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논문 기본 정보

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학술저널
저자정보
Myeong Ho Sung (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Jeong Sang Soon (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Kim Jung Hoon (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Lee Jae Meen (Department of Neurosurgery, Pusan National University Hospital, Busan, Korea.) Park Kwang Hyon (Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea.) Park Kawngwoo (Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea.) Park Hyun Joo (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Park Hye Ran (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.) Yoon Byung Woo (Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.) Lee Eun Jung (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Kim Jin Wook (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Chung Hyun Tai (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Kim Dong Gyu (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.) Paek Sun Ha (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.Department of Neurosurgery, Cancer Research Institute and Ischemic/Hypoxic Disease Institute, Seoul National Univ)
저널정보
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.39 No.32
발행연도
2024.8
수록면
1 - 12 (12page)
DOI
10.3346/jkms.2024.39.e229

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초록· 키워드

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Background: We aimed to evaluate long-term outcomes of gamma knife radiosurgery (GKS) for cerebral cavernous malformations (CCMs). Methods: Among the 233 CCM patients who underwent GKS, 79 adult patients (96 lesions) followed for over 10 years were included and analyzed retrospectively. Annual hemorrhage rate (AHR) was analyzed the entire cohort of 233 patients and the subset of 79 enrolled patients by dividing lesions into overall CCM lesions and brainstem lesions. AHR, neurologic outcome, adverse radiation effect (ARE), and changes of lesions in magnetic resonance imaging (MRI) were compared before and after GKS. Cox-regression analysis was performed to identify risk factors for hemorrhage following GKS. Results: Mean follow-up duration of 79 enrolled patients was 14 years (range, 10–23 years). The AHR of all CCMs for entire cohort at each time point was 17.8% (pre-GKS), 5.9% (≤ 2 years post-GKS), 1.8% (≤ 10 years post-GKS). The AHR of all CCM for 79 enrolled patients was 21.4% (pre-GKS), 3.8% (2 years post-GKS), 1.4% (10 years post-GKS), and 2.3% (> 10 years post-GKS). The AHR of brainstem cavernous malformation (CM) for entire cohort at each time point was 22.4% (pre-GKS), 10.1% (≤ 2 years post-GKS), 3.2% (≤ 10 years post-GKS). The AHR of brainstem CM for 79 enrolled patients was 27.2% (pre-GKS), 5.8% (2 years post-GKS), 3.4% (10 years post-GKS), and 3.5% (> 10 years post-GKS). Out of the 79 enrolled patients, 35 presented with focal neurologic deficits at the initial clinical visit. Among these patients, 74.3% showed recovery at the last follow-up. Symptomatic ARE occurred in five (6.4%) patients. No mortality occurred. Most lesions were decreased in size at the last follow-up MRI. Previous hemorrhage history (hazard ratio [HR], 8.38; 95% confidence interval [CI], 1.07–65.88; P = 0.043), and brainstem location (HR, 3.10; 95% CI, 1.26–7.64; P = 0.014) were significant risk factors for hemorrhage event. Conclusion: GKS for CCM showed favorable long-term outcomes. GKS should be considered for CCM, especially when it has a previous hemorrhage history and brainstem location.
#Cerebral Cavernous Malformation #Gamma Knife Radiosurgery #Long-term Outcomes #Annual Hemorrhage Rate #Adverse Radiation Effect

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