Stereotactic radiosurgery guidelines for the management of patients with intracranial cavernous malformations

Treatment options for cavernous malformations (CMs) have expanded with the application of stereotactic radiosurgery. In this report, we provide guidelines about the use of stereotactic radiosurgery in CM patients who had 2 documented symptomatic hemorrhages. We reviewed the evidence-based medicine and clinical experience with radiosurgery for CM of the brain and developed guidelines and provided a scientific foundation for patients and physicians. We also reviewed the controversy surrounding CM radiosurgery and discussed its origin and validity. Our recommendations include the selection of CM patients suitable for various management strategies ranging from observation to surgical excision and stereotactic radiosurgery. Radiosurgery is an effective management strategy that reduces the risk of additional hemorrhages from CMs that repeatedly bleed. The marginal dose ranges from 12 to 18 Gy (median 16 Gy). A clinical algorithm for the potential role of stereotactic radiosurgery for CM patients with 2 or more symptomatic hemorrhages is defined. These guidelines provide a framework for professional judgment and assessment of management alternatives for selected intracranial CMs.