RT Journal Article
SR Electronic
T1 Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 221
OP 229
DO 10.1136/svn-2023-002380
VO 9
IS 3
A1 Dumot, Chloe
A1 Mantziaris, Georgios
A1 Dayawansa, Sam
A1 Xu, Zhiyuan
A1 Pikis, Stylianos
A1 Peker, Selcuk
A1 Samanci, Yavuz
A1 Ardor, Gokce D
A1 Nabeel, Ahmed M
A1 Reda, Wael A
A1 Tawadros, Sameh R
A1 Abdelkarim, Khaled
A1 El-Shehaby, Amr M N
A1 Emad Eldin, Reem M
A1 Elazzazi, Ahmed H
A1 Moreno, Nuria Martínez
A1 Martínez Álvarez, Roberto
A1 Liscak, Roman
A1 May, Jaromir
A1 Mathieu, David
A1 Tourigny, Jean-Nicolas
A1 Tripathi, Manjul
A1 Rajput, Akshay
A1 Kumar, Narendra
A1 Kaur, Rupinder
A1 Picozzi, Piero
A1 Franzini, Andrea
A1 Speckter, Herwin
A1 Hernandez, Wenceslao
A1 Brito, Anderson
A1 Warnick, Ronald E
A1 Alzate, Juan
A1 Kondziolka, Douglas
A1 Bowden, Greg N
A1 Patel, Samir
A1 Sheehan, Jason
YR 2024
UL http://svn.bmj.com/content/9/3/221.abstract
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.