Outcomes of stereotaxic radiosurgery for subtentorial cavernous malformations
https://doi.org/10.17650/1683-3295-2018-20-4-40-51
Abstract
The study objective is to estimate treatment success of gamma knife radiosurgery (GKRS) in the patients with subtentorial cavernous malformation (CM) based on follow-up data and magnetic resonance imaging (MRI).
Materials and methods. The long-term follow-up of GKRS in 87 patients with CM in brain stem and cerebellum was obtained. The clinical outcomes were observed using phone-based SF-36 health status survey in 55 patients. MRI data was collected before and after GKRS within 1, 2, 3 and more years. The natural history of CM without GKRS were observed in 20 patients.
Results. The 1st year MRI observation after GKRS have demonstrated CM reduction in 66,6 % patients. At subsequent MRI-control the tendency of increase in number of CM, reacted on irradiation, and continuation of started processes of its sclerotization is revealed. The fast reduction of CM sizes was associated with lower risk of recurrent hemorrhages, that were observed in 3 patients with slow reduction. The CM reduction was also associated with good clinical outcomes, that was observed in 64,5 % patients.
Conclusion. The presence of CM reduction (72,4 %) and good clinical outcome in suggests GKRS as a frontline treatment modality in patient with subtentorial CM. In the cases of slow rate of treatment response and unexpired risk of repeated hemorrhage no mortality and significant disability were mentioned.
About the Authors
L. Ya. Kravets
Privolzhskiy Research Medical University, Ministry of Health of Russia
Russian Federation
10/1 Minin & Pozharsky Sq., Nizhny Novgorod 603950
Russian Federation
10/1 Minin & Pozharsky Sq., Nizhny Novgorod 603950
S. N. Gryaznov
Ivanovo Regional Clinical Hospital
Russian Federation
1 Lyubimova St., Ivanovo 153040
Russian Federation
1 Lyubimova St., Ivanovo 153040
S. Ya. Kalinina
Privolzhskiy Research Medical University, Ministry of Health of Russia
Russian Federation
10/1 Minin & Pozharsky Sq., Nizhny Novgorod 603950
Russian Federation
10/1 Minin & Pozharsky Sq., Nizhny Novgorod 603950
Yu. D. Avdonina
Privolzhskiy Research Medical University, Ministry of Health of Russia
Russian Federation
10/1 Minin & Pozharsky Sq., Nizhny Novgorod 603950
Russian Federation
10/1 Minin & Pozharsky Sq., Nizhny Novgorod 603950
P. I. Ivanov
A.L. Polenov Russian Research Institute of Neurosurgery – branch of V.A. Almazov National Medical Research Center, Ministry of Health of Russia
Russian Federation
12 Mayakovsky St., Saint Petersburg 191014
Russian Federation
12 Mayakovsky St., Saint Petersburg 191014
References
1. Belousova O.B., Konovalov A.N. Cavernouse malformations of the central nervous system. Moscow, 2014. 254 p. (In Russ.).
2. Kivelev J. Brain cavernomas. SPb.: Chelovek i ego zdorovie, 2013. 216 p. (In Russ.).
3. Konovalov A.N., Belousova O.B., Gavryushin A.V. Kavernomas of CNS. Modern technology and clinical investigations in neurosurgery. M., 2012. Pp. 353–368 (In Russ.).
4. Abla A.A., Spetzler R.F. Brainstem cavernoma surgery: the state of the art. World Neurosurg 2013;80(1–2):44–6. DOI: 10.1016/j.wneu.2012.06.011. PMID: 22705753.
5. Pollock B.E., Garces Y.I., Stafford S.L. et al. Stereotactic radiosurgery for cavernous malformations. J Neurosurg 2000;93(6):987–91. DOI: 10.3171/jns.2000.93.6.0987. PMID: 11117872.
6. Ding D. Effect of stereotactic radiosurgery on the hemorrhage risk of cerebral cavernous malformation: fact or fiction? Acta Neurochir (Wien) 2015;157(1):49–50. DOI: 10.1007/s00701-014-2262-y. PMID: 25342086.
7. Lee S.H., Choi, H. J., Shin H.S. et al. Gamma knife radiosurgery for brainstem cavernous malformations: should a patient wait for the rebleed? Acta Neurochir (Wien) 2014;156 (10):1937–46. DOI: 10.007/s00701-014-2155-0. PMID: 24965071.
8. Konovalov A.N., Belousova O.B., Okishev D.N. et al. Clinical recommendations for treatment of patients with cavernous malformations of the central nervous system. Moscow, 2014. 13 p. (In Russ.).
9. Zabramski J.M., Wascher T.M., Spetzler R.F. et al. The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg 1994;80(3):422–32. DOI: 10.3171/jns.1994.80.3.0422. PMID: 8113854.
10. Awad I.A., Barrow D.L. Cavernous malformations. Thieme Publishers Series, 1993. 224 p.
11. Clatterbuck R.E., Moriarity J.L., Elmaci I. et al. Dynamic nature of cavernous malformations: a prospective magnetic resonance imaging study with volumetric analysis. J Neurosurg 2000;93(6):981–6. DOI: 10.3171/jns.2000.93.6.0981. PMID: 11117871.
12. Palma L., Mastronardi L., Celli P., d’Addetta R. Cavernous angioma associated with oligoastrocitoma-like proliferation. Report of two cases and review of the literature with a reappraisal of the term “angioglioma”. Acta Neurochir (Wien) 1995;133(3–4):169–73. PMID: 8748761.
13. КKrylov V.V., Dashian V.G., Mukha A.M. Surgical treatment of ruptured cavernouse brain malformation. Nevrologicheskiy zhurnal = Neurological Journal 2016;21(1):24–9 (In Russ.). DOI: 10.18821/1560-9545-2016-21-1-24-29.
14. Lee S.H., Lim Y.J. Stereotactic radiosurgery for cavernous malformations: prejudice from ignorance. Acta Neurochir (Wien) 2015;157(1):51–2. DOI: 10.1007/s00701-014-2269-4. PMID: 25391973.
Review
For citations:
Kravets L.Ya., Gryaznov S.N., Kalinina S.Ya., Avdonina Yu.D., Ivanov P.I. Outcomes of stereotaxic radiosurgery for subtentorial cavernous malformations. Russian journal of neurosurgery. 2018;20(4):40-51. (In Russ.) https://doi.org/10.17650/1683-3295-2018-20-4-40-51
Views:
644
Email this article 