Gamma knife surgery for cavernous hemangiomas: an analysis of 125 patients.
OBJECTIVE
The authors sought to determine the value of gamma knife surgery (GKS) in the treatment of cavernous hemangiomas (CHs).


METHODS
Between 1993 and 2002, a total of 125 patients with symptomatic CHs were treated with GKS. Ninety-seven patients presented with bleeding and 45 of these had at least two bleeding episodes. Thirteen patients presented with seizures combined with hemorrhage, and 15 patients presented with seizures alone. The mean margin dose of radiation was 12.1 Gy and the mean follow-up time was 5.4 years. In the 112 patients who had bled the number of rebleeds after GKS was 32. These rebleeds were defined both clinically and based on magnetic resonance imaging for an annual rebleeding rate of 32 episodes/492 patient-years or 6.5%. Twenty-three of the 32 rebleeding episodes occurred within 2 years after GKS. Nine episodes occurred after 2 years; thus, the annual rebleeding rate after GKS was 10.3% for the first 2 years and 3.3% thereafter (p = 0.0038). In the 45 patients with at least two bleeding episodes before GKS, the rebleeding rate dropped from 29.2% (55 episodes/188 patient-years) before treatment to 5% (10 episodes/197 patient-years) after treatment (p < 0.0001). Among the 28 patients who presented with seizures, 15 (53%) had good outcomes (Engel Grades I and II). In this study of 125 patients, symptomatic radiation-induced complications developed in only three patients.


CONCLUSIONS
Gamma knife surgery can effectively reduce the rebleeding rate after the first symptomatic hemorrhage in patients with CH. In addition, GKS may be useful in reducing the severity of seizures in patients with CH.
Liu
Kang-Du
KD
Department of Neurosurgery, Cancer Center, Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan, Republic of China. kdliou@vghtpe.gov.tw
Chung
Wen-Yuh
WY
Wu
Hsiu-Mei
HM
Shiau
Cheng-Ying
CY
Wang
Ling-Wei
LW
Guo
Wan-You
WY
Pan
David Hung-Chi
DH
D000328:Adult; D002543:Cerebral Hemorrhage / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000150:complications / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011829:Radiation Dosage; D016634:Radiosurgery / Q000295:instrumentation*; D012640:Seizures / Q000175:diagnosis / Q000209:etiology; D012720:Severity of Illness Index