LINAC radiosurgery for intracranial cavernous malformation: 10-year experience.
BACKGROUND
The annual hemorrhage rate of intracranial cavernous malformation (CM) is reported to range from 0.23% to 1.1%. Because of the low hemorrhage rate, operating on a deep symptomatic lesion with or without hemorrhage is considered controversial. For the prevention of hemorrhage, radiosurgery is an alternative method, targeting smaller lesions and delivering higher doses of radiation. Linear accelerator (LINAC) radiosurgery, aside from the gamma knife (GK), is not often discussed in the treatment of CM.


METHODS
From 1995 to 2005, 30 patients presenting with hemorrhage or seizures, aged 14-79 years (mean 24.0 years) with single (27 patients) or multiple (three patients) CMs received LINAC radiosurgery at our institute. Six patients received LINAC radiosurgery following craniotomy for residual lesions revealed by the follow-up MRI. The temporal lobe was the most common site for CM in this series (n=8), followed by the brain stem (n=7). Thirty patients received 34 radiosurgery treatments with peripheral doses ranging from 800 cGy to 2200 cGy. The mean follow-up time was 59.9 months (range 1-122 months).


RESULTS
One patient re-bled post-radiosurgery (0.67% in 149.75 observation-years). Two patients had asymptomatic post-LINAC edema (6.7%). Those three patients were symptom-free during the follow-up period.


CONCLUSIONS
We suggest that LINAC radiosurgery is a relatively safe technique for treating deep or residual CM, although the actual effectiveness for CM obliteration is not known.
Huang
Yin-Cheng
YC
Department of Neurosurgery, Chang Gung Memorial Hospital, No 5, Fu-shin St, Kweishan, Tauoyuan, Taiwan.
Tseng
Chen-Kan
CK
Chang
Cheng-Nen
CN
Wei
Kuo-Cheng
KC
Liao
Cheng-Chih
CC
Hsu
Peng-Wei
PW
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D001933:Brain Stem / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000601:surgery; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D016634:Radiosurgery; D012086:Reoperation; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome