Radiosurgery for cavernous malformations and other vascular diseases

Abstract

Cavernous malformations are angiographically occult vascular malformations that can form in any vascular bed in the brain. The incidence is believed to be between 0.5 and 1 % and accounts for 15 % of intracranial vascular malformations. They possess a complex natural history and can be solitary or multiple. Symptomatic cavernous malformations often present with seizures, focal neurological deficit, or hemorrhage. The natural history for a cavernous malformation that has never bled is between 0.5 and 2.5 % per year. However, once a hemorrhage has occurred, the risk per year is often greater than 30 %. When these lesions present in deep structures with hemorrhage, the risk of permanent neurological deficit implores active management. Unfortunately in these locations the risk of surgical intervention is often significant. Gamma Knife when used in a properly selected patient population with experienced personnel provides a safer treatment option capable of reducing long-term hemorrhage risk. In this chapter we review the evidence-based literature and clinical experience associated with the treatment of cavernous malformations by Gamma Knife radiosurgery. In doing so we take into account the natural history and surgical literature to provide an adequate understanding of a topic that has resulted in significant debate over the years.​