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
{"title":"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。","authors":"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","doi":"10.1136/svn-2023-002380","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Single-session SRS for haemorrhagic CCM is associated with a decrease in haemorrhage rate. Margin doses ≤13 Gy seem advisable.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":" ","pages":"221-229"},"PeriodicalIF":4.4000,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221296/pdf/","citationCount":"0","resultStr":"{\"title\":\"Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study.\",\"authors\":\"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\",\"doi\":\"10.1136/svn-2023-002380\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Single-session SRS for haemorrhagic CCM is associated with a decrease in haemorrhage rate. Margin doses ≤13 Gy seem advisable.</p>\",\"PeriodicalId\":22021,\"journal\":{\"name\":\"Stroke and Vascular Neurology\",\"volume\":\" \",\"pages\":\"221-229\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-06-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221296/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Stroke and Vascular Neurology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/svn-2023-002380\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stroke and Vascular Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/svn-2023-002380","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study.
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.
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.
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