Gamma Knife Radiosurgery for Cerebral Cavernous Malformations: Clinical Results for Non-Hemorrhagic Hemispheric Lesions

Sang-Jin Park, MD1, Seong-Hyun Park, MD, PhD1, Jinsil Jeong, BS2, Minjae Kim, BS2, Geondo Park, BS2, Hyungmo Goo, BS2, Youngjun Wi, BS2

Abstract

J Kor Soc Ster Func Neurosurg. 2019 15(2): 63-70

Gamma Knife Radiosurgery for Cerebral Cavernous Malformations: Clinical Results for Non-Hemorrhagic Hemispheric Lesions

Sang-Jin Park, MD1, Seong-Hyun Park, MD, PhD1, Jinsil Jeong, BS2, Minjae Kim, BS2, Geondo Park, BS2, Hyungmo Goo, BS2, Youngjun Wi, BS2

1Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea, 2School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea

Objective: The purpose of this study is to evaluate the efficacy and safety of gamma knife radiosurgery (GKS) in symptomatic non-hemorrhagic hemispheric cerebral cavernous malformations (CCMs) with surgical morbidity. Methods: We retrospectively analyzed GKS for 95 CCM patients from 2006 to 2017. Among them, 13 non-hemorrhagic symptomatic hemispheric CCM patients were selected, and all of them also had developmental venous anomaly. We analyzed the clinical and radiological results of the selected patients. Results: The median age of 13 non-hemorrhagic symptomatic hemispheric CCM patients was 50 years (range, 28-72 years). CCM was present in the eloquent cortex and white matter in 10 patients (motor cortex, 1; somatosensory cortex, 2; visual cortex, 1; frontal lobe, 3; temporal lobe, 2; centrum semiovale, 1), basal ganglia/thalamus in 3 patients. Headache, seizure, motor weakness, and dysphasia were the symptoms in 8, 3, 1, and 1 patient, respectively. The median marginal radiation dose was 16Gy, and the median lesion volume was 2.8cc. The median follow-up period after radiosurgery was 48 months (range, 25-152 months). During the follow-up period, all patients, except those with motor weakness, showed symptom improvement after GKS; furthermore, during this period, no patient experienced hemorrhage, whereas an adverse radiation effect (ARE) was observed in three patients. No statistically significant difference was observed between ARE and seizure, symptom duration until GKS, decrease in lesion size, symptom improvement, prescription dose, lesion volume, and number of isocenters. Conclusions: GKS may be a good treatment alternative if hemispheric CCM patients have a risk of surgical morbidity or if they cannot be operated upon owing to patient factors.

Key words : Cerebral cavernous malformation, Radiation effect, Gamma knife radiosurgery.

중심단어 : Cerebral cavernous malformation, Radiation effect, Gamma knife radiosurgery.