RADIOSURGERY FOR CAVERNOUS MALFORMATIONS

Object. The authors examined 22 patients with cavernous malformations (CMs) who had undergone gamma knife radiosurgery (GKRS) to assess the value of this procedure in treating these lesions. Methods. At the Kar olinska Hospital, GKRS was used to treat 23 patients with CMs during t he period of 1985 through 1996. One of the patients was lost to follow up and the treatment results of the 22 remaining patients were analyz ed. In the first half of the series, the CMs were treated with high do ses of radiation (> 15-Gy dose to the periphery); in the second half o f the series, lower doses were used. Nine of the 22 patients suffered a post-GKRS hemorrhage and six developed a radiation-induced complicat ion (two of these patients experienced both). Some time after GKRS was performed, surgical removal of the CM had to be undertaken in four pa tients because of hemorrhage and in two patients because of radiation- induced complications. Four of the nine patients who experienced no po st-GKRS hemorrhage or radiation-induced complication were treated befo re 1990; recent magnetic resonance imaging revealed a decrease in the size of the CM in three of these individuals and no size change in the other. T he annual post-GKRS hemorrhage rate was 8% in this group. Th ere was a trend in the hemorrhage rate to decrease 4 years postsurgery . There was also a trend for higher radiation doses administered to th e periphery of the lesion to result in a lower risk of posttreatment h emorrhage. However, it could not be concluded whether GKRS affects the natural course of a CM. The incidence of radiation-induced complicati ons was approximately seven times higher than that expected if the sam e number of patients had been treated by GKRS with the same radiation dose distributions for arteriovenous malformations instead of CMs. Con clusions. The high incidence of radiation-induced complications does n ot seem to justify the limited protection the treatment may afford in only exceptional cases. A prospective randomized study is needed befor e the role of radiosurgery in the management of these lesions can be d efined. Until such a study has proved differently, a caveat must be ra ised for the treatment of CM with GKRS.