How do you manage multiple cavernous malformations that have bled and enlarged over time?

Intracranial hemorrhage (ICH) is one of the most common manifestations of cerebral cavernous malformations (CCMs) occurring in about 25% of the cases. Two recent meta-analyses report a risk of 15% of ICH at 5 years. The treatment of these patients is very controversial. A recent population-based study comparing surgical excision to conservative management revealed poorer outcome over the subsequent 5 years for patients undergoing surgery; in fact, the surgical group had a higher risk of symptoma...