Clinical Presentation and Management of Cerebral Cavernous Malformations: Institutional Experience in the Context of Current Literature

Background Cerebral cavernous malformations (CCMs) exhibit heterogeneous clinical behavior, from incidental findings to seizures and symptomatic hemorrhage. This study describes clinical presentation patterns and management strategies in a cohort from a public tertiary neurosurgical center, contextualizing the findings within contemporary guideline recommendations. Methods Retrospective observational cohort study of 87 patients with CCMs managed between 2016 and 2025. Variables included demographics, clinical presentation, lesion location, hemorrhage status, antiseizure therapy, and management strategy. Data were analyzed descriptively; Fisher’s exact test and chi-square tests were used to assess selected associations. Results The cohort was 55.2% female, with a mean age of 48.8 ± 16.2 years. Headache (35.6%) and seizures (20.7%) were the most common presentations. Symptomatic hemorrhage at diagnosis was present in 47.1% of patients and was significantly associated with presenting symptoms ( p = 0.020), clustering with focal neurological deficits and multisymptom presentations rather than isolated headache. Lesions were supratentorial in 48.3%, infratentorial in 33.3%, and multiple in 18.4%. Hemorrhage was more frequent in the infratentorial and multiple-lesion groups, but the association was not statistically significant ( p = 0.118). Conservative management predominated (86.2%); surgery was performed in 13.8%, primarily for recurrent hemorrhage or refractory seizures. Conclusion CCMs in this public tertiary cohort most commonly presented with headache or seizures, and nearly half of patients had symptomatic hemorrhage at diagnosis. Conservative management predominated, guided by clinical trajectory and lesion accessibility, consistent with contemporary risk-adapted guidelines. These findings support the feasibility of practice that is broadly consistent with guideline principles for CCM care in a resource-constrained public health system.