Radiosurgery for cerebral cavernous malformations: a systematic review.

BACKGROUND

Stereotactic radiosurgery (SRS) for cerebral cavernous malformations has been used for more than 30 years. However, indications for this method and outcomes are still discussable.

OBJECTIVE

To analyze available literature data on SRS for cerebral cavernous malformations with assessment of indications for treatment, radiation parameters, radiological and clinical complications and outcomes.

RESULTS

The final analysis included 20 reports describing post-SRS outcomes in 1834 patients with cerebral cavernous malformations. The main radiation parameter was mean radiation dose to the edge of cavernous malformation (prescribed dose, 13.25±2.16 Gy). In natural course of malformation, mean incidence of hemorrhages from cavernous malformation when counted after the second hemorrhage was 25.9±14.6%, after the patient's birth - 2.59±0.44%. Mean follow-up period after SRS was 66.7±24.1 months. Incidence of hemorrhages from cavernous malformation after SRS for the first 2 years of follow-up was assessed in 14 studies (4.67±3.51%). Incidence of hemorrhages ≥2 years after SRS was analyzed in 12 studies (1.55±0.8%).

CONCLUSION

Despite significant global experience in SRS for cerebral cavernous malformations and many studies devoted to this problem, clear patient selection criteria have not yet been formulated. Modern selection principles have insufficient evidence base.