This chapter discusses the demographic data, pathological characteristics and pathophysiological mechanisms of epilepsy in Cavernous malformations (CMs). It presents genetic aspects, clinical features, diagnostic tools and therapeutic options for CMs. CMs are characterized by low-flow sinusoidal vessels lined by thin endothelial walls with no obvious feeding arteries or venous drainage. For an optimal therapeutic approach it is mandatory to understand the epilepsy inducing mechanisms associated with CMs. Numerous studies of magnetoencephalography (MEG) in medically intractable epilepsy have shown that MEG can detect interictal and ictal epileptiform activity. The role in diagnosis and the history of imaging techniques such as cerebral angiography, computed tomography (CT), and magnetic resonance imaging (MRI) as well as the radiological characteristics of CM have been extensively reviewed in recent literature. The optimal management of CMs presenting with epileptic seizures is still a matter of debate.

There are four types of cerebral vascular malformations: arteriovenous malformations (AVMs), cavernous malformations (CMs), capillary telangiectasies, and venous malformations. This chapter presents a review of the pertinent literature on CMs regarding epidemiology, genetics, pathology, clinical findings, and therapeutic management with special emphasis placed upon the natural bleeding risk of these malformations. The most sensitive imaging study to detect CMs is magnetic resonance imaging (MRI). Predictive factors for intracranial hemorrhage in patients harboring CMs is a critical issue because the optimal therapeutic management of such lesions is tailored according to the bleeding risk. The main goal of radiosurgical treatment should be a significant reduction in bleeding risk, especially after a latency period of 2 years. By genetic linkage analyses, three cerebral CM loci have been assigned to chromosome 7p, 7q, and 3q. They account for all familial forms of CM, thus constituting a formidable Mendelian model of stroke.