Stereotactic radiosurgery for cavernous malformations

B. E. Pollock, Yolanda Isabel Garces, S. L. Stafford, R. L. Foote, P. J. Schomberg, M. J. Link

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

Object. The use of stereotactic radiosurgery to treat cerebral cavernous malformations (CMs) is controversial. To evaluate the efficacy and safety of CM radiosurgery, the authors reviewed the experience at the Mayo Clinic during the past 10 years. Methods. Seventeen patients underwent radiosurgery for high-surgical-risk CMs in the following sites: thalamus/basal ganglia (four patients), brainstem (12 patients), and corpus callosum (one patient). All patients had experienced at least two documented hemorrhages before undergoing radiosurgery. Stereotactic magnetic resonance (MR) imaging was used for target localization in all cases. The median margin radiation dose was 18 Gy and the median maximum dose was 32 Gy. The median length of follow-up review following radiosurgery was 51 months. The annual hemorrhage rate during the 51 months preceding radiosurgery was 40.1%, compared with 8.8% in the first 2 years following radiosurgery and 2.9% thereafter. In 10 patients (59%) new neurological deficits developed that were associated with regions of increased signal on long-repetition time MR imaging performed a median of 8 months (range 5-16 months) after radiosurgery. Three patients recovered, giving the group a permanent radiation-related morbidity rate of 41%. Compared with 31 patients harboring arteriovenous malformations (AVMs) of sizes and in locations similar to those of the aforementioned CMs, who underwent radiosurgery during the same time period, the patients with CMs were more likely to experience radiation-related complications (any complication, 59% compared with 10%; p < 0.001; permanent complication, 41% compared with 10%; p = 0.02). Conclusions. It is impossible to conclude that radiosurgery protects patients with CMs against future hemorrhage risk based on the available data, although it appears that some reduction in the bleeding rate occurs after a latency interval of several years. The risk of radiation-related complications after radiosurgery to treat CMs is greater than that found after radiosurgery in AVMs, even when adjusting for lesion size and location and for radiation dose.

Original languageEnglish (US)
Pages (from-to)987-991
Number of pages5
JournalJournal of Neurosurgery
Volume93
Issue number6
StatePublished - 2000

Fingerprint

Radiosurgery
Radiation
Hemorrhage
Arteriovenous Malformations
Central Nervous System Cavernous Hemangioma
Magnetic Resonance Imaging
Corpus Callosum
Basal Ganglia
Thalamus
Brain Stem

Keywords

  • Cavernous malformation
  • Hemorrhage
  • Radiation injury
  • Radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Pollock, B. E., Garces, Y. I., Stafford, S. L., Foote, R. L., Schomberg, P. J., & Link, M. J. (2000). Stereotactic radiosurgery for cavernous malformations. Journal of Neurosurgery, 93(6), 987-991.

Stereotactic radiosurgery for cavernous malformations. / Pollock, B. E.; Garces, Yolanda Isabel; Stafford, S. L.; Foote, R. L.; Schomberg, P. J.; Link, M. J.

In: Journal of Neurosurgery, Vol. 93, No. 6, 2000, p. 987-991.

Research output: Contribution to journalArticle

Pollock, BE, Garces, YI, Stafford, SL, Foote, RL, Schomberg, PJ & Link, MJ 2000, 'Stereotactic radiosurgery for cavernous malformations', Journal of Neurosurgery, vol. 93, no. 6, pp. 987-991.
Pollock BE, Garces YI, Stafford SL, Foote RL, Schomberg PJ, Link MJ. Stereotactic radiosurgery for cavernous malformations. Journal of Neurosurgery. 2000;93(6):987-991.
Pollock, B. E. ; Garces, Yolanda Isabel ; Stafford, S. L. ; Foote, R. L. ; Schomberg, P. J. ; Link, M. J. / Stereotactic radiosurgery for cavernous malformations. In: Journal of Neurosurgery. 2000 ; Vol. 93, No. 6. pp. 987-991.
@article{df3a8c1007994b96b327459e3c3b432a,
title = "Stereotactic radiosurgery for cavernous malformations",
abstract = "Object. The use of stereotactic radiosurgery to treat cerebral cavernous malformations (CMs) is controversial. To evaluate the efficacy and safety of CM radiosurgery, the authors reviewed the experience at the Mayo Clinic during the past 10 years. Methods. Seventeen patients underwent radiosurgery for high-surgical-risk CMs in the following sites: thalamus/basal ganglia (four patients), brainstem (12 patients), and corpus callosum (one patient). All patients had experienced at least two documented hemorrhages before undergoing radiosurgery. Stereotactic magnetic resonance (MR) imaging was used for target localization in all cases. The median margin radiation dose was 18 Gy and the median maximum dose was 32 Gy. The median length of follow-up review following radiosurgery was 51 months. The annual hemorrhage rate during the 51 months preceding radiosurgery was 40.1{\%}, compared with 8.8{\%} in the first 2 years following radiosurgery and 2.9{\%} thereafter. In 10 patients (59{\%}) new neurological deficits developed that were associated with regions of increased signal on long-repetition time MR imaging performed a median of 8 months (range 5-16 months) after radiosurgery. Three patients recovered, giving the group a permanent radiation-related morbidity rate of 41{\%}. Compared with 31 patients harboring arteriovenous malformations (AVMs) of sizes and in locations similar to those of the aforementioned CMs, who underwent radiosurgery during the same time period, the patients with CMs were more likely to experience radiation-related complications (any complication, 59{\%} compared with 10{\%}; p < 0.001; permanent complication, 41{\%} compared with 10{\%}; p = 0.02). Conclusions. It is impossible to conclude that radiosurgery protects patients with CMs against future hemorrhage risk based on the available data, although it appears that some reduction in the bleeding rate occurs after a latency interval of several years. The risk of radiation-related complications after radiosurgery to treat CMs is greater than that found after radiosurgery in AVMs, even when adjusting for lesion size and location and for radiation dose.",
keywords = "Cavernous malformation, Hemorrhage, Radiation injury, Radiosurgery",
author = "Pollock, {B. E.} and Garces, {Yolanda Isabel} and Stafford, {S. L.} and Foote, {R. L.} and Schomberg, {P. J.} and Link, {M. J.}",
year = "2000",
language = "English (US)",
volume = "93",
pages = "987--991",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "6",

