A series of 3 patients (35-60 years old) with bleeding distal aneurysm not associated with AVM who underwent radiosurgery by gamma knife are reported. One isocentre centralized over the aneurysm was used; peripheral dose 24-28.8 Gy was applied. Control angiography 20-36 months after gamma knife surgery (GKS) demonstrated obliteration of both the aneurysm and the feeding artery, without deterioration of the neurological symptoms. Our case series implies that GKS might serve as a safe mini-invasive technique in the treatment of selected distal aneurysms.
- MeSH
- aneurysma * MeSH
- arterie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- radiochirurgie * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
- MeSH
- klinické rozhodování MeSH
- lidé MeSH
- metastázy nádorů terapie MeSH
- nádory mozku terapie MeSH
- radiochirurgie * využití MeSH
- terciární zdravotní péče MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- rozhovory MeSH
- Geografické názvy
- Česká republika MeSH
The goal of pituitary adenoma radiosurgery is to halt tumor growth, normalize hormonal hypersecretion if present, maintain normal pituitary function, and preserve important structures around the sella. The radiation dose necessary to stop tumor growth is lower than the dose necessary to achieve normalization of hormonal hypersecretion. The minimum distance required between the irradiated target and the optic pathway should be 2 mm for secreting adenomas, but in cases of nonsecreting adenomas this distance is even lower. The current role of radiosurgery in most cases is as an adjuvant treatment of residual or recurrent adenomas after previous microsurgery.
- MeSH
- adenom patologie chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru * MeSH
- nádory hypofýzy patologie chirurgie MeSH
- nemoci hypofýzy chirurgie MeSH
- radiochirurgie škodlivé účinky metody MeSH
- reziduální nádor MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE: Radiosurgery of cavernomas should prevent rebleeding, growth of the lesion, and deterioration of clinical symptoms. However, there is no direct diagnostic tool to verify the endpoints of treatment. At present, the positive effects of radiosurgery are identified by clinical observation and analysis of imaging changes on magnetic resonance imaging during a sufficiently long follow-up period. METHODS: Between 1992 and 2000, a total of 112 patients with brain cavernomas were treated with Gamma Knife radiosurgery at our center. In all, 59 patients experienced bleeding before radiosurgery; the remainder did not. The median age of patients was 42 years, the median volume of the cavernomas was 0.9 cm(3), and the median applied marginal dose was 16 Gy. RESULTS: After a 2-year latent interval after treatment (median follow-up 84 months), the risk of bleeding in the group of patients with bleeding before radiosurgery had decreased from 3.7 % to 0.2 %. For the patients without bleeding before radiosurgery, the annual risk of bleeding was 0.8 %. The cavernoma size decreased in 53.0 % of cases and increased in 6.4 %. Epilepsy, if present before the treatment, was alleviated in 45 % of cases. The risks of temporary or permanent morbidity caused by radiosurgery were 14.6 % and 0.9 %, respectively. CONCLUSION: Radiosurgery of cavernomas was associated with a low risk of permanent morbidity. The risk of rebleeding after the 2-year latent interval after radiosurgery had decreased. Treatment of cavernomas with no history of bleeding was halted at our center.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- Kaplanův-Meierův odhad MeSH
- kavernózní hemangiom mortalita chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory mozku mortalita chirurgie MeSH
- pooperační komplikace MeSH
- radiochirurgie metody MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The radiosurgery of cavernomas remains a controversial issue. The only way to verify the positive effect of the treatment is by clinical observation during a longer follow-up period, where a decreased annual risk of rebleeding should be observed after the latent interval inherent to radiosurgery. Besides this, an improvement in clinical symptoms (e.g. secondary epilepsy) and regression of the treated lesion might also be observed. In a group of 112 patients with brain cavernomas treated in our centre between 1992 and 2000 with the marginal dose of a median 16 Gy, the risk of bleeding decreased from 2% before the treatment to 0.5% after 2 years' latent interval (median follow-up 84 months). A decrease in the extent of the cavernoma was observed in 53% of cases and an increase in 6.4%. Epilepsy, if present before the treatment, improved in 45% of cases. The risk of temporary and permanent morbidity caused by radiosurgery was 14.6 and 0.9%, respectively. This morbidity can be reduced by a lower marginal dose, and future studies should show if repeated radiosurgery decreases the risks from a natural course of the disease in those cases where the initial radiosurgery failed.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- kavernózní hemangiom centrálního nervového systému diagnóza epidemiologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- následné studie MeSH
- pooperační komplikace epidemiologie prevence a kontrola MeSH
- radiochirurgie trendy MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- radiochirurgie metody přístrojové vybavení MeSH
- radioterapie metody přístrojové vybavení MeSH
- Publikační typ
- novinové články MeSH
