Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaVA-171Radiosurgery for symptomatic cavernous malformationsLong-term results of our institute and all over Japan1Yoshihisa Kida, 1 Toshinori Hasegawa, 1 Takenori Katoh1Komaki City Hospital2Scientific Committee of Japanese Leksell Gamma Knife SocietyObjective: Long-term results of radiosurgery to cavernous malformations(CMs) are reported, andcompared with the symptomatic cases treated with surgery or followed up conservatively.Methods: There are 152 cases of symptomatic CMs, either by hemorrhage, neurological deficits or byepilepsy, which were treated with gamma knife(A). There are another 13 cases with surgical resection(B), and 33 cases with conservative treatment(C) as symptomatic controls.Results: Majority of lesions in Group (A) are located in eloquent areas like brainstem or basal ganglia,followed by lobar and cerebellar lesions. With the mean maximum and marginal dose of 26.4 and14.9 Gy respectively, 30% of them showed a shrinkage and the others were unchanged in the meanfollow-up of 55.4 months. Hemorrhage rate after radiosurgery are far decreased to 3.2%/year/case,which is almost one tenth of the one during 5 years before gamma knife (31.8%). Hemorrhage rateshowed 8% in the first year, then apparently decreased to less than 5% subsequently and finallyreached near to 0% in the 7th year. Convulsive seizures associated with CM either disappeared ordecreased in almost 70% of patients, who were treated with gamma knife.In cases of surgical resection, they had a similar hemorrhage rate to Group (A). In contrast, thehemorrhage rate in Group (C) was 7.6 %/year/case during 62 months of mean follow-up, which ismore than double than Group A.Conclusions: The purposes of radiosurgery for symptomatic CMs are not totally irradicate the lesions,but to successfully control the symptomatic events. Because of markedly decreased rate of hemorrhagewith acceptable rate of complications, radiosurgery for cavernous malformation is warranted andadvisable, especially for CMs in brainstem and basal ganglia with less than 15Gy at the margins.However, suprotentorial CMs associated with intractable seizures can be treated with surgery, sincethe effects of radiosurgery are not consitent. Moreover, a higher marginal dose more than 18Gy,which may cause adverse effects more often, is required to successfully control seizures.In this report, the results of radiosurgery from many institutes in Japan are collected and comparedwith ours.78
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaVA-190Gamma knife therapy for cavernous hemangiomas ofthe cavernous sinus: clinical outcome of 39 patients.Wei Wang, Peng Li, Haibo RenDepartment of neurosurgery, West China Hospital of Sichuan UniversityObjective: A retrospective study was carried out to evaluate the efficacy and safety of gamma knife(GK) for cavernous hemangiomas of the cavernous sinus (CHCS).Methods: From July 2004 to March 2010, forty-two patients with CHCS underwent gamma knife therapyat West China Hospital of Sichuan University. Among these patients, 38 patients underwent GKas the initial treatment; the other 4 cases had GK treatment after microsurgery. An average prescriptiondose was 13.3Gy (12-15Gy) at 47.9% (40-50%) isodose line. All patients were followed-up byperiodical enhanced MRI scan and physical examination. The improvement of clinical symptoms andtumor control were analyzed.Results: Thirty-nine patients accomplished follow-up with a mean duration of 38.4 months. Completetumor remission (tumor size decreased more than 90%) was observed in 7 patients. Twenty-eightpatients had significant tumor control (tumor size decreased more than 30%). No significant change intumor size was reported in 4 patients. Clinical symptoms were reported including headache (33 cases),facial numbness (19 cases), facial pain (14 cases) and diplopia (6 cases). Significant improvement inheadache, facial numbness, facial pain and diplopia was reported in 27, 11, 11 and 5 patients respectively.No newly developed cranial nerve damages were observed.Conclusions: The preliminary result indicated that GK might be an effective and safe option forCHCS management. Long term follow-up and more cases are needed to investigate the advantageand disadvantage of this management.79
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Plenary Oral Presentations - Macquarie University Hospital

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