Gamma Knife Surgery for Angiographically Occult Vascular Malformations

Seo, Yoshinobu; Fukuoka, Seiji; Takanashi, Masami; Nakagawara, Jyoji; Suematsu, Katsumi; Nakamura, Jean L.; Nagashima, Kazunori

doi:10.1159/000098769

Cited by 30 publications

(12 citation statements)

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“…Other reports have failed to reproduce similar reductions in hemorrhage risk but are limited by either their size, details of treatment, and/or limited follow-up. 24,33,35 Although Pollock and colleagues 31 treated 17 patients and showed a reduction in annual hemorrhage rates from 40% pre-SRS to 2.9% after a 2-year latency period post-SRS, they did not conclude that radiosurgery was protective against hemorrhage. Indeed, 59% of these patients had evidence of AREs, a finding possibly attributable to a high median target dose of 18 Gy causing toxicity in the radiation-sensitized adjacent hemosiderin-containing brain.…”

Section: Discussionmentioning

confidence: 98%

Stereotactic radiosurgery for the treatment of symptomatic brainstem cavernous malformations

Monaco¹,

Khan²,

Niranjan³

et al. 2010

FOC

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Object The authors performed a retrospective review of prospectively collected data to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) for the treatment of patients harboring symptomatic solitary cavernous malformations (CMs) of the brainstem that bleed repeatedly and are high risk for resection. Methods Between 1988 and 2005, 68 patients (34 males and 34 females) with solitary, symptomatic CMs of the brainstem underwent Gamma Knife surgery. The mean patient age was 41.2 years, and all patients had suffered at least 2 symptomatic hemorrhages (range 2–12 events) before radiosurgery. Prior to SRS, 15 patients (22.1%) had undergone attempted resection. The mean volume of the malformation treated was 1.19 ml, and the mean prescribed marginal radiation dose was 16 Gy. Results The mean follow-up period was 5.2 years (range 0.6–12.4 years). The pre-SRS annual hemorrhage rate was 32.38%, or 125 hemorrhages, excluding the first hemorrhage, over a total of 386 patient-years. Following SRS, 11 hemorrhages were observed within the first 2 years of follow-up (8.22% annual hemorrhage rate) and 3 hemorrhages were observed in the period after the first 2 years of follow-up (1.37% annual hemorrhage rate). A significant reduction (p < 0.0001) in the risk of brainstem CM hemorrhages was observed following radiosurgical treatment, as well as in latency period of 2 years after SRS (p < 0.0447). Eight patients (11.8%) experienced new neurological deficits as a result of adverse radiation effects following SRS. Conclusions The results of this study support a role for the use of SRS for symptomatic CMs of the brainstem, as it is relatively safe and appears to reduce rebleeding rates in this high-surgical-risk location.

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Section: Discussionmentioning

confidence: 98%

Stereotactic radiosurgery for the treatment of symptomatic brainstem cavernous malformations

Monaco¹,

Khan²,

Niranjan³

et al. 2010

FOC

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“…Some authors have reported a decrease in bleeding after GKRS [4], while the majority has reported no effect [3,5,6]. Therefore, the role of radiosurgery in the management of these lesions remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Gamma Knife Radiosurgery for Epilepsy Associated with Cavernous Hemangiomas: A Retrospective Study of 49 Cases

Bartolomei¹,

Régis

Kida

et al. 1999

Stereotact Funct Neurosurg

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“…Huang et al 21 and Seo et al 53 both demonstrated 0% postradiation morbidity rates in patients with a variety of lesions. Interestingly, researchers in these 2 studies used comparatively lower mean radiation doses to the tumor margin: 15.8 and 15.3 Gy, respectively.…”

Section: Radiation-induced Complicationsmentioning

confidence: 98%

Radiosurgery for angiographically occult vascular malformations

Pham

Gross

Bendok

et al. 2009

FOC

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The use of radiosurgery for angiographically occult vascular malformations (AOVMs) is a controversial treatment option for those that are surgically inaccessible or located in eloquent brain. To determine the efficacy of this treatment, the authors reviewed the literature reporting hemorrhage rates, seizure control, and radiation-induced morbidity. They found overall hemorrhage rates of 2–6.4%, overall postradiosurgery hemorrhage rates of 1.6–8%, and stratified postradiosurgery hemorrhage rates of 7.3–22.4% in the period immediately to 2 years after treatment; these latter rates declined to 0.8–5.2% > 2 years after treatment. Of 291 patients presenting with seizure across 16 studies, 89 (31%) attained a seizure-free status and 102 (35%) had a reduction in seizure frequency after radiosurgery. Overall radiation-induced morbidity ranged from 2.5 to 59%, with higher complication rates in patients with brainstem lesion locations. Researchers applying mean radiation doses of 15–16.2 Gy to the tumor margin saw both low radiationinduced complication rates (0–9.1%) and adequate hemorrhage control (0.8–5.2% > 2 years after treatment), whereas mean doses ≥ 16.5 Gy were associated with higher total radiation-induced morbidity rates (> 17%). Although the use of stereotactic radiosurgery remains controversial, patients with AOVMs located in surgically inaccessible areas of the brain may benefit from such treatment.

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Gamma Knife Surgery for Angiographically Occult Vascular Malformations

Cited by 30 publications

References 0 publications

Stereotactic radiosurgery for the treatment of symptomatic brainstem cavernous malformations

Stereotactic radiosurgery for the treatment of symptomatic brainstem cavernous malformations

Gamma Knife Radiosurgery for Epilepsy Associated with Cavernous Hemangiomas: A Retrospective Study of 49 Cases

Radiosurgery for angiographically occult vascular malformations

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