| Gamma Knife Radiosurgery for Cavernous Malformations Using Low Dose Radiation |
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Dong Ha Kim, Dong Wan Kang, Beong Ik Hur, Won Ho Cho, Seung Heon Cha, Chang Hwa Choi |
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Department of Neurosurgery, Pusan National University Hospital, Yangsan Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea |
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| Abstract |
Introduction: Gamma knife radiosurgery (GKRS) had proven to be a relatively safe and effective therapy for patients with cerebrovascular disease. But, the efficacy of radiosurgery for cerebral cavernous malformations (CMs) was controversial. In this study, we evaluated the efficacy and safety of CMs radiosurgery retrospectively.
Methods
Between December 2003 and June 2009, 46 patients with CMs were treated with the GKRS. Complete follow-up was available in 19 patients (7 women, 12 men). Initial symptoms were headache, focal neurologic deficit, seizure and dizziness. The location of CMs were brainstem (6 patients), thalamus and basal ganglia (3 patients), cerebellum (4 patients), and cerebral hemisphere (6 patients). Serial magnetic resonance image (MRI) was performed to assess the response. Mean marginal dose was 12.1Gy for 50% isodose line, which was slightly lower dose than other usual dosage. The mean follow-up period after radiosurgery was 31 months.
Results
The annual rebleeding rate after GKRS was 10.3%. After first 2 years following GKRS, the annual rebleeding rate was decreased to 5%. Initial symptoms were almost improved, but two patients suffered from the rebleeding. Complication associated with the post-radiosurgery edema developed in only one patient. The size of CMs after GKRS decreased in 9 patients, increased in 1 patient, and did not changed in others.
Conclusions
It was impossible that the radiosurgery protects patients with CMs against hemorrhage risk, but reduction in the bleeding rate after a latent period might be possible. In our series, lower dosage than other reports was also effective to control symptoms or bleeding risk and the rate of radiation-related complications was not high. We concluded that GKRS with low dose for CMs is effective and safe treatment modality. |
| Key Words:
Cavernous malformation, Gamma Knife radiosurgery. |
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