Gamma knife surgery for cavernous hemangiomas: an analysis of 125 patients

Liu, Kang-Du; Chung, Wen‐Yuh; Wu, Hsiu‐Mei; Shiau, Chung‐Wai; Wang, Ling-Wei; Guo, Wan-You; Pan, David Hung-Chi

doi:10.3171/jns.2005.102.s_supplement.0081

Cited by 71 publications

(42 citation statements)

References 32 publications

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“…Hasegawa et al 19 and Chang et al 8 reported similar dramatic decreases from 12.3 to 0.8% and from 12.3 to 1.9%, respectively. Less dramatic, but significant, decreases were seen in the studies of Pollock et al 46 and Liu et al 38 -from 8.8 to 2.9% and from 10.3 to 3.3%, respectively. Not all studies demonstrated this pronounced decreased hemorrhage rate after 2 years.…”

Section: Hemorrhage Ratesmentioning

confidence: 76%

“…In their study of 125 patients, Liu et al 38 used the lowest mean radiation dose to the tumor margin (12.1 Gy), resulting in one of the lowest reported radiation-induced morbidity rates (2.5%) over a mean follow-up period of 5.4 years. Among the larger studies with mainly deep-seated AOVMs in the basal ganglia, thalamus, or brainstem, total radiation-induced morbidity rates ranged from 8.8 to 27%.…”

Section: Radiation-induced Complicationsmentioning

confidence: 99%

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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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Section: Hemorrhage Ratesmentioning

confidence: 76%

Section: Radiation-induced Complicationsmentioning

confidence: 99%

Radiosurgery for angiographically occult vascular malformations

Pham

Gross

Bendok

et al. 2009

FOC

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“…1,12,25 More recent studies have reported complication rates similar to those in the present analysis. 14,17,21,22 Our results indicate that the cur rently used radiosurgical dose ranges (median dose to the margin between 12 and 15 Gy, range 10-20 Gy) and high ly conformal treatment planning have made radiosurgery safe (Table 3 and Fig. 4).…”

Section: Morbidity and Its Causesmentioning

confidence: 89%

“…14,18,17,22,29 In quoting a rebleed rate before radio surgery, authors of these studies would have been treating high-risk patients (that is, those with multiple bleeds). As a reflection, these figures agree well with the results in our high-risk group: a rebleed risk of 30% before treat ment, 15% per year in the 2 years after treatment, and 2.4% per year thereafter.…”

Section: Therapeutic Effects Of Radiosurgerymentioning

confidence: 99%

“…10,12,28 In support of this finding, the rehemorrhage rate can be significantly reduced after a latent period typi cally 2 years after radiosurgery to allow thrombooblitera tion to occur. 3,7,11,14,21,22,29 The problem in radiological as sessment is that CMs are capillary malformations and so are inherently occult angiographically. Thus, there is no way of confirming in an individual patient, either angio graphically or by any other radiological means, what has been achieved in terms of thromboobliteration or protec tion from further hemorrhage.…”

mentioning

confidence: 99%

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Stereotactic radiosurgery for deep-seated cavernous malformations: a move toward more active, early intervention

Nagy

Razak²,

Rowe

et al. 2010

JNS

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Object The role of radiosurgery in the treatment of cavernous malformations (CMs) remains controversial. It is frequently recommended only for inoperable lesions that have bled at least twice. Rehemorrhage can carry a substantial risk of morbidity, however. The authors reviewed their practice of treating deep-seated inoperable CMs to assess the complication rate of radiosurgery, the impact that radiosurgery might have on rebleeding, and whether a more active, earlier intervention is justified in managing this condition. Methods The authors performed a retrospective analysis of 113 patients with 79 brainstem and 39 thalamic/basal ganglia CMs treated with Gamma Knife surgery. Lesions were stratified into 2 groups: those that might be lower risk with no more than 1 symptomatic bleed before radiosurgical treatment and those deemed high risk with multiple symptomatic hemorrhages before treatment. Results Forty-one CMs had multiple symptomatic hemorrhages before radiosurgery with a first-ever bleed rate of 2.9% per lesion per year, a rebleed rate of 30.5% per lesion per year, and a median time of 1.5 years between the first and second bleeds. In this group the rebleed rate decreased to 15% for the first 2 years after radiosurgery and declined further to 2.4% thereafter. Pretreatment multiple bleeds led to persistent deficits in 72% of the patients. Seventy-seven CMs had no more than 1 symptomatic bleed before radiosurgery, making for a lifetime bleed rate of 2.2% per lesion per year. The short period between the presenting bleed and treatment (median 1 year) makes the natural history in this group uncertain. The rate of hemorrhage in the first 2 years after treatment was 5.1%, and 1.3% thereafter. Pretreatment hemorrhages resulted in permanent deficits in 43% of the patients in this group, a rate significantly lower than in the multiple-bleeds group (p < 0.001). Posttreatment hemorrhages led to persistent deficits in only 7.3% of the patients. Permanent adverse radiation effects were rare (7.3%) and minor in both groups. Conclusions Stereotactic radiosurgery is a safe management strategy for CMs in eloquent sites with the marked advantage of reducing rebleed risks in patients with repeated pretreatment hemorrhages. The benefit in treating CMs with a single bleed is less clear. Note, however, that repeated hemorrhage carries a significant risk of increased morbidity far in excess of any radiosurgery-related morbidity, and the authors assert that this finding justifies the early active management of deep-seated CMs.

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