Radiosurgery for cavernomas - A meta-analysis

The efficacy of radiosurgery for cavernomas is controversial. Some recommend it, while others claim that radiosurgery is contraindicated for this pathology. An attempt was therefore made to analyze these differences in opinions and to define the role of radiosurgery in the management of cavernomas. A meta-analysis of the literature reporting results from cavernoma radiosurgery was performed, and the results compared to the results from the Karolinska Hospital, Sweden. The incidence of side effects following cavernoma radiosurgery is significantly higher than what is seen after arteriovenous malformation radiosurgery. There was a disagreement if radiosurgery protected cavernomas from rupture or not. This disagreement could mainly be explained by different estimations of the natural course of cavernomas. By ascribing the selection criteria used in different publications to a virtual patient population it could be shown that radiosurgery offers very limited protection from haemorrhage. Radiosurgery for cavernomas, although conceptually attractive, does still not fulfil the rigid citeria of minimal risk and beneficial risk/benefit relation which must be set for the treatment of a lesion with a benign natural history

Management of brain metastases by using repeat gamma knife surgery

To assess if repeat Gamma Knife surgery [GKS] is an option to radiosurgery + up-front whole brain radiation therapy [WBRT] in the management of brain metastases. The results from 130 consecutive patients treated with GKS for brain metastases are reported. The patients were monitored every 3 months with magnetic resonance imaging. New cerebral lesions were managed with repeat GKS, WBRT or no treatment, depending on imaging finding and clinical situation. The likelihood to develop new brain metastases after the first treatment was 25%, as compared to 30% after the second treatment. There was no relation between the number of patients developing new lesions and the number of brain metastases at the first treatment. The mean time to develop a new lesion was longer after the first treatment as compared to the second. Whole brain radiation therapy was deemed necessary for 7% of the patients. Repeat radiosurgery could control the brain manifestation of a malignant disease in 92% of the patients. The benefit from up-front WBRT seems limited and it may be favourable to monitor the patient with serial imaging and to select the management option if and when new lesions are diagnosed

Gamma knife surgery of cerebral arteriovenous malformations: the Karolinska experience

The gamma knife treatment of cerebral arteriovenous malformation [AVM] has been studied at the Karolinska Hospital in Stockholm, Sweden, since 1970. In this review we evaluate the probability of total obliteration, the risk of radio-induced complications and the probability of post treatment of AVM. Applying this, the physician may be able to estimate the expected results following GK surgery for AVM