Optimizing gamma knife radiosurgery for cerebral cavernous malformation: Analysis of 54 patients treated at our
Pier Paolo Berti1, Marco Galuppo2, Michele Longhi3
1Department of Neurosurgery, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy; Teaching Hospital of Paracelsus Medical University, Italy.
Background:
We retrospectively analyzed the characteristics of patients affected by Cerebral Cavernous Malformations (CCMs) treated in our center with Leksell Gamma Knife Stereotactic Radiosurgery (LGKSRS) to identify subsets with better treatment response or greater risk of symptomatic Adverse Radiation Effects (AREs).
Methods:
The data of 54 patients (60 CCMs) treated in our Department with LGKSRS between January 2011 and January 2021 were retrieved (mean follow-up 4.8 years). All patients had at least 2 bleedings before treatment. Mean Prescription Dose (PD) was 15.4 Gy. In 20 cases (33 %) an associated Developmental Venous Anomaly (DVA) was identified; multiple CCMs were found in 17 cases (28 %).
Results:
After treatment occurred 8 bleedings and 5 out of 8 within the first 6 months of follow-up. The Annual Hemorrhage Rate dropped from 51.37 % (before treatment) to 4.2 % (within 2 years of treatment) and 1.84 % (beyond 2 years) (p < 0.00001). A statistically significant reduction in the mean number of hemorrhages per lesion was observed (2.08 before vs 0.12 after LGKSRS, p < 0.00001). A higher risk of post-treatment bleeding was significantly associated with age < 45 years at univariate analysis, but only PD lower than 15 Gy was significantly associated at the multivariate level; associated vascular malformations showed a trend toward significance (p = 0.08). Of note, AREs were more common in isolated CCMs (not associated with vascular malformations).
Conclusions:
Given the association of the outcomes with baseline lesion and patient features, our findings showed that lesion and patient features at baseline can predict the outcomes and should guide treatment decision.
