Gamma knife radiosurgery for cavernous hemangiomas

Abstract

Object. The authors analyzed the outcome of 53 patients with cavernous hemangiomas who underwent gamma knife radiosurgery (GKS) and evaluated the benefit of the treatment. Methods. From 1994 to 1995, 57 patients were treated with GKS for cavernous hemangiomas. The mean margin dose to the lesions was 20.3 Gy (range 14.5–25.2 Gy) and the prescription isodose was 50 to 80%. The mean follow-up period was 4.2 years. Four patients were lost to follow up. In 18 of 28 patients whose chief complaint was seizures, there was a decrease in seizure frequency. Five of 23 patients with hemorrhage suffered rebleeding 4 to 39 months after GKS. Seventeen patients in whom the hemangiomas were located at the frontal or parietal lobe had neurological disability and in five this was severe. Two patients underwent resection of their hemangioma after GKS. Three experienced visual problems. Follow-up imaging demonstrated shrinkage of the lesion in 19 patients. Conclusions. A higher margin dose (> 16 Gy) may be associated with a reduction in the incidence of rebleeding after GKS. Higher dosage and severe brain edema after GKS may decrease the frequency and intensity of seizures at least temporarily. Gamma knife radiosurgery may play a role in protection against hemorrhage and in reduction of the rate of seizure in selected cases with the appropriate dose.

Pediatric cerebral cavernous malformations: Genetics, pathogenesis, and management

“…Stereotactic radiosurgery (SRS) has been reported by some groups as a potential treatment option. [ 5 60 85 ] However, any reported decrease in the risk of hemorrhage appears to occur at 2 years after SRS; thus, it is difficult to discern whether this reflects true therapeutic benefit versus the natural history of decreased hemorrhage rates after initial “clustering” of hemorrhage events. [ 5 39 57 60 ] Because arteriopathy is not an etiology of CCM, some experts contend that the use of SRS for CCMs does not have an explanation grounded in biological basis.…”

Cerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients

“…According to Siegel et al it is unclear whether lesionectomy alone or tailored epilepsy surgery with previous invasive monitoring constitutes the optimal strategy in patients with intractable seizures; particularly in lesions located in the proximity to a functioning hippocampus, a limited lesionectomy may fail as seizure treatment [241]. While most authors report good outcomes with surgery [8,22,169,288], very few recommend radiosurgery for treatment of epilepsy associated with cavernous angioma [199,290]. Régis et al retrospectively reviewed 49 patients with long-lasting resistant epilepsy presumably caused by cavernous angiomas who were treated by gamma knife surgery for the control of epilepsy.…”

Development of a Posterior Fossa Cavernous Malformation Associated With Bilateral Venous Anomalies: Case Report

“…For those CMs not amenable to a conventional surgical approach, stereotactic radiosurgery has been shown to reduce the risk of hemorrhage. 6,7,14,15 In addition to protecting against hemorrhage, radiosurgery also appears to shrink the lesion and reduce the incidence of seizures associated with some supratentorial CMs. 7,14 When treated with radiosurgery, the venous anomalies are left outside of the radiosurgical field.…”

“…After discussing various options with the patient, including further observation with repeat imaging, surgical resection, and radiosurgery, the decision was made to treat both of the CMs with gamma knife radiosurgery. 6,7 We did not recommend additional observation because of the progressive nature of the patient's neurological symptoms as well as the chance for a hemorrhage that could result in neurological devastation. Surgical resection of both CMs would have been fraught with difficulties, including brainstem injury, cranial nerve palsies, worsening cerebellar dysfunction, and venous infarct as a result of damage to the adjacent VAs.…”