The Incidence of Imaging Abnormalities after Stereotactic Radiosurgery for Cerebral Arteriovenous and Cavernous Malforma
The aim of the study was to evaluate the incidence of postirradiation imaging changes after stereotactic radiosurgery for arteriovenous malformations (AVM) and cerebral cavernous malformations (CCM).
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Abstract Objective The aim of the study was to evaluate the incidence of postirradiation imaging changes after stereotactic radiosurgery for arteriovenous malformations (AVM) and cerebral cavernous malformations (CCM). Material and Methods A group of 85 patients treated for arteriovenous malformations (62 patients, 73%) and cavernomas (23 patients, 27%) between October 2001 and December 2005 was analyzed. All patients were treated with stereotactic radiosurgery with doses ranging from 8-28 Gy. After the irradiation, magnetic resonance imaging (MRI) or computed tomography (CT) was performed at 6 to 12-month intervals to assess the effects of the treatment. The mean follow-up time for the whole group was 27.3 months; AVM group – 26 months; CCM group – 30.9 months. All the imaging data were carefully reviewed to identify the radiological symptoms of postradiosurgical damage. T2 or FLAIR hyperintensity, T1-hypointensity and contrast enhancement on MRI and the presence of hypodense areas and contrast enhancement on CT examinations were assessed. Results Imaging abnormalities were found in 28 (33%) patients. The symptoms of postradiosurgical damage were observed in 21 (33.9%) patients in the AVM group and 7 (30.4%) patients in the CCM group. Radiological symptoms of radiation necrosis associated with neurological deterioration were identified in two patients with cavernomas, while no
S. Blamek (*), K. Ficek, L. Miszczyk, and R. Tarnawski Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branchul, Wybrzeże Armii Krajowej 15, Gliwice 44-100, Poland e-mail: [email protected] M. Boba and B. Eksner Department of Radiology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, ul. Wybrzeże Armii Krajowej 15, Gliwice Branch, 44-100, Gliwice, Poland D. Larysz and A. Rudnik Department of Neurosurgery, Medical University of Silesia, Katowice, U1 Medykow 16, Katowice 40-752, Poland
radiation necrosis was found in the AVM group. Patients in whom radiological signs of focal brain edema or gliosis existed were asymptomatic. Conclusions Radiological symptoms of postradiosurgical damage affected about one third of the irradiated patients, typically without any clinical manifestations. Patients irradiated for CCMs seem to be more prone to develop symptomatic postradiosurgical necrosis; this observation, however, requires further investigation. Keywords Stereotactic radiosurgery • arteriovenous malformations • cavernomas • radiation injury
Background and Purpose Although stereotactic radiosurgery (SRS) is a widely recognized method of treatment for cerebral arteriovenous malformations (AVMs), its usefulness in the treatment of cerebral cavernous malformations (CCMs) is still a subject of debate. Most reports concerning the effects of AVM or CCM treatment concentrate on the rate of AVM obliteration and the incidence of cerebral hemorrhages from AVMs or CCMs after radiosurgical treatment. Although incidence and factors influencing the probability of developi
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