Stereotactic radiosurgery of brainstem cavernous malformations: a systematic review and meta-analysis

Lu, Xinyu; Sun, Hui; Xu, Jianguo; Li, Qiaoyu

doi:10.3171/2013.12.jns13990

Cited by 44 publications

(30 citation statements)

References 31 publications

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“…Given the inability to illustrate angiographic or radiographic obliteration of a CM after treatment, studies have instead relied on demonstrating a decrease in CM hemorrhage rate after SRS [59][60][61][62]. Lunsford and colleagues reported their results for SRS used in 103 patients with solitary, symptomatic CMs managed over a 17-year period [59].…”

Section: Radiosurgerymentioning

confidence: 98%

Cerebral cavernous malformations: natural history and clinical management

Gross¹,

2015

Expert Review of Neurotherapeutics

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Cavernous malformations (CMs) are angiographically-occult clusters of dilated sinusoidal channels that may present clinically with seizures, focal neurological deficits and/or hemorrhage. Across natural history studies, the annual hemorrhage rate ranged from 1.6-3.1% per patient-year, decreasing to 0.08-0.2% per patient-year for incidental CMs and to 0.3-0.6% for the collective group of unruptured CMs. Prior hemorrhage is a significant risk factor for subsequent CM hemorrhage. Hemorrhage clustering, particularly within the first 2 years, is an established phenomenon that may confound results of natural history studies evaluating the rate of rehemorrhage. Indeed, rehemorrhage rates for hemorrhagic CMs range from 4.5-22.9% in the literature. Surgical resection is the gold standard treatment for surgically-accessible, symptomatic CMs. Incidental CMs or minimally symptomatic, surgically inaccessible eloquent lesions may be considered for observation. Stereotactic radiosurgery is a controversial treatment approach of consideration only for cases of highly aggressive, surgically inaccessible CMs.

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Section: Radiosurgerymentioning

confidence: 98%

Cerebral cavernous malformations: natural history and clinical management

Gross¹,

2015

Expert Review of Neurotherapeutics

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“…High-dose corticotherapy remains the main treatment of radiation injury in this location. The maximal efficiency of GKS appeared 2 years after radiosurgery according to some studies [14]. In our series, the AHR was similar before and after 2 years, maybe because of the limited number of patients.…”

Section: Discussionmentioning

confidence: 60%

“…The neurological status of the patient could deteriorate after the first hemorrhagic episode. The AHR in patients initially presenting with previous hemorrhage was estimated to be between 15 and 35% according to various studies [11,14]. Li et al [9] reported an AHR of 8.7% in patients presenting initially without hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…GKS is a safe alternative therapeutic tool appearing relevant in the treatment of brainstem CMs. Previous studies [7,14] demonstrated a significant reduction of hemorrhagic risk after this treatment, without asserting a complete cure of the patients. More evaluations are therefore suitable.…”

Section: Discussionmentioning

confidence: 99%

“…Lu et al [14] suggested in their meta-analysis about the radiosurgery of brainstem CMs that radiosurgery may be considered as an alternative treatment for brainstem CMs that are inoperable or have a high operative risk. Although some authors demonstrated that GKS is a safe and effective treatment, the role of this therapeutic option is still to be defined in the management of brainstem CMs.…”

Section: Discussionmentioning

confidence: 99%

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Gamma Knife Radiosurgery of Brainstem Cavernous Malformations

Aboukaïs

Estrade²,

Devos³

et al. 2016

Stereotact Funct Neurosurg

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Background/Aims: Our study aimed to evaluate the efficiency and morbidity of Gamma Knife radiosurgery (GKS) in the treatment of hemorrhagic brainstem cavernous malformations (CMs). Methods: We included in this study all patients who underwent GKS for the treatment of a hemorrhagic brainstem CM(s) in our institution between January 2007 and December 2012. The GKS was privileged when the surgical procedure was evaluated as very risky. The mean dose of radiation was 14.8 Gy, and the mean target volume was 0.282 cm³. All patients participated in a scheduled clinical follow-up. The posttreatment MRI was performed after 6 months and after 1 year, and then all patients had an annual MRI follow-up. Results: There were 19 patients with a mean age of 36.7 years. The mean follow-up period was 51.2 months. The annual hemorrhage rate (AHR) was 27.31% before GKS, 2.46% during the first 2 years following the GKS, and 2.46% after the first 2 years following the GKS. The decrease in AHR after GKS was significant (p < 0.001). Conclusion: GKS should be suggested when the surgical procedure harbors a high risk of neurological morbidity in patients with brainstem CM. Compared to prior literature results, a lower dose than applied in this study could be discussed.

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