Radiation-Induced Cerebral Cavernous Malformations: A Single-Center Experience and Systematic Literature Review

Koester, Stefan W.; Rhodenhiser, Emmajane G.; Dabrowski, Stephen J.; Benner, Dimitri; Rumalla, Kavelin; Scherschinski, Lea; Catapano, Joshua S.; Graffeo, Christopher S.; Srinivasan, Visish M.; Lawton, Michael T.

doi:10.1016/j.wneu.2023.08.036

Cited by 2 publications

(1 citation statement)

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“…The incidence of delayed adverse radiation events, such as cyst formation and radiation necrosis is much lower; Dumot et al reported 2 cases of cyst formation, with one requiring stereotactic aspiration [ 5 ]. Radiation-induced ICM formation has also been reported but is rare; Koester et al reported 10 cases after retrospectively reviewing a single-center database of 1662 treated with radiation treatment in the neck and head region [ 18 ]. Given the legitimate concern that radiation exposure may increase the formation of new lesions in patients with familial ICM, the Angioma Alliance recommends against utilizing SRS in the management of these patients [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery for intracranial cavernous malformations of the deep-seated locations: systematic review and meta-analysis

Tos,

Mantziaris,

Shaaban

et al. 2024

Neurosurg Rev

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Objective To determine the outcomes of stereotactic radiosurgery (SRS) for deep-seated (brainstem, basal ganglia, thalamus, cerebellar peduncle) intracranial cavernous malformations (ICMs). Methods A systematic review and meta-analysis was performed according to PRISMA and MOOSE guidelines. The main outcomes were comparing pre- and post-SRS hemorrhage rates, using the pooled risk ratios (RR) as the measure of effect. Additionally, the study assessed lesion volume changes and radiation-injury incidence. Results Data of 850 patients across 14 studies were included in the meta-analysis. The pooled RR of all deep-seated ICMs show a decrease in hemorrhage rate after SRS compared to pre-SRS over the total follow-up period (RR =0.13), initial 2 years (RR =0.22), and after 2 years (RR =0.07). For 9 studies that reported hemorrhage rate of the brainstem only, the pooled RR shows a decrease of hemorrhage rate after SRS compared to pre-SRS over the total follow-up period (RR =0.13), initial 2 years (RR =0.19), and after 2 years (RR =0.07). Volumetric regression was achieved in 44.25% and stability in 56.1%. The pooled incidence of symptomatic and permanent radiation injury was 9% (95% CI, 7–11) and 3% (95% CI, 0–1.9%), respectively. Conclusion SRS appears effective in reducing hemorrhage rates for deep-seated ICMs. The risk of symptomatic radiation injury is low. Given the high risk of surgical morbidity, SRS is a reasonable treatment option for patients with deep-seated ICMs with at least one prior hemorrhage.

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Section: Discussionmentioning

confidence: 99%