RADIOSURGERY OF INTRACEREBRAL CAVERNOMAS--CURRENT INTERNATIONAL TRENDS

• Published in: Ideggyógyászati szemle Vol. 68; no. 7-8; pp. 229 - 242
• Main Authors: Nagy, Gábor, Kemeny, A András, Major, Ottó, Erőss, Loránd, Várady, Péter, Mezey, Géza, Fedorcsák, Imre, Bognár, László
• Format: Journal Article
• Language: English; Hungarian
• Published: Hungary 30.07.2015
• Subjects: Basal Ganglia - surgery; Blood Loss, Surgical; Brain Neoplasms - complications; Brain Neoplasms - mortality; Brain Neoplasms - surgery; Brain Stem - surgery; Broca Area - surgery; Epilepsy - etiology; Hemangioma, Cavernous, Central Nervous System - complications; Hemangioma, Cavernous, Central Nervous System - mortality; Hemangioma, Cavernous, Central Nervous System - surgery; Humans; Internationality; Microsurgery; Neurosurgical Procedures; Patient Selection; Radiosurgery - adverse effects; Radiosurgery - standards; Radiosurgery - trends; Thalamus - surgery; Treatment Outcome; Watchful Waiting
• ISSN: 0019-1442
• DOI: 10.18071/isz.68.0229

Although still a controversial management option, radio-surgery of intracranial cavernomas has become increasingly popular world-wide during the last decade. Microsurgery is a safe and effective treatment for symptomatic hemispheric cavernomas. However, the indication for microsurgical resection of deep eloquent cavernomas is relatively limited even in experienced hands. The importance of radiosurgery has recently been appreciated in parallel with increasing positive experiences both in terms of effectiveness and safety, especially for cases high risk for surgical resection, in the brainstem, thalamus and basal ganglia. While radiosurgery was earlier indicated mainly for surgically inaccessible lesions that had bled multiple times, a more proactive policy has recently become more accepted. In our opinion preventive treatment with the low morbidity radiosurgery serves the patients' interest especially for deep eloquent lesions that had bled not more than once, due to the cumulative morbidity of repeated hemorrhages. Despite our increasing knowledge on natural history, there is currently no available treatment algorithm for cavernomas. Arguments for all three treatment modalities (observation, microsurgery and radiosurgery) are established, but their indication criteria are yet to be defined. It is time to organize a prospective population based data collection in Hungary, which appears to be the most realistic way to clarify indication criteria.