Abstract
Purpose: Radiosurgery of cavernomas should prevent rebleeding, growth of the lesion, and deterioration of clinical symptoms. However, there is no direct diagnostic tool to verify the endpoints of treatment. At present, the positive effects of radiosurgery are identified by clinical observation and analysis of imaging changes on magnetic resonance imaging during a sufficiently long follow-up period.
Methods: Between 1992 and 2000, a total of 112 patients with brain cavernomas were treated with Gamma Knife radiosurgery at our center. In all, 59 patients experienced bleeding before radiosurgery; the remainder did not. The median age of patients was 42 years, the median volume of the cavernomas was 0.9 cm3, and the median applied marginal dose was 16 Gy.
Results: After a 2-year latent interval after treatment (median follow-up 84 months), the risk of bleeding in the group of patients with bleeding before radiosurgery had decreased from 3.7 % to 0.2 %. For the patients without bleeding before radiosurgery, the annual risk of bleeding was 0.8 %. The cavernoma size decreased in 53.0 % of cases and increased in 6.4 %. Epilepsy, if present before the treatment, was alleviated in 45 % of cases. The risks of temporary or permanent morbidity caused by radiosurgery were 14.6 % and 0.9 %, respectively.
Conclusion: Radiosurgery of cavernomas was associated with a low risk of permanent morbidity. The risk of rebleeding after the 2-year latent interval after radiosurgery had decreased. Treatment of cavernomas with no history of bleeding was halted at our center.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Amin-Hanjani S, Ogilvy CS, Candia GJ, Lyons S, Chapman PH (1998) Stereotactic radiosurgery for cavernous malformations: Kjellberg’s experience with proton beam therapy in 98 cases at the Harvard cyclotron. Neurosurgery 42:1229–1238
Chang SD, Levy RP, Adler JR, Martin DP, Krakovitz PR, Steinberg GK (1998) Stereotactic radiosurgery of angiographically occult vascular malformations: 14-years experience. Neurosurgery 43:213–221
Karlson B, Kihlstrom L, Lindquist C, Ericson K, Steiner L (1998) Radiosurgery for cavernous malformations. J Neurosurg 88:293–297
Karlsson B, Soderman M (2009) Stereotactic radiosurgery for cavernomas. In: Lunsford LD, Sheehan JP (eds) Intracranial stereotactic radiosurgery. Theme, New York, pp 48–57
Kim DG, Choe WJ, Paek SH, Chung HT, Kim IH, Han DH (2002) Radiosurgery if intracranial cavernous malformations. Acta Neurochir (Wien) 144:869–878
Liščák R, Vladyka V, Šimonová G, Vymazal J, Novotný J Jr (2005) Gamma knife surgery of brain cavernous hemangiomas. J Neurosurg 102(Suppl):207–213
Liščák R, Vladyka V, Šimonová G, Urgošík D, Novotný J Jr, Janoušková L, Vymazal J (2007) Arteriovenous malformations after Leksell gamma knife radiosurgery: rate of obliteration and complications. Neurosurgery 60:1005–1016
Liu KD, Chung WY, Wu HM, Shiau CY, Wang LW, Guo WY, Pan DH (2005) Gamma knife surgery for cavernous hemangiomas: an analysis of 125 patients. J Neurosurg 102(Suppl):81–86
Lunsford LD, Khan AA, Niranjan A, Kano H, Flickinger JC, Kondziolka D (2010) Stereotactic radiosurgery for symptomatic solitary cerebral cavernous malformations considered high risk for resection. J Neurosurg 113:23–29
Mathiesen T, Edner G, Kihlstrom L (2003) Deep and brainstem cavernomas: a consecutive 8-years series. J Neurosurg 99:31–37
Mitchell P, Hodgson TJ, Seaman S, Kemeny AA, Forster DMC (2000) Stereotactic radiosurgery and the risk of haemorrhage from cavernous malformations. Br J Neurosurg 14:96–100
Nagy G, Razak A, Rowe JG, Hodgson TJ, Coley SC, Radatz MW, Patel UJ, Kemeny AA (2010) Stereotactic radiosurgery for deep-seated cavernous malformations: a move toward more active, early intervention. J Neurosurg 113:691–699
Pollock E, Garces YI, Stafford SL, Foote RL, Schomberg PJ, Link MJ (2000) Stereotacic radiosurgery for cavernous malformations. J Neurosurg 93:987–991
Régis J, Bartolomei F, Kida Y, Kobayashi T, Vladyka V, Liscàk R, Forster D, Kemeny A, Schröttner O, Pendl G (2000) Radiosurgery for epilepsy associated with cavernous malformation: retrospective study in 49 patients. Neurosurgery 47:1091–1097
Steiner L, Karlsson B, Yen CP, Torner JC, Lindquist C, Schlesinger D (2010) Radiosurgery in cavernous malformations: anatomy of a controversy. J Neurosurg 113:16–22
Szeifert GT, Timperley WR, Forster D, Kemeny A (2007) Histopathological changes in cerebral arteriovenous malformations following gamma knife radiosurgery. In: Szeifert GT, Kondziolka D, Levivier M, Lunsford LD (eds) Radiosurgery and Pathological Fundamentals. Prog Neurol Surg, vol 20. Karger, Basel, pp 212–219
Conflict of Interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Wien
About this paper
Cite this paper
Liscak, R., Urgosik, D., Simonova, G., Vymazal, J., Semnicka, J. (2013). Gamma Knife Radiosurgery of Brain Cavernomas. In: Chernov, M., Hayashi, M., Ganz, J., Takakura, K. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders. Acta Neurochirurgica Supplement, vol 116. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1376-9_17
Download citation
DOI: https://doi.org/10.1007/978-3-7091-1376-9_17
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-1375-2
Online ISBN: 978-3-7091-1376-9
eBook Packages: MedicineMedicine (R0)