Long-Term Outcome of Gamma Knife Radiosurgery for Brain Cavernoma: Factors Associated with Subsequent De Novo Cavernoma Formation

Sheen, Jae Jon; Lee, Do Heui; Lee, Deok Hee; Song, Yunsun; Kwon, Do Hoon

doi:10.1016/j.wneu.2018.07.046

Cited by 12 publications

(8 citation statements)

References 28 publications

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“…In case 1, the motor and sensory hemisyndrome could have been the clinical manifestation of a de novo cavernoma formation; similar cases have been reported in a small percentage of patients who had undergone radiosurgical treatment. 8 In case 2, the tremor was mistaken for a variant of Holmes' tremor because of its features: the irregular low-frequency pattern (presence at rest and prominence during posture and action) and the timing of onset after a central nervous system insult in the thalamo-pontine-midbrain region, which usually occurs between 1 and 24 months, as a consequence of a vascular lesion in 48.3% of cases. 9 In both cases, neurological examination revealed "red flags" of internal inconsistency, such as susceptibility to distractive maneuvers and a positive Hoover's sign in case 1, and incongruity, as demonstrated by the gradient of tremor severity in case 2.…”

Section: Discussionmentioning

confidence: 99%

Functional Motor Disorders Mimicking Symptoms Upon Resolution of Cerebrovascular Disease

Paio

Antelmi

Conti

et al. 2020

Movement Disord Clin Pract

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BackgroundBackground: Functional motor disorders encompass a variety of manifestations characterized by abnormal movements that are clinically incongruent with those known to be caused by neurological diseases. Cases Cases: We report 2 cases in which functional motor disorders developed after complete recovery of motor symptoms originating from underlying vascular brain lesions. The first case describes a young woman who developed a motor and sensory hemisyndrome after surgical removal of a postrolandic cavernoma. The second describes a 16-year-old girl who presented with a mixed component tremor after ventricular derivation and endovascular embolization for rupture of a brainstem arteriovenous malformation. Conclusion Conclusion:Motor symptoms and signs attributed to an underlying lesion may trigger "pure" functional motor disorders. In such cases, the differential diagnosis may be even more challenging. However, diagnosis of a functional rather than a defined structural disorder can be achieved by a "positive diagnostic process," considering the findings of internal inconsistency and incongruity.

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Section: Discussionmentioning

confidence: 99%

Functional Motor Disorders Mimicking Symptoms Upon Resolution of Cerebrovascular Disease

Paio

Antelmi

Conti

et al. 2020

Movement Disord Clin Pract

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“…Currently, low doses (≤ 15 Gy) are generally preferred, and provide a level of effectiveness similar to that of higher doses but with a lower risk profile (Table 6). 181,185–195…”

Section: Gkrs For Cavernous Malformationmentioning

confidence: 99%

“…The short- to mid-term outcomes up to ≂ 5 years are well-known. Recent retrospective studies have shown the post-radiosurgical hemorrhage rates to range from 3.3–15%/year within two years after GKRS and 0.8–4.7%/year thereafter (Table 2), a remarkable reduction compared to the pre-radiosurgical hemorrhage rates ranging from 20–40% 181,185–195. The histopathological responses following GKRS are not yet fully understood.…”

Section: Gkrs For Cavernous Malformationmentioning

confidence: 99%

“…First, the optimal radiosurgical dose for CMs has not as yet been standardized, with the mean prescription doses ranging from 11 and 16 Gy (Table 6). 181,185–195 Reflecting this, the dose-volume response also has not been clarified. These two issues are rather challenging because, unlike AVMs, there would be little visible or apparent change allowing clinicians to determine whether GKRS is effective.…”

Section: Gkrs For Cavernous Malformationmentioning

confidence: 99%

“…It seems that GKRS cannot completely eliminate the hemorrhage risk. To date, three studies have attempted to address this issue,186,194,195 of which the one with the longest follow-up (mean, 9.3 years)186 showed a post-radiosurgical hemorrhage rate for the first 5 years of 1.5–3.3%/year, apparently much better than the natural history documented in a prospective study178 (the rate of hemorrhage or neurological event; 20%/year during the first year, 12–13%/year during the second to third years, and 5%/year during the fourth to fifth years), while a mild increase up to 4.6%/year was noted after 5 years. These data underscore the importance of conducting further research, with larger patient populations and longer follow-up periods, to define the long-term efficacy of GKS.…”

Section: Gkrs For Cavernous Malformationmentioning

confidence: 99%

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<p>Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks</p>

Hasegawa¹,

Yamamoto

Shin³

et al. 2019

TCRM

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Gamma Knife radiosurgery (GKRS) has long been used for treating brain vascular malformations, including arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), and cavernous malformations (CMs). Herein, current evidence and controversies regarding the role of stereotactic radiosurgery for vascular malformations are described. 1) It has already been established that GKRS achieves 70–85% obliteration rates after a 3–5-year latency period for small to medium-sized AVMs. However, late radiation-induced adverse events (RAEs) including cyst formation, encapsulated hematoma, and tumorigenesis have recently been recognized, and the associated risks, clinical courses, and outcomes are under investigation. SRS-based therapeutic strategies for relatively large AVMs, including staged GKRS and a combination of GKRS and embolization, continue to be developed, though their advantages and disadvantages warrant further investigation. The role of GKRS in managing unruptured AVMs remains controversial since a prospective trial showed no benefit of treatment, necessitating further consideration of this issue. 2) Regarding DAVFs, GKRS achieves 41–90% obliteration rates at the second post-GKRS year with a hemorrhage rate below 5%. Debate continues as to whether GKRS might serve as a first-line solo therapeutic modality given its latency period. Although the post-GKRS outcomes are thought to differ among lesion locations, further outcome analyses regarding DAVF locations are required. 3) GKRS is generally accepted as an alternative for small or medium-sized CMs in which surgery is considered to be too risky. The reported hemorrhage rates ranged from 0.5–5% after GKRS. Higher dose treatments (>15 Gy) were performed during the learning curve, while, with the current standard treatment, a dose range of 12–15 Gy is generally selected, and has resulted in acceptable complication rates (< 5%). Nevertheless, further elucidation of long-term outcomes is essential.

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Cyberknife Radiosurgery for Cerebral Cavernous Malformations

Nataf

2020

CyberKnife NeuroRadiosurgery

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Long-Term Outcome of Gamma Knife Radiosurgery for Brain Cavernoma: Factors Associated with Subsequent De Novo Cavernoma Formation

Cited by 12 publications

References 28 publications

Functional Motor Disorders Mimicking Symptoms Upon Resolution of Cerebrovascular Disease

Functional Motor Disorders Mimicking Symptoms Upon Resolution of Cerebrovascular Disease

<p>Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks</p>

Cyberknife Radiosurgery for Cerebral Cavernous Malformations

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