Gamma-knife radiosurgery for intracranial cavernous malformations: A single center experience

Intracranial cavernous malformations (CMs) are vascular lesions that can present with seizures, focal neurological deficits, and intracranial hemorrhage. Management options include observation, microsurgical resection, and stereotactic radiosurgery (SRS), with Gamma-Knife radiosurgery (GKRS) emerging as a minimally invasive alternative.

To evaluate the effectiveness and safety of GKRS in the treatment of intracranial CMs, particularly in high-risk or eloquent brain regions.

This retrospective study analyzed 173 patients with intracranial CMs treated with GKRS at the N.N. Burdenko Neurosurgery Institute, Moscow, between November 2005 and August 2023. Patients were followed up for clinical and radiological outcomes, including hemorrhage rates, seizure control, and adverse radiation effects.

The mean follow-up was 66.3 ± 56.8 months. The annual post-SRS hemorrhage rate was 3.2 %, with a significant reduction observed after the initial 2-year period (2 % post-2 years vs. 5.6 % within the first 2 years). Partial or complete regression of symptoms was observed in 35.7 % of patients. Adverse radiation effects were noted in 11.3 % of patients, with most cases being temporary. In patients with epileptic syndrome, complete seizure freedom (Engel Class I) was achieved in 51.5 % of cases.

GKRS is an effective and safe treatment option for intracranial CMs, particularly in high-risk or eloquent brain regions. The study highlights the need for standardized reporting criteria and prospective trials to better evaluate long-term outcomes. A multidisciplinary approach is crucial in deciding the optimal treatment strategy for patients with intracranial CMs.