Radiosurgery for symptomatic cavernous malformations: A multi-institutional retrospective study in Japan.

Yoshihisa Kida,Manabu Satoh,Toshinori Hasegawa,Motohiro Hayashi,Takeshi Kondoh,Yoshiyasu Iwai,Takashi Shuto

doi:10.4103/2152-7806.157071

Abstract

Background:A group study for symptomatic cavernous malformation (CM) treated with gamma knife (GK) surgery was performed.Methods:A total of 298 cases collected from 23 GK centers across Japan were included. Hemorrhage was the most common manifestation, followed by seizures and neurological deficits. Most of the lesions were located in the brainstem and basal ganglia, followed by the cerebral or cerebellar hemispheres. The CMs, which had a mean diameter of 14.8 mm, were treated using GK surgery with a mean marginal dose of 14.6 Gy.Results:In terms of hemorrhage-free survival (HFS), a marked dissociation was confirmed between the hemorrhage and seizure groups, while no obvious difference was noted between sexes. Superficial CMs located in cerebellum or lobar regions responded to the treatment better than deeply located CMs in the basal ganglia or brainstem. No significant difference of dose-dependent response was seen for three different ranges of marginal dose: Less than 15 Gy, between 15 and 20 Gy, and more than 20 Gy. Complications were more frequent after a marginal dose of over 15 Gy and in patients with lesions more than 15 mm in diameter. The rates of annual hemorrhage were estimated to be 7.4% during the first 2 years after radiosurgery and 2.8% thereafter. The overall hemorrhage rate after radiosurgery was 4.4%/year/patient.Conclusion:The risk of hemorrhage is considerably reduced after GK treatment. The HFS as well as annual hemorrhage rate after GK treatment was apparently superior to that after conservative treatment for symptomatic CMs. To optimize the success of GK treatment, it is important to reduce the incidence of complications.

Highlights

Progress in neuroimaging has enabled cavernous malformations (CMs) in the brain to be detected using standard imaging studies, magnetic resonance imaging (MRI)
These symptomatic episodes associated with CMs have been well documented, the actual natural history of such symptomatic cavernous malformations (s‐CMs) has not been fully recognized
De novo CM lesions were confirmed in four cases during the follow‐up period [Table 3], which were not recognized at the radiosurgery

Summary

Introduction

Progress in neuroimaging has enabled cavernous malformations (CMs) in the brain to be detected using standard imaging studies, magnetic resonance imaging (MRI). Some CM lesions, show very aggressive behaviors, with frequent bleeding, intractable seizures, or neurological deficits presenting during a short period of time.[13,14] these symptomatic episodes associated with CMs have been well documented, the actual natural history of such symptomatic cavernous malformations (s‐CMs) has not been fully recognized. Because of this lack of information, the treatment results of surgery or radiosurgery for symptomatic lesions cannot be evaluated precisely. A group study for symptomatic cavernous malformation (CM) treated with gamma knife (GK) surgery was performed

Methods

Results

Discussion

Conclusion