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Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Stereotactic radiosurgery for cerebral cavernous malformations: A systematic review
Michiel H F Poorthuis1, Leon A Rinkel1, Simon Lammy1
1From the Department of Neurology and Neurosurgery (M.H.F.P.), Brain Center Rudolf Magnus, University Medical Center Utrecht; University Medical Centre Groningen (L.A.R.), University of Groningen, the Netherlands; Department of Neurosurgery (S.L.), Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow; and Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK.
Stereotactic radiosurgery (SRS) for cerebral cavernous malformations (CCMs) shows low annual incidences of death, intracerebral hemorrhage (ICH), and focal neurologic deficit (FND). These outcomes appear comparable to conservative management, suggesting SRS is a safe option for CCM treatment.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Cerebral cavernous malformations (CCMs) are vascular malformations of the brain.
- The efficacy of stereotactic radiosurgery (SRS) for CCM treatment remains uncertain.
- Comparison with microsurgical excision or conservative management is needed.
Purpose of the Study:
- To quantify clinical outcomes after SRS for CCM.
- To compare SRS outcomes with microsurgical excision or conservative management.
Main Methods:
- Systematic review of 30 cohort studies (1,576 patients) from Ovid Medline and EMBASE.
- Data extraction on cohort characteristics and outcomes: death, symptomatic intracerebral hemorrhage (ICH), and nonhemorrhagic focal neurologic deficit (FND).
- Assessment of dramatic associations in comparative studies (rate ratio > 10, probability < 0.01).
Main Results:
- Median follow-up was 48 months post-SRS.
- Annual incidences: death 0.18%, ICH 2.40%, FND 0.71%, composite 3.63%.
- Outcomes did not vary by CCM location or SRS type; no dramatic associations found in comparative studies.
Conclusions:
- Annual incidences of death, ICH, and FND after SRS for CCM are <5%.
- Outcomes appear comparable to conservative management.
- A randomized controlled trial is recommended to further evaluate SRS efficacy for CCM.
