Decision to treat brain cavernoma depends on assessment of bleeding risk from cavernous angioma. Hemorrhage risk depends on location of cavernoma in the brain. Leading cerebrovascular neurosurgeon. What are the risk factors for brain cavernous angioma bleeding? Dr. Anton Titov, MD. What are the different types of bleeding of or brain cavernoma? What type of hemorrhage from brain cavernous can affect patient's life? Dr. Anton Titov, MD. What cavernous angioma bleeding types require early or late treatment of cavernous angioma in the brain? Dr. Mika Niemela, MD. There are no known risk factors for brain cavernoma bleeding except the size and a deep location. But patients cannot affect the bleeding anyhow. Blood pressure, smoking has no meaning in these lesions. But if cavernous angioma is deep, if it's larger, then the risk of bleeding is higher. How do you compare indications for early versus late treatment of brain cavernous angioma? You have done some clinical research on the brain cavernoma treatment outcomes. Dr. Mika Niemela, MD. Sometimes the patient has several cavernoma bleedings. Then the prognosis is worse than if the cavernoma has been removed earlier. It applies to risk of epilepsy. This worse prognosis also applies to spine cavernoma. A cavernoma in the spine region could be a problem. Dr. Mika Niemela, MD. Spine cavernous could cause a big bleeding. Then it's a problem. It's better to take cavernoma out at that point at the latest. Dr. Anton Titov, MD. You should not passively observe patients with such cavernous angioma. But the bleeding from cavernous could be very small. Bleeding could be on the surface of the brain only. The patient could have no no symptoms. Dr. Anton Titov, MD. Then you may observe a patient with such cavernoma in the brain area. But you cannot observe patients with a brain stem cavernous angioma that has already bled. Dr. Mika Niemela, MD. Because even a smaller bleeding in the brain stem may be difficult. But that also depends on the size and location of cavernoma within the brain stem. You followed the patients with brain cavernoma who are elderly. Cavernous angioma treatment in the elderly patient could be different from a younger patient. We tend to be more conservative. Dr. Anton Titov, MD. Cavernous angioma treatment depends on the patient's symptoms and size and location of the cavernoma. But not necessarily so. Most of the brain cavernomas are just observed. And sometimes we excise all of the cavernoma together.