title: LINAC radiosurgery for intracranial cavernous malformation: 10-year experience.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, No 5, Fu-shin St, Kweishan, Tauoyuan, Taiwan.
authors.forename: Yin-Cheng
authors.initials: YC
authors.lastname: Huang
authors.forename: Chen-Kan
authors.initials: CK
authors.lastname: Tseng
authors.forename: Cheng-Nen
authors.initials: CN
authors.lastname: Chang
authors.forename: Kuo-Cheng
authors.initials: KC
authors.lastname: Wei
authors.forename: Cheng-Chih
authors.initials: CC
authors.lastname: Liao
authors.forename: Peng-Wei
authors.initials: PW
authors.lastname: Hsu
mesh_terms: 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