OBJECTIVE: There are few reports of outcomes following stereotactic radiosurgery (SRS) for the management of cerebral cavernous malformations (CCMs) of the basal ganglia or thalamus. Therefore, the authors aimed to clarify these outcomes. METHODS: Centers participating in the International Radiosurgery Research Foundation were queried for CCM cases managed with SRS from October 2001 to February 2021. The primary outcome of interest was hemorrhage-free survival (HFS) with a secondary outcome of symptomatic adverse radiation events (AREs). Assessment of the association of prognostic factors with HFS was conducted via Kaplan-Meier analysis and log-rank test. Chi-square tests were conducted to assess potential factors associated with the incidence of AREs. RESULTS: Seventy-three patients were identified. The median patient age was 43.5 years (range 4.4-79.5 years). Fifty-nine (80.8%) patients had hemorrhage prior to SRS. The median treatment volume was 0.9 cm3 (range 0.07-10.1 cm3) with a median margin prescription dose (MPD) of 12 Gy (range 10-20 Gy). One-, 3-, 5-, and 10-year HFS were 93.0%, 89.9%, 89.9%, and 83.0%, respectively, with one hemorrhage-related death approximately 1 year after SRS and nearly 60% and 30% of patients having improvement or stability of symptoms, respectively. There was no correlation between lesion size or MPD and HFS. Seven (9.6%) patients experienced AREs (MPDs > 12 Gy in all cases). Lesion size > 1.0 cm3 was correlated with the incidence of an ARE (p = 0.019). Forty-two (93.3%) of 45 patients treated with an MPD ≤ 12 Gy experienced neither hemorrhage nor AREs following SRS versus 17 (60.7%) of 28 patients treated with an MPD > 12 Gy (p = 0.0006). CONCLUSIONS: SRS is a reasonable treatment strategy and confers clinical stability or improvement and hemorrhage avoidance in patients harboring CCMs of the basal ganglia or thalamus. An MPD of approximately 12 Gy is recommended for the management of CCM.

Clinical Oncology Ain Shams University Cairo Egypt

Department of Neurological Surgery Civil Hospices of Lyon France

Department of Neurological Surgery University of Virginia Charlottesville Virginia

Department of Neurosurgery and

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery NYU Langone New York New York

Department of Neurosurgery Scientific Institute for Research Hospitalization and Healthcare IRCCS Humanitas Research Hospital Milan Italy

Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt

Department of Radiation Oncology The James Cancer Hospital and Solove Research Institute The Ohio State University Wexner Medical Center Columbus Ohio

Department of Radiosurgery Rúber International Hospital Madrid Spain

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Departments of14Neurosurgery and

Departments of7Neurosurgery and

Division of Neurosurgery Université de Sherbrooke Centre de Recherche du CHUS Sherbrooke Québec Canada

Division of Radiation Oncology Department of Oncology University of Alberta Edmonton Alberta Canada

Dominican Gamma Knife Center and Radiology Department CEDIMAT Santo Domingo Dominican Republic

Extended Modular Program Faculty of Medicine Ain Shams University Cairo Egypt

Gamma Knife Center Cairo Nasser Institute Hospital Cairo Egypt

Gamma Knife Center Jewish Hospital Mayfield Clinic Cincinnati Ohio

Neurosurgery Department Faculty of Medicine Benha University Qalubya Egypt

Radiation Therapy Postgraduate Institute of Medical Education and Research Chandigarh India

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