Propranolol as treatment for cavernous angioma malformation – a prospective study and a critical review

Introduction: Cavernomas are vascular malformations that could cause hemorrhage especially in young patients. It could be a genetic condition associated to familiar heritage or be sporadic. Generally are small lesions that could be localized in eloquent areas making difficult the surgical approach and despite they often have small size, they could be lethal.

Objective: Describe a prospective study protocol considering patients treated with surgery or those one that received conservative treatment with propranolol. METHODS: Ethics committee approval was obtained and a specific ambulatory of cavernous angioma created. A research protocol is fulfilled and based on signs/symptoms, size and topography of cavernomas, patients are selected to receive propranolol at the initial doses of 1mg/kg/day (gradually this doses is increased until 2mg/kg/day). Only after cardiology evaluation this drug is administered. Periodically evaluations are performed during consults and MRI is ordered every 6 months after the beginning.

Results: In 10 months 30 patients were evaluated and had the diagnosis of cavernous angioma malformation. Among them, 13 were selected to receive conservative treatment and initiated the continuous use of Propranolol. Six months after the initial propranolol administration, the first MRI was performed in 8 of them. In 7 the lesion remained with the same characteristics, without additional growth and only in one it seems that occurred a minor reduction at cavernoma size (according with radiology evaluation).

Conclusions: Options to surgical approach must be encourage in cases of small and deep-located in eloquent areas cavernomas for trying to minimize neurological sequelae. Propranolol is a well-known medication that seems to decrease/estabilize the size of this malformations, however further studies including genetic analysis and a longer period of observation must be performed for a better efficacy evaluation.