Outcome of intracerebral cavernoma treated by Gamma Knife radiosurgery based on a double-blind assessment of treatment indication
Purpose The benefit and risk profile of Gamma Knife radiosurgery (GKRS) for intracerebral cavernoma remains undefined due to the low incidence of bleeding and spontaneous regression of cavernoma. We retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with GKRS using a double blinded review process for treatment. Methods From 2003 to 2018, 94 cases of cavernoma were treated by GKRS with margin dose of 11–12 Gy. The treatment
... reatment indications were doubly blinded assessed by two experienced neurosurgeon and afterward assessed for neurological outcome, radiologic response, and quality of life. Results Seven of 16(43.7%) achieved seizure freedom and 9 of 16 (56.3%) achieved decreased seizures. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post GKRS. The nidus volume demonstrated the decrease in 20 (21.3%) cases, 69(73.4%) stable and 5 (7.3%) increase. Eight-seven of 94 (92.5%) cases achieve improvement in their quality of life. The effective seizure control was correlated with patients harboring a single lesion (p < 0.05) and deep seated location of the cavernoma (p < 0.01). New neurological deficits were correlated with decreased mental (p < 0.001) and physical (p < 0.05) components of quality of life testing, KPS (p < 0.001), deep seated location (p < 0.01), and increased nidus volume (p < 0.05). Quality of life deterioration either in physical component (p < 0.01), mental component (p < 0.01), and KPS (p < 0.05) was correlated with increased cavernoma volume. Conclusion Low margin dose GKRS for intracerebral cavernoma offers reasonable seizure control and improved quality of life with a low risk of treatment complications.