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Gamma knife radiosurgery of the brain stem cavernomas
R Liscák1, V Vladyka, G Simonová
1Department of Stereotactic and Radiation Neurosurgery, Hospital Na Homolce, Prague, Czech Republic. Roman.Liscak@homolka.cz
Minimally Invasive Neurosurgery : MIN
|March 29, 2001
Summary
Leksell gamma knife radiosurgery for brain stem cavernomas shows low morbidity and zero mortality. Rebleeding risk post-treatment is similar to pre-treatment levels, with some patients experiencing improved neurodeficit.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Neurology
Background:
- Brain stem cavernomas pose significant risks, including bleeding and progressive neurological deficits.
- Microsurgery for these lesions can be high-risk, necessitating alternative treatment options.
Purpose of the Study:
- To evaluate the efficacy and safety of Leksell gamma knife radiosurgery for brain stem cavernomas.
- To assess the risk of rebleeding and neurological outcomes after radiosurgery.
Main Methods:
- Retrospective analysis of 26 patients with brain stem cavernomas treated with Leksell gamma knife between 1992-1998.
- Follow-up included clinical assessment, MRI/CT scans, and evaluation of bleeding events and neurological status.
Main Results:
- The annual risk of rebleeding after radiosurgery was 6.8%, not significantly different from the pre-treatment risk of 4%.
- No rebleeding or cavernoma enlargement was observed on imaging; 33% of patients showed decreased cavernoma size.
- Neurological deficit improvement occurred in 43% of patients, with temporary morbidity in 28% and permanent morbidity in 8%.
Conclusions:
- Leksell gamma knife radiosurgery for brain stem cavernomas demonstrates low morbidity and zero mortality in this cohort.
- Radiosurgery is a viable option for patients with bleeding history or progressive deficits where microsurgery is too risky.
- While effective, the timing of the protective effect against rebleeding is crucial; delayed effects may lead to outcomes similar to untreated disease.