Radiosurgery of Intracranial Cavernous Malformations

Kim, D G; Choe, Wonyoung; Paek, Sun Ha; Chung, Hyun‐Tai; Kim, I H; Han, Dae Hee

doi:10.1007/s00701-002-0983-9

Cited by 77 publications

(37 citation statements)

References 21 publications

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“…Nearly 10-fold decreases in overall bleed rates were reported in the studies of Kim et al 26 and Tsien et al 61 On the other hand, postradiosurgery clinical event rates only decreased from 2.0 to 1.6% in the study of Liscák et al, 35 and data provided by Stea et al 57 did not demonstrate a significant decrease in hemorrhage rates.…”

Section: Hemorrhage Ratesmentioning

confidence: 86%

“…Among the larger studies with mainly deep-seated AOVMs in the basal ganglia, thalamus, or brainstem, total radiation-induced morbidity rates ranged from 8.8 to 27%. 8,14,19,26,35 Table 3 stratifies radiation-induced permanent morbidity and mortality rates according to lesion location. Several studies including AOVMs from various locations documented only long-term morbidity rates for patients with lesions in the brainstem.…”

Section: Radiation-induced Complicationsmentioning

confidence: 99%

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Radiosurgery for angiographically occult vascular malformations

Pham

Gross

Bendok

et al. 2009

FOC

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The use of radiosurgery for angiographically occult vascular malformations (AOVMs) is a controversial treatment option for those that are surgically inaccessible or located in eloquent brain. To determine the efficacy of this treatment, the authors reviewed the literature reporting hemorrhage rates, seizure control, and radiation-induced morbidity. They found overall hemorrhage rates of 2–6.4%, overall postradiosurgery hemorrhage rates of 1.6–8%, and stratified postradiosurgery hemorrhage rates of 7.3–22.4% in the period immediately to 2 years after treatment; these latter rates declined to 0.8–5.2% > 2 years after treatment. Of 291 patients presenting with seizure across 16 studies, 89 (31%) attained a seizure-free status and 102 (35%) had a reduction in seizure frequency after radiosurgery. Overall radiation-induced morbidity ranged from 2.5 to 59%, with higher complication rates in patients with brainstem lesion locations. Researchers applying mean radiation doses of 15–16.2 Gy to the tumor margin saw both low radiationinduced complication rates (0–9.1%) and adequate hemorrhage control (0.8–5.2% > 2 years after treatment), whereas mean doses ≥ 16.5 Gy were associated with higher total radiation-induced morbidity rates (> 17%). Although the use of stereotactic radiosurgery remains controversial, patients with AOVMs located in surgically inaccessible areas of the brain may benefit from such treatment.

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Section: Hemorrhage Ratesmentioning

confidence: 86%

Section: Radiation-induced Complicationsmentioning

confidence: 99%

Radiosurgery for angiographically occult vascular malformations

Pham

Gross

Bendok

et al. 2009

FOC

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“…There are concerns about the high risk of complications associated with radiosurgery for CAs, particularly in the brainstem and deep locations. 9,69,95 It is also known, as discussed above, that the risk of bleeding of a CA significantly decreases by itself beyond 2 years after the initial hemorrhage. Consequently, the positive results associated with radiosurgery in the previously cited studies could simply reflect the natural history of these lesions.…”

Section: Natural History and Management Of Incidentally Discovered Casmentioning

confidence: 95%

Management of incidentally discovered intracranial vascular abnormalities

Chalouhi¹,

Dumont²,

Randazzo³

et al. 2011

FOC

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With the widespread use of brain imaging studies, neurosurgeons have seen a marked increase in the number of incidental intracranial lesions, including vascular abnormalities. Specifically, the detection of incidentally discovered aneurysms, arteriovenous malformations, cavernous angiomas, developmental venous anomalies, and capillary telangiectasias has increased. The best management strategy for most of these lesions is controversial. Treatment options include observation, open surgery, endovascular procedures, and radiosurgery. Multiple factors should be taken into account when discussing treatment indications, including the natural history of the disease and the risk of the treatment. In this article, the authors focus on the natural history of these lesions and the risk of the treatment, and they give recommendations regarding the most appropriate management strategy based on the current evidence in the literature and their experience with intracranial vascular abnormalities.

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“…This is particularly true because there is no reliable neuroimaging modality that can be used to document total lesion occlusion. 28 Consequently, the only way to evaluate the effectiveness of radiosurgery in CMs is to analyze the reduction in the bleeding rate. In high-flow vascular malformations such as AVMs, the gap between radiosurgery and lesion obliteration is approximately 2 years.…”

Section: Neurosurg Focus / Volume 21 / July 2006mentioning

confidence: 99%

“…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. 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.…”

Section: Neurosurg Focus / Volume 21 / July 2006mentioning

confidence: 99%

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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Radiosurgery of Intracranial Cavernous Malformations

Cited by 77 publications

References 21 publications

Radiosurgery for angiographically occult vascular malformations

Radiosurgery for angiographically occult vascular malformations

Management of incidentally discovered intracranial vascular abnormalities

Neurosurgical management of cerebellar cavernous malformations

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