Pathological response of cavernous malformations following radiosurgery. J Neurosurg 2015 Oct;123(4):938-44
Date
06/20/2015Pubmed ID
26090838DOI
10.3171/2014.10.JNS14499Scopus ID
2-s2.0-84953344372 (requires institutional sign-in at Scopus site) 19 CitationsAbstract
OBJECT: Stereotactic radiosurgery (SRS) is a therapeutic option for repeatedly hemorrhagic cavernous malformations (CMs) located in areas deemed to be high risk for resection. During the latency period of 2 or more years after SRS, recurrent hemorrhage remains a persistent risk until the obliterative process has finished. The pathological response to SRS has been studied in relatively few patients. The authors of the present study aimed to gain insight into the effect of SRS on CM and to propose possible mechanisms leading to recurrent hemorrhages following SRS.
METHODS: During a 13-year interval between 2001 and 2013, bleeding recurred in 9 patients with CMs that had been treated using Gamma Knife surgery at the authors' institution. Microsurgical removal was subsequently performed in 5 of these patients, who had recurrent hemorrhages between 4 months and 7 years after SRS. Specimens from 4 patients were available for analysis and used for this report.
RESULTS: Histopathological analysis demonstrated that vascular sclerosis develops as early as 4 months after SRS. In the samples from 2 to 7 years after SRS, sclerotic vessels were prominent, but there were also vessels with incomplete sclerosis as well as some foci of neovascularization.
CONCLUSIONS: Recurrent bleeding after SRS for CM could be related to incomplete sclerosis of the vessels, but neovascularization may also play a role.
Author List
Shin SS, Murdoch G, Hamilton RL, Faraji AH, Kano H, Zwagerman NT, Gardner PA, Lunsford LD, Friedlander RMAuthor
Nathan Zwagerman MD Associate Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Female
Humans
Intracranial Arteriovenous Malformations
Intracranial Hemorrhages
Male
Middle Aged
Radiosurgery
Retrospective Studies
Treatment Outcome
Young Adult
