These risk estimates are derived from long-term clinical cohorts tracking the natural history of cerebral cavernous malformations.
Haemorrhage Sentinel Probe
Input the anatomical territory and clinical history of the cavernoma to generate its specific annual haemorrhic risk profile.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Counseling patients with incidental or symptomatic cerebral cavernous malformations (CCM).
Estimating the yearly risk of first-time haemorrhage vs. the risk of re-bleeding.
Aiding the decision process for surgical resection in high-risk locations (e.g. brainstem).
Section 2
Literature
Development
Risk estimates for cavernoma hemorrhage are derived from large prospective cohorts and meta-analyses, most notably those by Al-Shahi Salman et al. and the Horne et al. Lancet Neurology study (2016). These studies identified that the two dominant predictors of future hemorrhage are the location (brainstem/deep vs. cortical) and whether the patient has already experienced a prior symptomatic bleed.
Section 3
Pearls/Pitfalls
The Sentinel Bleed
The "Prior Haemorrhage" variable is the single most powerful predictor of future risk. An incidental brainstem cavernoma has a relatively modest risk (~4%), but once it has bled once, the risk of a second, potentially devastating re-bleed spikes to over 30% per year, often triggering an urgent surgical discussion.
Section 4
Evidence Appraisal
Primary Reference
Clinical course of cerebral cavernous malformations: a cluster-level meta-analysis
Horne MA et al. • Lancet Neurol. 2016;15(2):166-73
