Evaluation of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for cerebral cavernous malformations: a 15-year single-center experience

• Published in: Annals of Saudi medicine 2014-01, Vol.34 (1), p.54-58
• Main Authors: Sager, Omer, Beyzadeoglu, Murat, Dincoglan, Ferrat, Uysal, Bora, Gamsiz, Hakan, Demiral, Selcuk, Oysul, Kaan, Dirican, Bahar, Sirin, Sait
• Format: Article
• Language: English
• Subjects: Adult; Ataxia; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - etiology; Cerebral Hemorrhage - surgery; Female; Follow-Up Studies; Headaches; Hemangioma, Cavernous, Central Nervous System - surgery; Hemorrhage; Humans; Male; Medical imaging; Middle Aged; NMR; Nuclear magnetic resonance; Original; Patients; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - etiology; Radiosurgery - adverse effects; Radiosurgery - methods; Retrospective Studies; Studies; Surgery; Time Factors; Treatment Outcome
• ISSN: 0256-4947; 0975-4466
• DOI: 10.5144/0256-4947.2014.54

Surgery is the principal treatment for safely accessible hemorrhagic and symptomatic cavernous malformations. Nevertheless, the role of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) in the management of high-risk, symptomatic cavernoma lesions warrants further refinement. In this study, we evaluate the use of LINAC-based SRS for cerebral cavernous malformations (CMs) and report our 15-year single-center experience. A retrospective study from the Department of Radiation Oncology and the Department of Neurosurgery at Gulhane Military Medical Academy and Medical Faculty, Ankara from April 1998 to June 2013. Fifty-two patients (22 females and 30 males) with cerebral CM referred to our department underwent high-precision single-dose SRS using a LINAC with 6-MV photons. All patients had at least 1 bleeding episode prior to radiosurgery along with related symptoms. Median dose prescribed to the 85% to 95% isodose line encompassing the target volume was 15 Gy (range, 10-20). Out of the total 52 patients, follow-up data were available for 47 patients (90.4%). Median age was 35 years (range, 19-63). Median follow-up time was 5.17 years (range, 0.08-9.5) after SRS. Three hemorrhages were identified in the post-SRS period. Statistically significant decrease was observed in the annual hemorrhage rate after radiosurgical treatment (pre-SRS 39% vs post-SRS 1.21, P < .0001). Overall, there were no radiosurgery-related complications resulting in mortality. LINAC-based SRS may be considered as a treatment option for high-risk, symptomatic cerebral CM of selected patients with prior bleeding from lesions located at surgically inaccessible or eloquent brain areas.