Since earning the prestigious Center of Excellence designation from the Alliance to Cure Cavernous Malformation over a year ago, Duke’s cerebral cavernous malformation (CCM) program has elevated its expertise in treating the most complex CCM cases. It’s the only program with this distinction in North Carolina and surrounding states, excluding Virginia.  

“We’re attracting and successfully treating the most complex CCM cases, including many cases other centers won’t operate on,” says David M. Hasan, MD, microvascular surgeon and neurosurgeon. 

Having a multidisciplinary neurology, neurosurgery, and radiology team differentiates Duke as a destination program. “We have the resources to diagnose and tackle nearly any cavernoma, including those affecting children, adults, pregnant women, and many other unique cases,” says Hasan. 

The stability of the cavernoma determines the course of treatment, Hasan explains. To determine this, state-of-the-art CT imaging tools are required, which are available at Duke. “In 70% of cases, cavernomas are silent. We often decide to monitor these patients,” says Hasan. 

Cavernomas actively bleeding, causing neurological deficits, or in higher-risk locations need treatment. “Our neurosurgeons and multidisciplinary team collaborate on each case to deliver the best possible outcomes,” says Hasan. 

For patients with familial CCMs, access to a designated Center of Excellence is critical. Molecular genetic testing, screening, and monitoring can best support family members of relatives diagnosed with CCM. 

Duke has a long-standing history of CCM research and innovation, as Duke physicians first discovered the genes causing the condition more than 20 years ago.

“We are also exploring new approaches for treating CCM using minimally invasive laser and thermal therapy techniques,” says Hasan. “Thermal techniques are showing promise in holding the progression of a cavernoma.” 

Additional research efforts focus on initiating an early-phase clinical trial to test high-intensity focused ultrasound treatment, which could benefit patients with cavernomas in challenging or high-risk locations like the eloquent cortex. Hasan and the team are also studying potential new drugs to treat cavernoma, including the novel use of an aspirin to decrease the risk of cavernoma bleeding. 

“Aspirins are contraindicated in cavernoma treatment due to perceived bleeding risk, but we have some evidence to believe that they might prevent bleeding,” says Hasan. “We’re moving swiftly to research this as a potentially effective treatment option in the future.”