Publication year: 2012
Source:World Neurosurgery
Seong-Hyun Park, Sung-Kyoo Hwang
Objective The purpose of this study was to evaluate the efficacy and safety of gamma knife radiosurgery (GKRS) for the treatment of symptomatic brainstem intraaxial cavernous malformations (CMs) associated with high surgical morbidity. Methods Twenty-one patients with symptomatic brainstem intra-axial CMs were treated by GKRS between 2005 and 2010. One patient was lost to follow up. The median age of the patients was 39.5 years (range 24−69 years). All patients had experienced 1 or more symptomatic hemorrhages before GKRS (range 1−3). The median marginal radiation dose was 13 Gy, and the median volume of the malformation was 0.56 mL. The median follow-up period after radiosurgery was 32 months (range 12−82 months, mean 38.9 months). Results Before GKRS, 31 hemorrhages (1.55 per patient) were observed. The annual hemorrhage rate before GKRS was 39.5%, excluding the first hemorrhage. After GKRS, 1 hemorrhage (0.05 per patient) was identified. It occurred 6 months after radiosurgery. The patient showed complete recovery to a premorbid status with steroid medication. The annual hemorrhage rate after GKRS was 8.2% for the first 2 years. After the expected latency period, no hemorrhages were identified. One patient (5%) exhibited permanent paresthesia, which was a new neurological symptom in absence of any hemorrhagic event, after the radiosurgery. Conclusions GKRS seems to be relatively effective and safe for reducing the rebleeding rate of brainstem intra-axial CMs that have high surgical risk. Carefulselection of a low margin dose and an optimal radiosurgical technique are helpful toachieve good outcomes.
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