}

TY - JOUR

T1 - Stereotactic radiosurgery for cavernous malformations

AU - Pollock, B. E.

AU - Garces, Yolanda Isabel

AU - Stafford, S. L.

AU - Foote, R. L.

AU - Schomberg, P. J.

AU - Link, M. J.

PY - 2000

Y1 - 2000

N2 - Object. The use of stereotactic radiosurgery to treat cerebral cavernous malformations (CMs) is controversial. To evaluate the efficacy and safety of CM radiosurgery, the authors reviewed the experience at the Mayo Clinic during the past 10 years. Methods. Seventeen patients underwent radiosurgery for high-surgical-risk CMs in the following sites: thalamus/basal ganglia (four patients), brainstem (12 patients), and corpus callosum (one patient). All patients had experienced at least two documented hemorrhages before undergoing radiosurgery. Stereotactic magnetic resonance (MR) imaging was used for target localization in all cases. The median margin radiation dose was 18 Gy and the median maximum dose was 32 Gy. The median length of follow-up review following radiosurgery was 51 months. The annual hemorrhage rate during the 51 months preceding radiosurgery was 40.1%, compared with 8.8% in the first 2 years following radiosurgery and 2.9% thereafter. In 10 patients (59%) new neurological deficits developed that were associated with regions of increased signal on long-repetition time MR imaging performed a median of 8 months (range 5-16 months) after radiosurgery. Three patients recovered, giving the group a permanent radiation-related morbidity rate of 41%. Compared with 31 patients harboring arteriovenous malformations (AVMs) of sizes and in locations similar to those of the aforementioned CMs, who underwent radiosurgery during the same time period, the patients with CMs were more likely to experience radiation-related complications (any complication, 59% compared with 10%; p < 0.001; permanent complication, 41% compared with 10%; p = 0.02). Conclusions. It is impossible to conclude that radiosurgery protects patients with CMs against future hemorrhage risk based on the available data, although it appears that some reduction in the bleeding rate occurs after a latency interval of several years. The risk of radiation-related complications after radiosurgery to treat CMs is greater than that found after radiosurgery in AVMs, even when adjusting for lesion size and location and for radiation dose.

AB - Object. The use of stereotactic radiosurgery to treat cerebral cavernous malformations (CMs) is controversial. To evaluate the efficacy and safety of CM radiosurgery, the authors reviewed the experience at the Mayo Clinic during the past 10 years. Methods. Seventeen patients underwent radiosurgery for high-surgical-risk CMs in the following sites: thalamus/basal ganglia (four patients), brainstem (12 patients), and corpus callosum (one patient). All patients had experienced at least two documented hemorrhages before undergoing radiosurgery. Stereotactic magnetic resonance (MR) imaging was used for target localization in all cases. The median margin radiation dose was 18 Gy and the median maximum dose was 32 Gy. The median length of follow-up review following radiosurgery was 51 months. The annual hemorrhage rate during the 51 months preceding radiosurgery was 40.1%, compared with 8.8% in the first 2 years following radiosurgery and 2.9% thereafter. In 10 patients (59%) new neurological deficits developed that were associated with regions of increased signal on long-repetition time MR imaging performed a median of 8 months (range 5-16 months) after radiosurgery. Three patients recovered, giving the group a permanent radiation-related morbidity rate of 41%. Compared with 31 patients harboring arteriovenous malformations (AVMs) of sizes and in locations similar to those of the aforementioned CMs, who underwent radiosurgery during the same time period, the patients with CMs were more likely to experience radiation-related complications (any complication, 59% compared with 10%; p < 0.001; permanent complication, 41% compared with 10%; p = 0.02). Conclusions. It is impossible to conclude that radiosurgery protects patients with CMs against future hemorrhage risk based on the available data, although it appears that some reduction in the bleeding rate occurs after a latency interval of several years. The risk of radiation-related complications after radiosurgery to treat CMs is greater than that found after radiosurgery in AVMs, even when adjusting for lesion size and location and for radiation dose.

KW - Cavernous malformation

KW - Hemorrhage

KW - Radiation injury

KW - Radiosurgery

UR - http://www.scopus.com/inward/record.url?scp=0034433375&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034433375&partnerID=8YFLogxK

M3 - Article

C2 - 11117872

AN - SCOPUS:0034433375

VL - 93

SP - 987

EP - 991

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 6

ER -