Gamma knife surgery for intracranial cavernous hemangioma

Abstract

Object. The purpose of this study was to assess the benefits of radiosurgery for cavernous hemangioma. Methods. Sixty-five cavernous hemangiomas were treated with gamma knife surgery (GKS) between October 1994 and December 2002. Forty-two patients attended follow up. The mean patient age was 37.6 years (range 7–60 years). The lesions were located in the frontal lobe in 12 cases, deep in the parietal lobe in five, in the basal ganglia in five, in the temporal in three, in the cerebellum in three, in the pons/midbrain in six, and in multiple locations in eight cases. The presenting symptoms were seizure in 12, hemorrhage in 11, and other in 19. The maximum dose was 26.78 Gy, and the mean margin dose was 14.55 Gy. The mean follow-up period after radiosurgery was 29.6 months (range 5–93 months). The tumor decreased in size in 29 cases, was unchanged in 12, and increased in size in one. In the seizure group, seizures were controlled without anticonvulsant medication in nine cases (81.8%) after 31.3 months (range 12–80 months). After 93 months, one patient developed a cyst, which was resected. Rebleeding occurred in one case (2.3%). On T2-weighted imaging changes were seen in 11 cases (26.2%), in three (7.1%) of which neurological deterioration was correlated with imaging changes. In other cases these deficits were temporary. Conclusions. The authors found that GKS was an effective treatment modality for cavernous hemangiomas, especially for those located within the brainstem, basal ganglia, or deep portions of the brain. It can reduce seizure frequency significantly although this takes time. In the group receiving a marginal dose below 15 Gy the patients fared better than when the dose exceeded 15 Gy.

The Brainstem Cavernoma Case Series: A Formula for Surgery and Surgical Technique

“…Stereotactic radiosurgery (SRS) has been used as an alternative treatment modality for cerebral cavernous malformations, but the number of patients treated is much smaller than that of surgical series, and the results are not comparable to those of surgical series [ 16 , 17 , 18 , 19 , 20 , 29 ]. Nevertheless, some authors still emphasize the advantages of SRS compared to surgical treatment.…”

“…Nevertheless, some authors still emphasize the advantages of SRS compared to surgical treatment. However, recent data show that surgical treatment, especially by experienced neurosurgeons, results in much lower morbidity than SRS in these lesions [ 17 , 18 , 20 ]. SRS relies on accurate visualization of the lesion, which is particularly difficult when haemorrhage has occurred because the lesion appears larger on MR images due to surrounding blood [ 13 ].…”

“…Given the available data on the natural history of BS CMs, there is an ongoing debate about the timing and method of treatment. Data on conservative strategies with observation, radiosurgery, and microsurgical excision can be found in the literature [ 3 , 4 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Considering the natural history of BS CMs, with a risk of bleeding ranging from 0.6% to 60% in some series, depending on the previous occurrence of a bleeding episode and surgically induced morbidities, it becomes clear how difficult it is to choose the right timing and appropriate treatment for each individual patient, especially in cases with deep-seated BS CMs [ 4 , 8 , 10 , 11 , 14 , 15 , 22 , 29 ].…”