Radiosurgery for cavernomas - A meta-analysis

ABSTRACT

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