Epilepsy associated with cerebral cavernous malformations managed with stereotactic radiosurgery: an international, multicenter study

Dumot, Chloé; Mantziaris, Georgios; Pikis, Stylianos; Dayawansa, Sam; Xu, Zhiyuan; Samancı, Yavuz; Ardor, Gokce Deniz; Peker, Selçuk; Nabeel, Ahmed M; Reda, Wael A; Tawadros, Sameh R; Karim, Khaled Abdel; El-Shehaby, Amr M N; Eldin, Reem M Emad; Elazzazi, Ahmed Hesham; Moreno, Nuria Martínez; Álvarez, Roberto Martínez; May, Jaromir; Mathieu, David; Tourigny, Jean-Nicolas; Tripathi, Manjul; Rajput, Akshay; Kumar, Narendra; Kaur, Rajnish; Picozzi, Piero; Franzini, Andrea; Speckter, Herwin; Hernández, Wenceslao; Warnick, Ronald E.; Alzate, Juan Diego; Kondziolka, Douglas; Bowden, Gregory; Patel, Samir; Sheehan, Jason P.

doi:10.1007/s00415-023-11836-6

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…The Angioma Alliance Scientific Advisory Board underscored the significance of ICM location on neurosurgical treatment decisions; despite the ever evolving technical adjuncts, postoperative morbidity is 5-8%, and mortality approaches 2% [2]. Stereotactic radiosurgery (SRS) represents an alternative treatment modality, with prior studies showing significant reduction of hemorrhage rate and epileptic activity after treatment [ 5 , 6 ]. This systematic review and meta-analysis focuses on SRS outcomes for ICMs located in often less accessible, deep-seated regions of the brain that are often associated with high surgical morbidity risk.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiosurgery for intracranial cavernous malformations of the deep-seated locations: systematic review and meta-analysis

Tos,

Mantziaris,

Shaaban

et al. 2024

Neurosurg Rev

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Objective To determine the outcomes of stereotactic radiosurgery (SRS) for deep-seated (brainstem, basal ganglia, thalamus, cerebellar peduncle) intracranial cavernous malformations (ICMs). Methods A systematic review and meta-analysis was performed according to PRISMA and MOOSE guidelines. The main outcomes were comparing pre- and post-SRS hemorrhage rates, using the pooled risk ratios (RR) as the measure of effect. Additionally, the study assessed lesion volume changes and radiation-injury incidence. Results Data of 850 patients across 14 studies were included in the meta-analysis. The pooled RR of all deep-seated ICMs show a decrease in hemorrhage rate after SRS compared to pre-SRS over the total follow-up period (RR =0.13), initial 2 years (RR =0.22), and after 2 years (RR =0.07). For 9 studies that reported hemorrhage rate of the brainstem only, the pooled RR shows a decrease of hemorrhage rate after SRS compared to pre-SRS over the total follow-up period (RR =0.13), initial 2 years (RR =0.19), and after 2 years (RR =0.07). Volumetric regression was achieved in 44.25% and stability in 56.1%. The pooled incidence of symptomatic and permanent radiation injury was 9% (95% CI, 7–11) and 3% (95% CI, 0–1.9%), respectively. Conclusion SRS appears effective in reducing hemorrhage rates for deep-seated ICMs. The risk of symptomatic radiation injury is low. Given the high risk of surgical morbidity, SRS is a reasonable treatment option for patients with deep-seated ICMs with at least one prior hemorrhage.

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Section: Introductionmentioning

confidence: 99%

Stereotactic radiosurgery for intracranial cavernous malformations of the deep-seated locations: systematic review and meta-analysis

Tos,

Mantziaris,

Shaaban

et al. 2024

Neurosurg Rev

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Stereotactic Radiosurgery for Intracranial Cavernous Malformations: International Stereotactic Radiosurgery Society, Systematic Review, Meta-Analysis, and Practice Guidelines

Tos,

Shaaban,

Mantziaris

et al. 2024

World Neurosurgery

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Gamma Knife Stereotactic Radiosurgery for Cerebral Cavernous Malformations: Meta-Analysis of Reconstructed Time-to-Event Data

da Fontoura Galvão,

Verly,

Bessa

et al. 2024

Cerebrovasc Dis

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Introduction: Cavernomas are vascular lesions with a genetic heritage that can be spotted on the central nervous system. Whenever these lesions are localized in eloquent regions, surgical resection is not recommended. In this type of situation, Gamma Knife stereotactic radiosurgery (GKRS) could be a feasible option for treating patients. Thus, we aim to explore the outcomes associated with this procedure. Methods: We performed a systematic review and meta-analysis of reconstructed time-to-event data based on Kaplan-Meier curves. A thorough search was conducted on PubMed, Cochrane, Web of Science and Embase databases targeting papers that provided information regarding hemorrhagic outcomes associated with GKRS through Kaplan-Meier curves. Results: After a systematic search in the specific databases, seven studies were included in this review. Notably, a total of 1071 patients had 1104 cavernomas treated by GKRS. Assessment of short-term and long-term post-procedure outcomes was performed, with the estimated overall events-free rate at 2 years being 89.8% (95% CI 87.7 – 91.5), whilst, at ten years, the estimated overall events-free rate was 71.3% (95% CI 67.2 – 75.1). Conclusion: GKRS seems to be a good alternative for control of symptomatic events in early and long-term follow-up, despite the need of further investigation provided by future studies. Keywords: cavernoma, bleeding, radiosurgery, radiotherapy, vascular.

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Epilepsy associated with cerebral cavernous malformations managed with stereotactic radiosurgery: an international, multicenter study

Cited by 3 publications

References 18 publications

Stereotactic radiosurgery for intracranial cavernous malformations of the deep-seated locations: systematic review and meta-analysis

Stereotactic radiosurgery for intracranial cavernous malformations of the deep-seated locations: systematic review and meta-analysis

Stereotactic Radiosurgery for Intracranial Cavernous Malformations: International Stereotactic Radiosurgery Society, Systematic Review, Meta-Analysis, and Practice Guidelines

Gamma Knife Stereotactic Radiosurgery for Cerebral Cavernous Malformations: Meta-Analysis of Reconstructed Time-to-Event Data

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