Role of Radiosurgery for Cerebral Vascular Malformations : Emphasis on Brain Stem Lesions

Ju, Jeong-Hyuk; Jung, Chul-Ku; Ha, Ho-Gyun; Kim, Hyun-Woo; Lee, Cheol-Young

Original article

Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2012;8(2):97-103.
Published online September 30, 2012.

Role of Radiosurgery for Cerebral Vascular Malformations : Emphasis on Brain Stem Lesions

Jeong-Hyuk Ju, Chul-Ku Jung, Ho-Gyun Ha, Hyun-Woo Kim, Cheol-Young Lee

Department of Neurosurgery, Konyang University College of Medicine, Daejeon, Korea

Abstract

Objective
s: To study the role of radiosurgery, we focused on the effectiveness of radiosurgery on cerebral vascular malformation in high surgical risk patients whose vascular malformation was located at the eloquent or deep seated region and simultaneously the anatomical feature of mixed vascular malformation on brainstem. Material and Methods: We retrospectively analyzed the outcomes of 18 lesions in 18 patients with cerebral vascular malformation who underwent X-ray based radiosurgery using a CyberKnife between 2007 and 2011. The average patient age was 41 years (range 15-66 years) and 13 were male. Four lesions were in the posterior fossa (brainstem, 3 ; cerebellum, 1). The diagnosis was made by brain computed tomography (CT), magnetic resonance imaging (MRI) with Gadorinium enhancement, and cerebral angiography. MRI scan was performed 6 month interval. Complete obliteration of malformed vessels was confirmed using cerebral angiography.
Results
The median follow-up period was 22 months (range 7-57 months). Among 18 cerebral vascular malformation patients, 10 patients showed arteriovenous malformation (AVM), 8 patients showed other cerebral vascular malformations. Other cerebral vascular malformations included cavernous malformation in 3 patients, developmental venous anomaly in 1, capillary telangiectasia in 1, mixed vascular malformation in 3. Among 10 AVM patients, 6 patients showed complete obliteration. After the radiosurgery, rebleeding and seizure occurred in one patient each. Patients did not have surgery-induced morbidity after radiosurgery.
Conclusions
For cerebral vascular malformations in patients with high surgical risks, radiosurgery is a safe and effective treatment modality.

Key Words: Radiosurgery, Vascular malformation, Brain stem.