Target Volume Definition for Stereotactic Radiosurgery (SRS) Of Cerebral Cavernous Malformations (CCMS)

Objective: Cerebral cavernous malformations (CCMs) are composed of abnormal hyalinized capillary clusters typically surrounded by deposits of hemosiderin. These vascular abnormalities of the brain may be asymptomatic, however, a plethora of symptoms may occur in some of the affected patients including seizures, hemorrhages, and neurological deficits. Stereotactic radiosurgery (SRS) has been utilized as a noninvasive modality of management for selected patients with high risk CCMs located at eloquent brain regions typically not amenable to surgical removal. In this study, we assessed incorporation of multimodality imaging into target volume definition of CCM radiosurgery. Materials and methods: Twenty-three patients treated with SRS for CCM at our institution were included. Target definition with CT only and by incorporation of CT-MR fusion was comparatively evaluated. Results: Twenty-three patients receiving SRS for CCMs at our institution were evaluated for target volume determination using CT-only imaging and CT-MR fusion based imaging. Ground truth target volume defined by treating physicians after comprehensive assessment and consensus was identical to target definition using CT-MR fusion based imaging in the majority of patients. Conclusion: MRI may be utilized for improving the definition of SRS target for CCM management.