Radiosurgery with a Rotating Gamma System: A Very Effective Treatment for Symptomatic Cerebral Cavernomas

Abstract

Aim: To evaluate the value of radiosurgery with a rotating gamma-system (RGS) for cerebral cavernomas.

Patients and methods: Seventy-nine patients with symptomatic cerebral cavernomas underwent RGS radiosurgery at the Bach Mai Hospital, Hanoi, Vietnam. Median dose (single fraction) was 20 Gy (range=14-26 Gy). Endpoints included effect on headache, seizures and tumor size.

Results: Of 60 patients with headache, 17% had complete response, 82% partial response and 2% stable disease (best response). Of 39 patients with seizures, 31% had complete response, 64% partial response and 5% stable disease. Four patients developed recurrent seizures after 1 year. Regarding the size of cavernoma at 15 months, complete response was observed in 6%, partial response in 75%, stable disease in 15%, progression in 1% and pseudo-progression in 3% of patients. Bleeding within 2 years after RGS radiosurgery occurred in only five patients (6%). RGS dose had no significant impact on outcomes.

Conclusion: RGS radiosurgery provided very high rates of symptom relief in patients with cerebral cavernomas.

Keywords: Cerebral cavernoma; Rotating-Gamma System; cavernous angioma; cavernous hemangioma; headache; radiosurgery; seizures; symptom relief.