headache. Dr. Mika Niemela, MD. Cavernous angioma may cause epileptic symptoms if it is located in certain brain areas. A large cavernous angioma bleeding may cause even unconsciousness and hemiplegia or hemiparesis. But that's quite rare.