Radiosurgery for cerebral cavernous malformations: a systematic review

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BACKGROUND

Stereotactic radiosurgery (SRS) for cerebral cavernous malformations has been used for more than 30 years. However, indications for this method and outcomes are still discussable.

OBJECTIVE

To analyze available literature data on SRS for cerebral cavernous malformations with assessment of indications for treatment, radiation parameters, radiological and clinical complications and outcomes.

RESULTS

The final analysis included 20 reports describing post-SRS outcomes in 1834 patients with cerebral cavernous malformations. The main radiation parameter was mean radiation dose to the edge of cavernous malformation (prescribed dose, 13.25±2.16 Gy). In natural course of malformation, mean incidence of hemorrhages from cavernous malformation when counted after the second hemorrhage was 25.9±14.6%, after the patient’s birth — 2.59±0.44%. Mean follow-up period after SRS was 66.7±24.1 months. Incidence of hemorrhages from cavernous malformation after SRS for the first 2 years of follow-up was assessed in 14 studies (4.67±3.51%). Incidence of hemorrhages ≥2 years after SRS was analyzed in 12 studies (1.55±0.8%).

CONCLUSION

Despite significant global experience in SRS for cerebral cavernous malformations and many studies devoted to this problem, clear patient selection criteria have not yet been formulated. Modern selection principles have insufficient evidence base.

Keywords:

cavernous malformation

radiosurgery

Gamma Knife

Authors:

Semenov D.E.

Burdenko Neurosurgical Center

ORCID: 0000-0001-9105-671X

Belousova O.B.

Burdenko Neurosurgical Center

ORCID: 0000-0003-4908-8923

Kostyuchenko V.V.

Burdenko Neurosurgical Center

ORCID: 0000-0002-7806-5774

Golanov A.V.

Burdenko Neurosurgical Center

ORCID: 0000-0002-0976-4547

Received:

11.02.2024

Accepted:

31.05.2024

List of references:

