Scientific Reports (Oct 2024)
Stereotactic radiosurgery (SRS) for patients with brainstem cerebral cavernous malformations (CCMs): an international, multicentric study
- Sam Dayawansa,
- Chloe Dumot,
- Georgios Mantziaris,
- Zhiyuan Xu,
- Stylianos Pikis,
- Selcuk Peker,
- Yavuz Samanci,
- Gokce D. Ardor,
- Ahmed M. Nabeel,
- Wael A. Reda,
- Sameh R. Tawadros,
- Khaled Abdelkarim,
- Amr M. N. El-Shehaby,
- Reem M. Emad Eldin,
- Ahmed H. Elazzazi,
- Nuria Martínez Moreno,
- Roberto Martínez Álvarez,
- Roman Liscak,
- Jaromir May,
- David Mathieu,
- Jean-Nicolas Tourigny,
- Manjul Tripathi,
- Akshay Rajput,
- Narendra Kumar,
- Rupinder Kaur,
- Piero Picozzi,
- Andrea Franzini,
- Herwin Speckter,
- Wenceslao Hernandez,
- Anderson Brito,
- Ronald E. Warnick,
- Juan Alzate,
- Douglas Kondziolka,
- Greg N. Bowden,
- Samir Patel,
- Jason P. Sheehan
Affiliations
- Sam Dayawansa
- Department of Neurological Surgery, University of Virginia
- Chloe Dumot
- Department of Neurological Surgery, University of Virginia
- Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia
- Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia
- Stylianos Pikis
- Department of Neurological Surgery, University of Virginia
- Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine
- Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine
- Gokce D. Ardor
- Department of Neurosurgery, Koc University School of Medicine
- Ahmed M. Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital
- Wael A. Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital
- Sameh R. Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital
- Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital
- Amr M. N. El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital
- Reem M. Emad Eldin
- Gamma Knife Center Cairo, Nasser Institute Hospital
- Ahmed H. Elazzazi
- Extended Modular Program- Faculty of Medicine, Ain Shams University
- Nuria Martínez Moreno
- Department of Radiosurgery, Rúber Internacional Hospital
- Roberto Martínez Álvarez
- Department of Radiosurgery, Rúber Internacional Hospital
- Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital
- Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital
- David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS
- Jean-Nicolas Tourigny
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research
- Akshay Rajput
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research
- Narendra Kumar
- Department of Radiation Therapy, Postgraduate Institute of Medical Education and Research
- Rupinder Kaur
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research
- Piero Picozzi
- Department of Neurosurgery, Scientific Institute for Research, Hospitalization and Healthcare – IRCCS Humanitas Research Hospital
- Andrea Franzini
- Department of Neurosurgery, Scientific Institute for Research, Hospitalization and Healthcare – IRCCS Humanitas Research Hospital
- Herwin Speckter
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT
- Wenceslao Hernandez
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT
- Anderson Brito
- Dominican Gamma Knife Center and Radiology Department, CEDIMAT
- Ronald E. Warnick
- Gamma Knife Center, Jewish Hospital, Mayfield Clinic
- Juan Alzate
- Department of Neurosurgery, NYU Langone
- Douglas Kondziolka
- Department of Neurosurgery, NYU Langone
- Greg N. Bowden
- Department of Neurosurgery and Department of Oncology, University of Alberta
- Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta
- Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia
- DOI
- https://doi.org/10.1038/s41598-024-77140-z
- Journal volume & issue
-
Vol. 14,
no. 1
pp. 1 – 9
Abstract
Abstract Brainstem cerebral cavernous malformations (CCM) are clinically more aggressive compared to superficial CCMs. Due to their location, resection can be challenging, making stereotactic radiosurgery (SRS) an attractive alternative for symptomatic patient. Brainstem CCM patients (n = 170) were treated with Gamma Knife SRS at 11 radiosurgical centers. Hemorrhagic risk reduction, risk factors of post-SRS hemorrhage, and clinical outcomes were retrospectively analyzed. Most patients had a single (165/170 patients) brainstem CCMs treated; the majority of CCMs (165/181) presented with bleeding. Single-session SRS decreased the risk of repeat hemorrhage in patients with hemorrhagic brainstem CCM (HR: 0.17, p 13 Gy (HR = 2.57, p = 0.044). Adverse radiation effect (ARE) occurred in 9 patients (5.3%) and was symptomatic in four (2.4%). At a median follow-up of 3.4 years (Inter-quartile range: 5.4), 13 patients (8.0%) had a worsened clinical status, with the treated CCM being the cause in 5.6% (10) of the patients. Single-session SRS decreased the risk of repeat hemorrhage in patients with hemorrhagic brainstem CCM and conveyed this benefit with a low risk of advrse radiation effects (ARE) and worsening clinical status.
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