The pros and cons of conservative and surgical treatment of cavernous malformations

Introduction Cavernous malformations (CMs) of the nervous system were once poorly understood entities. With the advent and use of computed tomography (CT) and magnetic resonance imaging (MRI), our ability to diagnose and understand their behavior has advanced. As our knowledge of their natural history has increased, it has become clear that certain CMs require treatment while others do not. However, the ability to predict the behavior of individual CMs remains beyond our current limitations. Currently, management of CMs is based on the clinical presentation, the anatomical location of the lesion, and our knowledge of behavior patterns based on these two factors. Traditionally, CMs have been managed either conservatively or with surgery. More recently, radiosurgery has evolved as a possible treatment option. We present a systematic review of the management of CMs based on presentation and anatomical location. We also present algorithms based on current knowledge to guide the management of CMs.