Stereotactic radiosurgery for the treatment of symptomatic brainstem cavernous malformations
- 1 September 2010
- journal article
- research article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Neurosurgical Focus
- Vol. 29 (3), E11
- https://doi.org/10.3171/2010.7.focus10151
Abstract
The authors performed a retrospective review of prospectively collected data to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) for the treatment of patients harboring symptomatic solitary cavernous malformations (CMs) of the brainstem that bleed repeatedly and are high risk for resection. Between 1988 and 2005, 68 patients (34 males and 34 females) with solitary, symptomatic CMs of the brainstem underwent Gamma Knife surgery. The mean patient age was 41.2 years, and all patients had suffered at least 2 symptomatic hemorrhages (range 2-12 events) before radiosurgery. Prior to SRS, 15 patients (22.1%) had undergone attempted resection. The mean volume of the malformation treated was 1.19 ml, and the mean prescribed marginal radiation dose was 16 Gy. The mean follow-up period was 5.2 years (range 0.6-12.4 years). The pre-SRS annual hemorrhage rate was 32.38%, or 125 hemorrhages, excluding the first hemorrhage, over a total of 386 patient-years. Following SRS, 11 hemorrhages were observed within the first 2 years of follow-up (8.22% annual hemorrhage rate) and 3 hemorrhages were observed in the period after the first 2 years of follow-up (1.37% annual hemorrhage rate). A significant reduction (p < 0.0001) in the risk of brainstem CM hemorrhages was observed following radiosurgical treatment, as well as in latency period of 2 years after SRS (p < 0.0447). Eight patients (11.8%) experienced new neurological deficits as a result of adverse radiation effects following SRS. The results of this study support a role for the use of SRS for symptomatic CMs of the brainstem, as it is relatively safe and appears to reduce rebleeding rates in this high-surgical-risk location.Keywords
This publication has 40 references indexed in Scilit:
- Gamma knife surgery for cavernous hemangiomas: an analysis of 125 patientsJournal of Neurosurgery, 2005
- Gamma knife surgery of brain cavernous hemangiomasJournal of Neurosurgery, 2005
- Histopathological findings in a surgically resected thalamic cavernous hemangioma 1 year after 40-Gy irradiationJournal of Neurosurgery, 2005
- Radiosurgery of Intracranial Cavernous MalformationsActa Neurochirurgica, 2002
- Long-term Results after Stereotactic Radiosurgery for Patients with Cavernous MalformationsNeurosurgery, 2002
- Stereotactic radiosurgery of cavernous malformationsJournal of Neurosurgery, 2000
- Stereotactic radiosurgery and the risk of haemorrhage from cavernous malformationsBritish Journal of Neurosurgery, 2000
- Formation of intracerebral cavernous malformations after brain radiation treatment for central nervous system neoplasia in childrenJournal of Neurosurgery, 1998
- Intracranial Cavernous MalformationsNeurosurgery, 1995
- Natural history of intracranial cavernous malformationsJournal of Neurosurgery, 1995