Gamma Knife Radiosurgery for Symptomatic Brainstem Intra-Axial Cavernous Malformations

Park, Seong‐Hyun; Hwang, Sung-Kyoo

doi:10.1016/j.wneu.2012.09.013

Cited by 36 publications

(27 citation statements)

References 8 publications

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“…The annual hemorrhagic rates were calculated with the following formula: rate = total number of bleeds in all patients/total number of patient-years in the observation period. 20 The observation period comprised the time from the first symptomatic, image-documented hemorrhage to the time of SRS. A meta-analysis was performed for each study.…”

Section: Meta-analysismentioning

confidence: 99%

“…Four studies used Gamma Knife surgery (GKS; n = 164 patients), and 1 used LINACbased SRS (n = 14). 9,16,17,19,20 In all patients, the targeted edge of the CM was considered to be the region characterized by mixed signal change within the T2-weighted signal, which was defined as a hemosiderin ring. The surrounding hemosiderin ring was not the CM itself.…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

“…20 However, despite the theoretical benefits of SRS, only a few studies have reported the use of this treatment modality for brainstem CMs. Those studies that have been published have been limited by their small sample sizes, short follow-up durations, and lack of control groups.…”

mentioning

confidence: 99%

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Stereotactic radiosurgery of brainstem cavernous malformations: a systematic review and meta-analysis

Sun

et al. 2014

JNS

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Object Over the last two decades, stereotactic radiosurgery (SRS) has arisen as a promising approach in the management of brainstem cavernous malformations (CMs). In the present study, the authors report a systematic review and meta-analysis of the available published data regarding the radiosurgical management of brainstem CMs. Methods To identify eligible studies, systematic searches for brainstem CMs treated with SRS were conducted in major scientific publication databases. The search yielded 5 studies, which were included in the meta-analysis. Data from 178 patients with brainstem CMs were extracted. Hemorrhage rates before and after SRS were calculated, a meta-analysis was performed, and the risk ratio (RR) was determined. Results Four studies showed a statically significant reduction in the annual hemorrhage rate after SRS. The overall RR was 0.161 (95% CI 0.052–0.493; p = 0.001), and 21 patients (11.8%) had transient or permanent neurological deficits. Conclusions The present meta-analysis for the radiosurgical management of brainstem CMs shows that SRS can decrease the rate of repeat hemorrhage and has a low rate of adverse effects compared with surgery. The authors suggest that SRS may be considered as an alternative treatment for brainstem CMs that are inoperable or have a high operative risk.

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Section: Meta-analysismentioning

confidence: 99%

Section: Systematic Literature Reviewmentioning

confidence: 99%

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Stereotactic radiosurgery of brainstem cavernous malformations: a systematic review and meta-analysis

Sun

et al. 2014

JNS

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“…Nagy et al found that the rebleeding rate went from 30.5% before treatment to 15% in the first two years and further fell to 2.4% Seong-Hyun Park and Chalouhi both suggest that radiosurgery is an alternative to microsurgery for treating patients with CMs in high-risk areas who are symptomatic and at risk for future bleeds. 15,17 The decision for radiosurgical intervention in asymptomatic patients with incidental cavernous malformations is a complex issue. Cavernous malformations have variable courses.…”

mentioning

confidence: 99%

“…15 Lunsford et al found that their mean marginal dose of 16 Gy resulted in adverse radiation effects in 11.65% of their radiosurgically treated patients, and Pollock et al reported adverse radiation effects in 59% of patients with a mean marginal dose of 18 Gy. 13,16 These studies highlight the significance of adverse effects that can occur with radiosurgery, and make the decision to treat a radiosurgically eligible incidental cavernous malformation more difficult, especially taking into consideration the eloquent areas involved.…”

mentioning

confidence: 99%