Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study.

IF 4.4 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology Pub Date : 2024-06-21 DOI:10.1136/svn-2023-002380

Chloe Dumot, Georgios Mantziaris, Sam Dayawansa, 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 Sheehan

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引用次数: 0

Abstract

Background: Cerebral cavernous malformations (CCMs) frequently manifest with haemorrhages. Stereotactic radiosurgery (SRS) has been employed for CCM not suitable for resection. Its effect on reducing haemorrhage risk is still controversial. The aim of this study was to expand on the safety and efficacy of SRS for haemorrhagic CCM.

Methods: This retrospective multicentric study included CCM with at least one haemorrhage treated with single-session SRS. The annual haemorrhagic rate (AHR) was calculated before and after SRS. Recurrent event analysis and Cox regression were used to evaluate factors associated with haemorrhage. Adverse radiation effects (AREs) and occurrence of new neurological deficits were recorded.

Results: The study included 381 patients (median age: 37.5 years (Q1-Q3: 25.8-51.9) with 414 CCMs. The AHR from diagnosis to SRS excluding the first haemorrhage was 11.08 per 100 CCM-years and was reduced to 2.7 per 100 CCM-years after treatment. In recurrent event analysis, SRS, HR 0.27 (95% CI 0.17 to 0.44), p<0.0001 was associated with a decreased risk of haemorrhage, and the presence of developmental venous anomaly (DVA) with an increased risk, HR 1.60 (95% CI 1.07 to 2.40), p=0.022. The cumulative risk of first haemorrhage after SRS was 9.4% (95% CI 6% to 12.6%) at 5 years and 15.6% (95% CI% 9 to 21.8%) at 10 years. Margin doses> 13 Gy, HR 2.27 (95% CI 1.20 to 4.32), p=0.012 and the presence of DVA, HR 2.08 (95% CI 1.00 to 4.31), p=0.049 were factors associated with higher probability of post-SRS haemorrhage. Post-SRS haemorrhage was symptomatic in 22 out of 381 (5.8%) patients, presenting with transient (15/381) or permanent (7/381) neurological deficit. ARE occurred in 11.1% (46/414) CCM and was responsible for transient neurological deficit in 3.9% (15/381) of the patients and permanent deficit in 1.1% (4/381) of the patients. Margin doses >13 Gy and CCM volume >0.7 cc were associated with increased risk of ARE.

Conclusion: Single-session SRS for haemorrhagic CCM is associated with a decrease in haemorrhage rate. Margin doses ≤13 Gy seem advisable.

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立体定向放射外科治疗出血性脑海绵畸形：一项多机构回顾性研究。

背景：脑海绵畸形（CCMs）经常表现为出血。立体定向放射外科（SRS）已被用于治疗不适合切除的脑海绵状畸形。但其对降低出血风险的效果仍存在争议。本研究的目的是扩大 SRS 对出血型 CCM 的安全性和有效性：这项回顾性多中心研究纳入了接受单次 SRS 治疗的至少有一次出血的 CCM。计算了SRS前后的年出血率（AHR）。复发事件分析和 Cox 回归用于评估与出血相关的因素。研究还记录了放射不良反应（AREs）和新出现的神经功能缺损：研究共纳入 381 名患者（中位年龄：37.5 岁（Q1-Q3：25.8-51.9），414 例 CCM。从诊断到 SRS（不包括首次出血）的 AHR 为每 100 CCM 年 11.08 例，治疗后降至每 100 CCM 年 2.7 例。在复发事件分析中，SRS，HR 0.27（95% CI 0.17 至 0.44），p 13 Gy，HR 2.27（95% CI 1.20 至 4.32），p=0.012，以及存在 DVA，HR 2.08（95% CI 1.00 至 4.31），p=0.049 是 SRS 后出血概率较高的相关因素。381例患者中有22例（5.8%）出现SRS后出血症状，表现为一过性（15/381）或永久性（7/381）神经功能缺损。11.1%（46/414）的 CCM 发生了 ARE，3.9%（15/381）的患者出现一过性神经功能缺损，1.1%（4/381）的患者出现永久性神经功能缺损。边缘剂量大于 13 Gy 和 CCM 体积大于 0.7 cc 与 ARE 风险增加有关：结论：单次 SRS 治疗出血性 CCM 可降低出血率。边缘剂量≤13 Gy似乎是可取的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stroke and Vascular Neurology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

11.20

自引率

1.70%

发文量

审稿时长

15 weeks

期刊介绍： Stroke and Vascular Neurology (SVN) is the official journal of the Chinese Stroke Association. Supported by a team of renowned Editors, and fully Open Access, the journal encourages debate on controversial techniques, issues on health policy and social medicine.