PT  - JOURNAL ARTICLE
AU  - Dumot, Chloe
AU  - Mantziaris, Georgios
AU  - Dayawansa, Sam
AU  - Xu, Zhiyuan
AU  - Pikis, Stylianos
AU  - Peker, Selcuk
AU  - Samanci, Yavuz
AU  - Ardor, Gokce D
AU  - Nabeel, Ahmed M
AU  - Reda, Wael A
AU  - Tawadros, Sameh R
AU  - Abdelkarim, Khaled
AU  - El-Shehaby, Amr M N
AU  - Emad Eldin, Reem M
AU  - Elazzazi, Ahmed H
AU  - Moreno, Nuria Martínez
AU  - Martínez Álvarez, Roberto
AU  - Liscak, Roman
AU  - May, Jaromir
AU  - Mathieu, David
AU  - Tourigny, Jean-Nicolas
AU  - Tripathi, Manjul
AU  - Rajput, Akshay
AU  - Kumar, Narendra
AU  - Kaur, Rupinder
AU  - Picozzi, Piero
AU  - Franzini, Andrea
AU  - Speckter, Herwin
AU  - Hernandez, Wenceslao
AU  - Brito, Anderson
AU  - Warnick, Ronald E
AU  - Alzate, Juan
AU  - Kondziolka, Douglas
AU  - Bowden, Greg N
AU  - Patel, Samir
AU  - Sheehan, Jason
TI  - Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study
AID  - 10.1136/svn-2023-002380
DP  - 2024 Jun 01
TA  - Stroke and Vascular Neurology
PG  - 221--229
VI  - 9
IP  - 3
4099  - http://svn.bmj.com/content/9/3/221.short
4100  - http://svn.bmj.com/content/9/3/221.full
SO  - Stroke Vasc Neurol2024 Jun 01; 9
AB  - Background Cerebral cavernous malformations (CCMs) frequently manifest with haemorrhages. Stereotactic radiosurgery (SRS) has been employed for CCM not suitable for resection. Its effect on reducing haemorrhage risk is still controversial. The aim of this study was to expand on the safety and efficacy of SRS for haemorrhagic CCM.Methods This retrospective multicentric study included CCM with at least one haemorrhage treated with single-session SRS. The annual haemorrhagic rate (AHR) was calculated before and after SRS. Recurrent event analysis and Cox regression were used to evaluate factors associated with haemorrhage. Adverse radiation effects (AREs) and occurrence of new neurological deficits were recorded.Results The study included 381 patients (median age: 37.5 years (Q1–Q3: 25.8–51.9) with 414 CCMs. The AHR from diagnosis to SRS excluding the first haemorrhage was 11.08 per 100 CCM-years and was reduced to 2.7 per 100 CCM-years after treatment. In recurrent event analysis, SRS, HR 0.27 (95% CI 0.17 to 0.44), p<0.0001 was associated with a decreased risk of haemorrhage, and the presence of developmental venous anomaly (DVA) with an increased risk, HR 1.60 (95% CI 1.07 to 2.40), p=0.022. The cumulative risk of first haemorrhage after SRS was 9.4% (95% CI 6% to 12.6%) at 5 years and 15.6% (95% CI% 9 to 21.8%) at 10 years. Margin doses> 13 Gy, HR 2.27 (95% CI 1.20 to 4.32), p=0.012 and the presence of DVA, HR 2.08 (95% CI 1.00 to 4.31), p=0.049 were factors associated with higher probability of post-SRS haemorrhage. Post-SRS haemorrhage was symptomatic in 22 out of 381 (5.8%) patients, presenting with transient (15/381) or permanent (7/381) neurological deficit. ARE occurred in 11.1% (46/414) CCM and was responsible for transient neurological deficit in 3.9% (15/381) of the patients and permanent deficit in 1.1% (4/381) of the patients. Margin doses >13 Gy and CCM volume >0.7 cc were associated with increased risk of ARE.Conclusion Single-session SRS for haemorrhagic CCM is associated with a decrease in haemorrhage rate. Margin doses ≤13 Gy seem advisable.Data are available upon reasonable request. Data are available on reasonable request to the corresponding author.