Radiation Oncology/CNS/Cavernous malformation

Overview

 * A cavernous malformation is a vascular malformation composed of sinusoidal vessels without a large feeding artery.
 * The primary difference between a cavernous malformation and an AVM is the lower pressure gradient.
 * Represent 8-15% of intracranial malformations
 * 70-80% are supratentorial.
 * 0.25% to 6% annual risk of hemorrhage.

Stereotactic radiosurgery

 * Pittsburgh, 2002 (1987-2000) - PMID 12015835 -- "Long-term results after stereotactic radiosurgery for patients with cavernous malformations." Hasegawa T et al. Neurosurgery. 2002 Jun;50(6):1190-7.
 * Ho et al. (2012) Brainstem Cavernoma Treated with Cone-based Stereotactic Radiosurgery, Therapeut Radiol Oncol 2012; 19(3): 255-261 • Two cases with brainstem cavernoma treated with linear accelerator (LlNAC) cone-based stereotactic radiosurgery  • CASE 1: 14 Gy in two fractions, brain MRI showed the cavernoma over left pons remitted gradually  • CASE 2: 18 Gy in two fractions, 0.7 cm cavernoma at left ambient cistern of the 4th ventricle roof, follow-up brain MRI of the cavernoma demonstrated very good treatment response