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Gamma Knife radiosurgery for cerebral cavernous malformation.

Cheng-Chia Lee1,2,3, Wei-Hsin Wang1,2, Huai-Che Yang1,2

  • 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

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|December 26, 2019
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Summary

Gamma Knife radiosurgery (GKS) significantly reduces hemorrhage risk in cerebral cavernous malformations (CCMs) patients. This effective treatment option offers a viable alternative for those with surgically inaccessible CCMs or other health issues.

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Neurology

Background:

  • Cerebral cavernous malformations (CCMs) are vascular malformations that can cause significant neurological symptoms, including hemorrhage.
  • Symptomatic CCMs often require treatment to prevent further bleeding and neurological deficits.
  • Gamma Knife radiosurgery (GKS) is a minimally invasive treatment option for various brain lesions.

Purpose of the Study:

  • To evaluate the efficacy and safety of Gamma Knife radiosurgery (GKS) for treating symptomatic cerebral cavernous malformations (CCMs).
  • To assess the impact of GKS on hemorrhage recurrence rates in CCM patients.
  • To determine the incidence of complications and mortality associated with GKS in this patient cohort.

Main Methods:

  • Retrospective study analyzing data from 261 patients with 331 symptomatic CCMs treated between 1993 and 2018.
  • Patients received GKS with a median margin dose of 11.9 Gy to a median isodose level of 59%.
  • Clinical and imaging follow-up data were collected, with median follow-up times of 69 and 61 months, respectively.

Main Results:

  • Pre-GKS annual hemorrhage incidence was 23.6%. Post-GKS, annual incidence decreased to 3.22% within 2 years and 3.16% after 2 years.
  • Symptomatic radiation-induced complications occurred in 3.1% of patients.
  • Mortality related to GKS was observed in 0.4% of patients.

Conclusions:

  • Gamma Knife radiosurgery (GKS) effectively reduces the risk of hemorrhage in patients with symptomatic cerebral cavernous malformations (CCMs).
  • GKS presents a viable and safe alternative treatment for CCMs, particularly for patients with surgically inaccessible lesions or significant comorbidities.
  • The study demonstrates a favorable risk-benefit profile for GKS in managing symptomatic CCMs.