Awad IA, Polster SP. Cavernous angiomas: deconstructing a neurosurgical disease. Journal of Neurosurgery. 2019;131(1):1-13. https://doi.org/10.3171/2019.3.JNS181724
Sheen JJ, Lee DH, Lee DH, Song Y, Kwon DH. Long-Term Outcome of Gamma Knife Radiosurgery for Brain Cavernoma: Factors Associated with Subsequent De Novo Cavernoma Formation. World Neurosurgery. 2018;120:e17-e23. https://doi.org/10.1016/j.wneu.2018.07.046
Kondziolka D, Lunsford LD, Coffey RJ, Bissonette DJ, Flickinger JC. Stereotactic radiosurgery of angiographically occult vascular malformations: indications and preliminary experience. Neurosurgery. 1990;27(6):892-900. https://doi.org/10.1097/00006123-199012000-00006
Kondziolka D, Lunsford LD, Flickinger JC, Kestle JR. Reduction of hemorrhage risk after stereotactic radiosurgery for cavernous malformations. Journal of Neurosurgery. 1995;83(5):825-831. https://doi.org/10.3171/jns.1995.83.5.0825
Park K, Kim JW, Chung HT, Paek SH, Kim DG. Long-Term Outcome of Gamma Knife Radiosurgery for Symptomatic Brainstem Cavernous Malformation. World Neurosurgery. 2018;116:e1054-e1059. https://doi.org/10.1016/j.wneu.2018.05.164
Nagy G, Burkitt W, Stokes SS, Bhattacharyya D, Yianni J, Rowe JG, Kemeny AA, Radatz MWR. Contemporary radiosurgery of cerebral cavernous malformations: Part 1. Treatment outcome for critically located hemorrhagic lesions. Journal of Neurosurgery. 2018;130(6):1817-1825. https://doi.org/10.3171/2017.5.JNS17776
Nagy G, Stokes SS, Erőss LG, Bhattacharyya D, Yianni J, Rowe JG, Kemeny AA, Radatz MWR. Contemporary radiosurgery of cerebral cavernous malformations: Part 2. Treatment outcome for hemispheric lesions. Journal of Neurosurgery. 2018;130(6):1826-1834. https://doi.org/10.3171/2018.2.JNS171267
Lee CC, Wang WH, Yang HC, Lin CJ, Wu HM, Lin YY, Hu YS, Chen CJ, Chen YW, Chou CC, Liu YT, Chung WY, Shiau CY, Guo WY, Hung-Chi Pan D, Hsu SPC. Gamma Knife radiosurgery for cerebral cavernous malformation. Scientific Reports. 2019;9(1):19743. https://doi.org/10.1038/s41598-019-56119-1
Kefeli AU, Sengoz M, Peker S. Gamma Knife Radiosurgery for Hemorrhagic Brainstem Cavernomas. Turkish Neurosurgery. 2019;29(1):14-19. https://doi.org/10.5137/1019-5149.JTN.21690-17.1
Karaaslan B, Gülsuna B, Erol G, Dağli Ö, Emmez H, Kurt G, Çeltikçi E, Börcek AÖ. Stereotactic radiosurgery for cerebral cavernous malformation: comparison of hemorrhage rates before and after stereotactic radiosurgery. Journal of Neurosurgery. 2021;136(3):655-661. https://doi.org/10.3171/2021.2.JNS21138
Shen CC, Sun MH, Yang MY, You WC, Sheu ML, Chen YJ, Chen YJ, Sheehan J, Pan HC. Outcome of intracerebral cavernoma treated by Gamma Knife radiosurgery based on a double-blind assessment of treatment indication. Radiation Oncology. 2021;16(1):164. https://doi.org/10.1186/s13014-021-01885-4
Sasaki A, Hayashi M, Tamura N, Horiba A, Kawamata T. Gamma Knife Radiosurgery for Symptomatic Cavernous Malformations: Tokyo Women’s Medical University Experience. Acta Neurochirurgica Supplement. 2021;128:121-125. https://doi.org/10.1007/978-3-030-69217-9_13
Hu YJ, Zhang LF, Ding C, Tian Y, Chen J. Gamma Knife Radiosurgery for Cavernous Malformations of Basal Ganglia and Thalamus: A Retrospective Study of 53 Patients. Stereotactic and Functional Neurosurgery. 2021;99(4):273-280. https://doi.org/10.1159/000510108
Samanci Y, Ardor GD, Peker S. Management of pediatric cerebral cavernous malformations with gamma knife radiosurgery: a report of 46 cases. Child’s Nervous System. 2022;38(5):929-938. https://doi.org/10.1007/s00381-022-05485-9
Shanker MD, Webber R, Pinkham MB, Huo M, Olson S, Hall B, Jayalath R, Watkins T, Foote MC. Gamma Knife® stereotactic radiosurgery for intracranial cavernous malformations. Journal of Clinical Neuroscience. 2022;106:96-102. https://doi.org/10.1016/j.jocn.2022.10.015
Chung MW, Chuang CC, Wang CC, Chen HC, Hsu PW. Prognostic Factors Analysis for Intracranial Cavernous Malformations Treated with Linear Accelerator Stereotactic Radiosurgery. Life. 2022;12(9):1363. https://doi.org/10.3390/life12091363
Shim Y, Phi JH, Wang KC, Cho BK, Lee JY, Koh EJ, Kim KH, Lee EJ, Kim KJ, Kim SK. Clinical outcomes of pediatric cerebral cavernous malformation: an analysis of 124 consecutive cases. Journal of Neurosurgery: Pediatrics. 2022;30(5):474-483. https://doi.org/10.3171/2022.7.PEDS22299
