Gamma Knife Stereotactic Radiosurgery For Thalamic

Keywords: cavernous malformation, brain stem, gamma knife, thalamus, outcome

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     To determine outcome following gamma knife stereotactic radiosurgery (GKS) as the primary modality of treatment for cavernous angioma (CA) of the thalamus and brainstem.
     Over a period of 10 years a series of 18 consecutively presenting patients (M = 9, F = 9) with thalamic or brainstem CA were treated with GKS to a single lesion, specifically excluding the haemosiderin ring from the target. Nine patients had previously suffered one symptomatic haemorrhage, and nine had suffered more than one symptomatic haemorrhage within the year prior to treatment. Mean age at treatment was 39.4 years (15-55 years).
     Mean prescription dose 13.4Gy (11.0Gy to 16.0Gy). Patients were followed up radiologically and, more importantly, clinically for a mean period of 42.2 months (2-101 months), median 36 months.
     One patient suffered recurrent haemorrhage at 23 months post-GKS, but has not re-bled in 61 months following this ictus.  There have been no other clinical episodes or radiological findings to suggest post-GKS haemorrhage in the remaining 16 patients. One patient has been lost to follow up. One patient died at 90 months post treatment from complications related to hydrocephalus and its treatment, a condition which pre-dated his GKS. No complications were observed in the treated population. We discuss these results in the light of those previously reported in the literature.  
     This is a retrospective study.
     GKS is safe and effective in the treatment of thalamic & brainstem CA.
     As assessed by significant reduction in observed rate of re-bleed over that expected from the known natural history of those CAs which have already demonstrated a tendency to haemorrhage in highly eloquent areas.


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