Comprehensive Review of Cranial Cavernous Malformations: Results of a Single-center Study of 31 Cases

Objective To evaluate the demographic, clinical, radiological features, and surgical outcomes of 31 patients who underwent surgery for cranial cavernous malformations (CCM). Methods A retrospective analysis was conducted on 31 patients who underwent CCM between July 2020 and January 2024. Data included demographic and clinical, radiological, intraoperative, and histopathological findings, and postoperative complications. Detailed neurological examinations were performed before and after surgery. All patients underwent preoperative computed tomography and magnetic resonance imaging (MRI), and the lesions were evaluated using the Zabramski classification. Surgeries aimed at total resection using neuronavigation, intraoperative MRI, and ultrasonography when needed. The average follow-up duration was 25.3 months. Results Thirty-three transcranial microsurgical excisions were performed in 31 patients (48% male, 52% female; mean age 30.8 years). Lesions were most commonly parietal (39%) and frontal (26%). Clinical findings included epilepsy (62%), headache (20%), and focal neurological deficits (6%). According to Zabramski, 42% were type I, 52% were type II, and 6% were type III. Total excision was achieved in 94% of the patients, with 6% requiring a second operation. Postoperative seizures were absent in 74% of patients with epilepsy. The average length of hospital stay was 5.7 days, with no permanent neurological deterioration or mortality. Conclusion Surgical resection is effective for treating symptomatic CCM. Total resection cases should be closely monitored due to the risk of recurrence. A conservative approach is recommended for asymptomatic, deep-seated, or eloquent lesions, and radiosurgery is considered for high surgical risk cases. Multidisciplinary and personalized treatment protocols can improve outcomes in patients with CCM.