Artikel
Long-term results after gamma knife radiosurgery for patients with cavernous malformations
Langjähriges Follow-up nach Gamma-Knife Behandlung von Patienten mit zerebralen Cavernomen
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
The benefits of radiosurgery for cerebral cavernous malformations are difficult to assess because of the unclear natural history of this vascular lesion. Furthermore there is an inability to image accurately malformation vessels with the lack of an imaging technique defining “cure”. Up to date the only parameter that helps defining the efficiency of treatment methods is the patient’s clinical outcome. This study presents the long term results of 37 cases of cavernous malformations that underwent gamma knife radiosurgery.
Methods
41 patients presenting with cavernous malformations underwent radiosurgery between January 1994 and October. 2003. Four patients were lost for follow-up. Mean follow-up for the remaining 37 patients after radiosurgery was 4.3 years. The mean patient age was 45, 8 years (27-78 years). The mean cavernous malformation volume was 0.81 ml treated with a mean marginal radiation dose of 11.8 Gy (range: 5–19.2 Gy). Disease presentation was due to focal neurological deficits in 21 patients, seizures in six patients and headache in one patient. Four patients underwent radiosurgery for cavernous malformation after surgical resection. In five patients the disease was an incidental finding. The malformation was supratentorial in 20 cases and infratentorial in 14 cases. Three patients had multiple cavernous malformations.
Results
The mean follow-up period after radiosurgery was 4.3 years. After radiosurgery a total of four hemorrhages (10.8%) were observed. The new bleeding episodes occurred (as assessed clinically and by magnetic resonance imaging) between 0.6 and 1.8 years (mean one year) after treatment. One of those patients died because of rebleeding. In four cases acute rebleeding was seen in MRI images without neurological disturbance. Seizures were excellently controlled in all concerned patients. In our series radiation-induced complications developed in only one patient (paraparesis of the upper limb).
Conclusions
Our morbidity after radiosurgery is low (1/37 patients). Achievement of seizure control was possible in all patients. Radiosurgery appears to reduce the rate of hemorrhage after a 2-year latency but the results of longer follow-up reviews have to be critically compared to the natural history of cavernous malformations.