Currently, the NHS offers two treatment options for symptomatic cavernoma alongside a ‘wait and see’ (or conservative medical management) approach: neurosurgery or stereotactic radiosurgery. 

Stereotactic radiosurgery (SRS) is typically considered for smaller deep-seated or surgically high-risk cavernomas, where neurosurgery would carry greater danger. It uses focused radiation to target specific areas in the brain without needing to make any cuts or incisions. Gamma Knife is one of the most common forms of this treatment, using highly focused beams of gamma radiation to treat conditions like cavernomas. 

Despite the name, there’s no actual ‘knife’ involved – it’s a painless procedure usually done in a single session. It does not involve incisions or general anaesthesia. Instead, multiple beams of radiation converge on the targeted area, delivering a high dose of radiation while minimizing exposure to surrounding healthy tissue.

The radiation damages the DNA within cavernoma cells, preventing them from reproducing, and may help reduce the risk of future bleeds over time. However, the cavernoma itself is not removed, and the effects of the treatment can take up to two years to fully develop.

To ensure accuracy, the person’s head is kept completely still during treatment. Depending on the centre, this might involve a head frame or a custom-fitted mask.

SRS remains a topic of ongoing research and discussion among specialists. It has not yet been proven effective through a large clinical trial beyond the CARE pilot study, so there is still some uncertainty about how well it works and for whom it is most suitable. Decisions about SRS should always be made in discussion with your neurosurgeon or neurologist, taking into account your individual situation.