Detail
Article
Online article
FT
Medvik - BMC
  • Something wrong with this record ?

Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study

C. Dumot, G. Mantziaris, S. Dayawansa, Z. Xu, S. Pikis, S. Peker, Y. Samanci, GD. Ardor, AM. Nabeel, WA. Reda, SR. Tawadros, K. Abdelkarim, AMN. El-Shehaby, RM. Emad Eldin, AH. Elazzazi, NM. Moreno, R. Martínez Álvarez, R. Liscak, J. May, D....

. 2024 ; 9 (3) : 221-229. [pub] 20240621

Language English Country England, Great Britain

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc24013473

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.

References provided by Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc24013473
003      
CZ-PrNML
005      
20240905134344.0
007      
ta
008      
240725s2024 enk f 000 0|eng||
009      
AR
024    7_
$a 10.1136/svn-2023-002380 $2 doi
035    __
$a (PubMed)37586775
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a enk
100    1_
$a Dumot, Chloe $u Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA $1 https://orcid.org/0000000313332533
245    10
$a Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study / $c C. Dumot, G. Mantziaris, S. Dayawansa, Z. Xu, S. Pikis, S. Peker, Y. Samanci, GD. Ardor, AM. Nabeel, WA. Reda, SR. Tawadros, K. Abdelkarim, AMN. El-Shehaby, RM. Emad Eldin, AH. Elazzazi, NM. Moreno, R. Martínez Álvarez, R. Liscak, J. May, D. Mathieu, JN. Tourigny, M. Tripathi, A. Rajput, N. Kumar, R. Kaur, P. Picozzi, A. Franzini, H. Speckter, W. Hernandez, A. Brito, RE. Warnick, J. Alzate, D. Kondziolka, GN. Bowden, S. Patel, J. Sheehan
520    9_
$a 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.
650    _2
$a lidé $7 D006801
650    12
$a radiochirurgie $x škodlivé účinky $7 D016634
650    _2
$a retrospektivní studie $7 D012189
650    _2
$a mužské pohlaví $7 D008297
650    _2
$a ženské pohlaví $7 D005260
650    12
$a kavernózní hemangiom centrálního nervového systému $x chirurgie $7 D020786
650    _2
$a dospělí $7 D000328
650    _2
$a lidé středního věku $7 D008875
650    _2
$a rizikové faktory $7 D012307
650    _2
$a výsledek terapie $7 D016896
650    _2
$a časové faktory $7 D013997
650    _2
$a hodnocení rizik $7 D018570
650    _2
$a recidiva $7 D012008
650    _2
$a cerebrální krvácení $x etiologie $7 D002543
655    _2
$a časopisecké články $7 D016428
655    _2
$a multicentrická studie $7 D016448
700    1_
$a Mantziaris, Georgios $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
700    1_
$a Dayawansa, Sam $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
700    1_
$a Xu, Zhiyuan $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
700    1_
$a Pikis, Stylianos $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
700    1_
$a Peker, Selcuk $u Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey $1 https://orcid.org/0000000330573355
700    1_
$a Samanci, Yavuz $u Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
700    1_
$a Ardor, Gokce D $u Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
700    1_
$a Nabeel, Ahmed M $u Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt $u Neurosurgery Department, Benha University, Benha, Egypt
700    1_
$a Reda, Wael A $u Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt $u Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
700    1_
$a Tawadros, Sameh R $u Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt $u Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
700    1_
$a Abdelkarim, Khaled $u Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt $u Department of Clinical Oncology, Ain Shams University, Cairo, Egypt
700    1_
$a El-Shehaby, Amr M N $u Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt $u Departments of Neurosurgery, Ain Shams University, Cairo, Egypt
700    1_
$a Emad Eldin, Reem M $u Gamma-knife Center, Nasser institute Hospital, Cairo, Egypt $u Department of Radiation Oncology, National Cancer Institute, Cairo University, Giza, Egypt
700    1_
$a Elazzazi, Ahmed H $u Faculty of Medicine, Extended Modular Program, Ain Shams University, Cairo, Egypt
700    1_
$a Moreno, Nuria Martínez $u Department of Radiosurgery, Rúber Internacional Hospital, Madrid, Spain
700    1_
$a Martínez Álvarez, Roberto $u Department of Radiosurgery, Rúber Internacional Hospital, Madrid, Spain
700    1_
$a Liscak, Roman $u Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
700    1_
$a May, Jaromir $u Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
700    1_
$a Mathieu, David $u Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
700    1_
$a Tourigny, Jean-Nicolas $u Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
700    1_
$a Tripathi, Manjul $u Neurosurgery, PGIMER, Chandigarh, Chandigarh, India
700    1_
$a Rajput, Akshay $u Neurosurgery, PGIMER, Chandigarh, Chandigarh, India
700    1_
$a Kumar, Narendra $u Radiation Therapy, PGIMER, Chandigarh, Chandigarh, India
700    1_
$a Kaur, Rupinder $u Neurosurgery, PGIMER, Chandigarh, Chandigarh, India
700    1_
$a Picozzi, Piero $u Neurosurgery, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
700    1_
$a Franzini, Andrea $u Neurosurgery, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
700    1_
$a Speckter, Herwin $u Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
700    1_
$a Hernandez, Wenceslao $u Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
700    1_
$a Brito, Anderson $u Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
700    1_
$a Warnick, Ronald E $u Gamma Knife Center, Mayfield Clinic, The Jewish Hospital - Mercy Health, Cincinnati, Ohio, USA
700    1_
$a Alzate, Juan $u Neurosurgery, NYU Langone Health, New York, New York, USA
700    1_
$a Kondziolka, Douglas $u Neurosurgery, NYU Langone Health, New York, New York, USA
700    1_
$a Bowden, Greg N $u Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
700    1_
$a Patel, Samir $u Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
700    1_
$a Sheehan, Jason $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA jsheehan@virginia.edu
773    0_
$w MED00198792 $t Stroke and vascular neurology $x 2059-8696 $g Roč. 9, č. 3 (2024), s. 221-229
856    41
$u https://pubmed.ncbi.nlm.nih.gov/37586775 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y - $z 0
990    __
$a 20240725 $b ABA008
991    __
$a 20240905134338 $b ABA008
999    __
$a ok $b bmc $g 2143349 $s 1225339
BAS    __
$a 3
BAS    __
$a PreBMC-MEDLINE
BMC    __
$a 2024 $b 9 $c 3 $d 221-229 $e 20240621 $i 2059-8696 $m Stroke and vascular neurology $n Stroke Vasc Neurol $x MED00198792
LZP    __
$a Pubmed-20240725

Find record

Citation metrics

Archiving options