Radiosurgery for cavernous malformations

Karlsson, Bengt; Kihlström, Lars; Lindquist, Christer; Ericson, K.; Steiner, Ladislau

doi:10.3171/jns.1998.88.2.0293

Cited by 197 publications

(104 citation statements)

References 16 publications

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“…A similar thrombooblit erative response is described after the irradiation of CMs. 10,12,28 In support of this finding, the rehemorrhage rate can be significantly reduced after a latent period typi cally 2 years after radiosurgery to allow thrombooblitera tion to occur. 3,7,11,14,21,22,29 The problem in radiological as sessment is that CMs are capillary malformations and so are inherently occult angiographically.…”

supporting

confidence: 60%

Stereotactic radiosurgery for deep-seated cavernous malformations: a move toward more active, early intervention

Nagy

Razak²,

Rowe

et al. 2010

JNS

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Object The role of radiosurgery in the treatment of cavernous malformations (CMs) remains controversial. It is frequently recommended only for inoperable lesions that have bled at least twice. Rehemorrhage can carry a substantial risk of morbidity, however. The authors reviewed their practice of treating deep-seated inoperable CMs to assess the complication rate of radiosurgery, the impact that radiosurgery might have on rebleeding, and whether a more active, earlier intervention is justified in managing this condition. Methods The authors performed a retrospective analysis of 113 patients with 79 brainstem and 39 thalamic/basal ganglia CMs treated with Gamma Knife surgery. Lesions were stratified into 2 groups: those that might be lower risk with no more than 1 symptomatic bleed before radiosurgical treatment and those deemed high risk with multiple symptomatic hemorrhages before treatment. Results Forty-one CMs had multiple symptomatic hemorrhages before radiosurgery with a first-ever bleed rate of 2.9% per lesion per year, a rebleed rate of 30.5% per lesion per year, and a median time of 1.5 years between the first and second bleeds. In this group the rebleed rate decreased to 15% for the first 2 years after radiosurgery and declined further to 2.4% thereafter. Pretreatment multiple bleeds led to persistent deficits in 72% of the patients. Seventy-seven CMs had no more than 1 symptomatic bleed before radiosurgery, making for a lifetime bleed rate of 2.2% per lesion per year. The short period between the presenting bleed and treatment (median 1 year) makes the natural history in this group uncertain. The rate of hemorrhage in the first 2 years after treatment was 5.1%, and 1.3% thereafter. Pretreatment hemorrhages resulted in permanent deficits in 43% of the patients in this group, a rate significantly lower than in the multiple-bleeds group (p < 0.001). Posttreatment hemorrhages led to persistent deficits in only 7.3% of the patients. Permanent adverse radiation effects were rare (7.3%) and minor in both groups. Conclusions Stereotactic radiosurgery is a safe management strategy for CMs in eloquent sites with the marked advantage of reducing rebleed risks in patients with repeated pretreatment hemorrhages. The benefit in treating CMs with a single bleed is less clear. Note, however, that repeated hemorrhage carries a significant risk of increased morbidity far in excess of any radiosurgery-related morbidity, and the authors assert that this finding justifies the early active management of deep-seated CMs.

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supporting

confidence: 60%

Stereotactic radiosurgery for deep-seated cavernous malformations: a move toward more active, early intervention

Nagy

Razak²,

Rowe

et al. 2010

JNS

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“…11,39,51,52 In most series, however, an equal distribution between the sexes 13,24,26,31,40,43,48,53 has been reported, and this was also the case in ours. Some authors have suggested a higher propensity for bleeding episodes in female patients, 16,48 often during pregnancy.…”

Section: Age and Sex Of The Patientssupporting

confidence: 47%

“…8 Although some authors report a reduction in the rate of hemorrhage in patients whose CMs are treated with radiosurgery, 21,30 others not only failed to confirm such a reduction but also showed a high incidence of complications induced by radiation. 4,26,42 Gewirtz, et al, 17 found no evidence of vascular obliteration in histopathological samples of CMs that were previously treated with radiation (either conventional radiotherapy or stereotactic radiosurgery), after a mean follow-up period of 3.5 years. There is a report of a cerebellar CM treated with radiosurgery in which the lesion showed reduction without hemorrhage after a mean follow-up duration of 34 months.…”

Section: Neurosurg Focus / Volume 21 / July 2006mentioning

confidence: 99%

“…28 The lack of evidence for the effectiveness of radiosurgery for intracranial CMs, along with the risk of a higher rate of radiation-induced complications, justifies prospective randomized studies on this subject. 26,35,42 Surgical Treatment. Cerebellar hemorrhage from CMs has a wide range of clinical presentations, from minimal symptoms to sudden death caused by massive hemorrhage.…”

Section: Neurosurg Focus / Volume 21 / July 2006mentioning

confidence: 99%

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Neurosurgical management of cerebellar cavernous malformations

Oliveira

Rassi-Neto²,

Ferraz³

et al. 2006

FOC

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Object The aim of this study was to analyze cerebellar cavernous malformations (CMs) with respect to epide-miological, clinical, radiological, and therapeutic aspects. Methods Between 1984 and 2004, 100 patients were surgically treated for intracranial CMs at the Division of Neurosurgery of Federal University of São Paulo. The authors reviewed the records of 10 patients whose lesions were located in the cerebellum. There were four male and six female patients (ratio 1:1.5) whose ages ranged from 14 to 45 years (mean age 33 years). Clinical presentation was sudden or acute in all cases, and neuroimaging examinations performed in all patients demonstrated signs of bleeding. The mean size of the malformations was 4.6 cm, and in all but one patient the lesions were totally removed without complications. After a mean follow-up period of 70 months, all patients were considered to be in good or excellent clinical condition. Conclusions Cerebellar CMs should be analyzed separately from other posterior fossa CMs. These lesions can reach large sizes and cause massive hemorrhages, resulting in acute or sudden presentation. Surgery is a safe and effective option that provides a curative treatment when a complete removal is achieved.

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“…1,5,7 Other respected groups have declared radiosurgery to be of little to no use, a treatment associated with an unexpectedly high rate of radiosurgery-induced complications for patients. 4,6,9 Groups from both camps frequently publish similar results for other radiosurgical indications. Why is there such disagreement over radiosurgery for CMs?…”

mentioning

confidence: 59%