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. 2026 Jan 1;98(1):3-22.
doi: 10.1227/neu.0000000000003459. Epub 2025 May 21.

Guidelines for the Diagnosis and Clinical Management of Cavernous Malformations of the Brain and Spinal Cord: Consensus Recommendations Based on a Systematic Literature Review by the Alliance to Cure Cavernous Malformation Clinical Advisory Board Experts Panel

Amy L Akers  1 , John Albanese  2 , Roberto J Alcazar-Felix  3 , Rustam Al-Shahi Salman  4 , Issam A Awad  3 , Edward S Connolly  5 , Amy Danehy  6 , Kelly D Flemming  7 , Errol Gordon  8 , Stephanie Hage  3 , Helen Kim  9 , Giuseppe Lanzino  7 , Cornelia H Lee  1 , Paul C McCormick  5 , Marc C Mabray  10 , Douglas A Marchuk  11 , Edward Smith  2 , Kelsey M Smith  7 , Siddharth Srivastava  12 , J Michael Taylor  13 , Sudhakar Vadivelu  14
Affiliations

Guidelines for the Diagnosis and Clinical Management of Cavernous Malformations of the Brain and Spinal Cord: Consensus Recommendations Based on a Systematic Literature Review by the Alliance to Cure Cavernous Malformation Clinical Advisory Board Experts Panel

Amy L Akers et al. Neurosurgery. .

Abstract

Background and objectives: Despite many publications about cavernous malformations (CMs), controversy remains regarding diagnostic and management strategies. To update evidence-based guidelines for the clinical management of brain and spinal cord CMs.

Methods: The Alliance to Cure CMs, the patient support group in the United States advocating on behalf of patients and research in CM, convened a multidisciplinary writing group comprising expert CM clinicians to help summarize the existing literature related to the clinical care of CM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and imaging standards, (4) neurosurgical considerations, and (5) neurological considerations. Building on prior evidence-based recommendations reflecting literature review through October 2014, the group conducted a systematic review of the more recent literature, identified references for mandatory citation, rated evidence, developed recommendations, and established consensus according to a prespecified protocol. Finally, the writing group outlined remaining knowledge gaps and controversies to guide future research.

Results: From 2672 publications published between October 1, 2014, and March 15, 2023, and meeting key word criteria, 234 were selected based on prearticulated criteria for mandatory consideration in evidence-based recommendations. Topic authors used these and other supporting references to summarize current knowledge and arrive at 53 management recommendations, with unanimous consensus based on a Delphi process. These were rated by class (strength of recommendation) and level (quality of evidence) per the American Heart Association/American Stroke Association criteria. Eighteen recommendations were class 1 (34%), class 2 in 31 (58%), and class 3 in 4 (8%). Three were level A (6%), 19 (36%) were level B, and 31 (58%) were level C.

Conclusion: Current evidence supports prior and new recommendations for the management of CMs, but many reflect moderate classes and low levels, mandating further research to better inform clinical practice.

Keywords: Angioma; Cavernoma; Cavernous; Guidelines; Malformation; Recommendations.

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References

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