Efficacy of gamma knife radiosurgery for cerebral cavernous malformations - A single-institution retrospective study

Cerebral cavernous malformations (CCMs) are low-flow vascular malformations of the central nervous system. Although surgical resection is the primary treatment for symptomatic CCMs, gamma knife radiosurgery (GKRS) has been considered as an alternative treatment for CCMs with high surgical risk. This study aims to evaluate outcomes of GKRS in the treatment of CCMs.

A retrospective study was conducted on 235 patients diagnosed with CCMs who underwent GKRS at Cho Ray Hospital between October 2016 and September 2022. We assessed the annual hemorrhage rate (AHR) after GKRS, seizure control rate, and changes in symptoms after treatment. The mean follow-up duration was 40.34 ± 22.01 months.

The overall post-GKRS AHR was 1.66 % per patient-year, increasing to 4.96 % among patients with brainstem lesions. Hemorrhagic events following GKRS were significantly associated with larger lesion diameters (p = 0.018). Among 43 patients with pre-GKRS epilepsy, 83.7 % achieved favorable seizure control (Engel class I-II). Most patients experienced stable or improved symptoms; worsening occurred in 3.0 % for headache, 2.1 % for dizziness, and 3.4 % for focal neurological deficits. Transient post-GKRS brain edema occurred in 7 patients (3.0 %), all of whom achieved full recovery. No cases of cyst formation were observed.

GKRS is an effective alternative treatment for controlling hemorrhage, reducing seizure rates, and alleviating symptoms for CCMs, particularly those at high surgical risk.