Wu X, Chen W, Lin Y, Liang R. The Impact of Volume Factor on the Long-Term Outcome of Gamma Knife Radiosurgery for Sporadic Cerebral Cavernous Malformations. World Neurosurgery. 2022;158:e627-e635. https://doi.org/10.1016/j.wneu.2021.11.029
Dumot C, Mantziaris G, Dayawansa S, Xu Z, Pikis S, Peker S, Samanci Y, Ardor GD, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad Eldin RM, Elazzazi AH, Moreno NM, Martínez Álvarez R, Liscak R, May J, Mathieu D, Tourigny JN, Tripathi M, Rajput A, Kumar N, Kaur R, Picozzi P, Franzini A, Speckter H, Hernandez W, Brito A, Warnick RE, Alzate J, Kondziolka D, Bowden GN, Patel S, Sheehan J. Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study. Stroke and Vascular Neurology. 2023;svn-2023-002380. https://doi.org/10.1136/svn-2023-002380
Hill CS, Borg A, Horsfall HL, Al-Mohammad A, Grover P, Kitchen N. Cerebral cavernous malformation: Management, outcomes, and surveillance strategies — A single centre retrospective cohort study. Clinical Neurology and Neurosurgery. 2023;225:107576. https://doi.org/10.1016/j.clineuro.2022.107576
Berber T, Celik SE, Aksaray F, Yoney A, Harmanci K, Tambas M, Yılmaz BD, Numanoglu C, Yolcu A, Açan Hİ, Dinçer ST, Yıldırım BA. Radiosurgery effects and adverse effects in symptomatic eloquent brain-located Cavernomas. Journal of Radiation Research. 2023;64(1):133-141. https://doi.org/10.1093/jrr/rrac056
Jacobs R, Kano H, Gross BA, Niranjan A, Monaco EA 3rd, Lunsford LD. Defining Long-Term Clinical Outcomes and Risks of Stereotactic Radiosurgery for Brainstem Cavernous Malformations. World Neurosurgery. 2018;S1878-8750(18)32787-6. https://doi.org/10.1016/j.wneu.2018.11.226
Haciyakupoglu E, Yilmaz DM, Kinali B, Akbas T, Haciyakupoglu S. Analysis of Cavernous Malformations: Experience with 18 Cases. Turkish Neurosurgery. 2019;29(3):340-348. https://doi.org/10.5137/1019-5149.JTN.22645-18.2
Gao X, Yue K, Sun J, Cao Y, Zhao B, Zhang H, Dai S, Zhang L, Luo P, Jiang X. Microsurgery vs. Gamma Knife Radiosurgery for the Treatment of Brainstem Cavernous Malformations: A Systematic Review and Meta-Analysis. Frontiers in Neurology. 2021;12:600461. https://doi.org/10.3389/fneur.2021.600461
Taweel BA, Hannan CJ, Chavredakis E. Letter to the Editor. Stereotactic radiosurgery for cavernous malformations: does it beat the natural history? Journal of Neurosurgery. 2022;138(1):296-297. https://doi.org/10.3171/2022.5.JNS22904
Kalani MYS, Lawton MT, Spetzler RF. Letter to the Editor. Radiosurgery for cerebral cavernous malformations: a word of caution. Journal of Neurosurgery. 2018;130(6):2086-2090. https://doi.org/10.3171/2018.8.JNS182284
Barker FG 2nd, Amin-Hanjani S, Butler WE, Lyons S, Ojemann RG, Chapman PH, Ogilvy CS. Temporal clustering of hemorrhages from untreated cavernous malformations of the central nervous system. Neurosurgery. 2001;49(1):15-24; discussion 24-25. https://doi.org/10.1097/00006123-200107000-00002
Flemming KD, Lanzino G. Stereotactic radiosurgery for cavernous malformations: Natural history or treatment effect? Neurology. 2019;93(21):921-922. https://doi.org/10.1212/WNL.0000000000008516
Shin SS, Murdoch G, Hamilton RL, Faraji AH, Kano H, Zwagerman NT, Gardner PA, Lunsford LD, Friedlander RM. Pathological response of cavernous malformations following radiosurgery. Journal of Neurosurgery. 2015;123(4):938-944. https://doi.org/10.3171/2014.10.JNS14499
Nagy G, McCutcheon BA, Giannini C, Link MJ, Pollock BE. Radiation-induced cavernous malformations after single-fraction meningioma radiosurgery. Operative Neurosurgery. 2018;15(2):207-212.
Gao X, Yue K, Sun J, Cao Y, Zhao B, Zhang H, Dai S, Zhang L, Luo P, Jiang X. Treatment of Cerebral Cavernous Malformations Presenting With Seizures: A Systematic Review and Meta-Analysis. Frontiers in Neurology. 2020;11:590589. https://doi.org/10.3389/fneur.2020.590589
Santos AN, Rauschenbach L, Riess C, Georgiades I, Fiçilar B, Gallardo EG, Quesada CM, Li Y, Tippelt S, Dohna-Schwake C, Schmidt B, Jabbarli R, Siegel AM, Benet A, Wrede KH, Sure U, Dammann P. Outcome after conservative or surgical treatment for new-onset epilepsy in children with cerebral cavernous malformation. Seizure. 2023;111:23-29. https://doi.org/10.1016/j.seizure.2023.07.011

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