Cavernomas: Outcomes after gamma-knife radiosurgery in Iran

Abstract

Background:Treatment of cavernomas remains a challenge in surgically inaccessible regions. The purpose of this study was to evaluate outcomes after gamma-knife surgery (GKS) for these patients.Materials and Methods:A retrospective review of 100 patients treated between 2003 and 2011 was conducted in order to evaluate hemorrhage rates, complications, radiation effects after GKS. Dosage at the tumor margin was stratified into two groups: those that received ≤13 Gy; and those who received >13 Gy. The demographic and clinical characteristics of patients including age, gender, and hemorrhage rates were extracted from care records.Results:The median age was 32.5 years (ranging from 15 to 79). 44% were female. The median follow-up time was 42.2 months (ranging from 24 to 90). The median volume of the lesions was 1050.0 mm3 (ranging from 112.0 to 4100.0) before GKS. A reduction of 27.5% in median size of cavernomas was achieved at the last follow-up. There was 12% treatment-related morbidity after GKS. The hemorrhage rate in the first 2 years after GKS was 4.1% and 1.9% thereafter. There was no mortality due to GKS, and 93 patients were alive at the last follow-up. The radiation-related complication developed with marginal dose 13 Gy.Conclusion:The GKS for cavernomas appears to be a safe and beneficial in carefully selected patients. Low-dose GKS may be effective for the management of cavernous malformations.

Significant Hemorrhage Rate Reduction after Gamma Knife Radiosurgery in Symptomatic Cavernous Malformations: Long-Term Outcome in 95 Case Series and Literature Review

“…The bleeding risk could be underestimated, but our intention was to avoid overestimation of the pretreatment hemorrhage rate in order to further validate SRS posttreatment results. Other authors have employed this equation before [16,21,22]. …”

“…A significant volume reduction after GKRS was observed in 24 patients (61.5%). Azimi et al [21] reported a retrospective review of 100 patients. The radiation-related complication developed with a marginal dose of 13 Gy.…”

Radiosurgery for cerebral cavernous malformations

“…Pollock et al [40] 18 Gy, Kondziolka et al [65], and Liscak et al [66] applied a marginal dose of 16 Gy and tried to reduce ARE. Azimi et al [67], and Park and Hwang [68] prescribed a low marginal dose of 13 Gy on average (Table 2) [19,22,29,40,[66][67][68][69][70][71][72]. In 2019, Lunsford et al [32] wrote that the median radiation dose to the CM margin was 13 Gy to reduce hemorrhagic risk and radiation-induced complications.…”