Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks
Hirotaka Hasegawa,1 Masaaki Yamamoto,2 Masahiro Shin,1 Bierta E Barfod2 1Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan; 2Katsuta Hospital Mito Gamma House, Hitachinaka, Ibaraki, JapanCorrespondence: Masaaki YamamotoKatsuta Hospital Mito GammaHouse, 5125-2 Nakane, Hitachi...
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Dove Medical Press
2019-11-01
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| Series: | Therapeutics and Clinical Risk Management |
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| Online Access: | https://www.dovepress.com/gamma-knife-radiosurgery-for-brain-vascular-malformations-current-evid-peer-reviewed-article-TCRM |
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| author | Hasegawa H Yamamoto M Shin M Barfod BE |
| author_facet | Hasegawa H Yamamoto M Shin M Barfod BE |
| author_sort | Hasegawa H |
| collection | DOAJ |
| description | Hirotaka Hasegawa,1 Masaaki Yamamoto,2 Masahiro Shin,1 Bierta E Barfod2 1Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan; 2Katsuta Hospital Mito Gamma House, Hitachinaka, Ibaraki, JapanCorrespondence: Masaaki YamamotoKatsuta Hospital Mito GammaHouse, 5125-2 Nakane, Hitachi-Naka, Ibaraki 312-0011, JapanTel +81-29-271-0011Fax +81-29-274-1475Email BCD06275@nifty.comAbstract: Gamma Knife radiosurgery (GKRS) has long been used for treating brain vascular malformations, including arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), and cavernous malformations (CMs). Herein, current evidence and controversies regarding the role of stereotactic radiosurgery for vascular malformations are described. 1) It has already been established that GKRS achieves 70–85% obliteration rates after a 3–5-year latency period for small to medium-sized AVMs. However, late radiation-induced adverse events (RAEs) including cyst formation, encapsulated hematoma, and tumorigenesis have recently been recognized, and the associated risks, clinical courses, and outcomes are under investigation. SRS-based therapeutic strategies for relatively large AVMs, including staged GKRS and a combination of GKRS and embolization, continue to be developed, though their advantages and disadvantages warrant further investigation. The role of GKRS in managing unruptured AVMs remains controversial since a prospective trial showed no benefit of treatment, necessitating further consideration of this issue. 2) Regarding DAVFs, GKRS achieves 41–90% obliteration rates at the second post-GKRS year with a hemorrhage rate below 5%. Debate continues as to whether GKRS might serve as a first-line solo therapeutic modality given its latency period. Although the post-GKRS outcomes are thought to differ among lesion locations, further outcome analyses regarding DAVF locations are required. 3) GKRS is generally accepted as an alternative for small or medium-sized CMs in which surgery is considered to be too risky. The reported hemorrhage rates ranged from 0.5–5% after GKRS. Higher dose treatments (>15 Gy) were performed during the learning curve, while, with the current standard treatment, a dose range of 12–15 Gy is generally selected, and has resulted in acceptable complication rates (< 5%). Nevertheless, further elucidation of long-term outcomes is essential.Keywords: arteriovenous malformation, cavernous malformation, dural arteriovenous fistula, gamma knife radiosurgery, stereotactic radiosurgery |
| first_indexed | 2024-12-18T05:17:58Z |
| format | Article |
| id | doaj.art-b2759c8c510143f9a02977a5f6392f25 |
| institution | Directory Open Access Journal |
| issn | 1178-203X |
| language | English |
| last_indexed | 2024-12-18T05:17:58Z |
| publishDate | 2019-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Therapeutics and Clinical Risk Management |
| spelling | doaj.art-b2759c8c510143f9a02977a5f6392f252022-12-21T21:19:43ZengDove Medical PressTherapeutics and Clinical Risk Management1178-203X2019-11-01Volume 151351136749832Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future TasksHasegawa HYamamoto MShin MBarfod BEHirotaka Hasegawa,1 Masaaki Yamamoto,2 Masahiro Shin,1 Bierta E Barfod2 1Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan; 2Katsuta Hospital Mito Gamma House, Hitachinaka, Ibaraki, JapanCorrespondence: Masaaki YamamotoKatsuta Hospital Mito GammaHouse, 5125-2 Nakane, Hitachi-Naka, Ibaraki 312-0011, JapanTel +81-29-271-0011Fax +81-29-274-1475Email BCD06275@nifty.comAbstract: Gamma Knife radiosurgery (GKRS) has long been used for treating brain vascular malformations, including arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), and cavernous malformations (CMs). Herein, current evidence and controversies regarding the role of stereotactic radiosurgery for vascular malformations are described. 1) It has already been established that GKRS achieves 70–85% obliteration rates after a 3–5-year latency period for small to medium-sized AVMs. However, late radiation-induced adverse events (RAEs) including cyst formation, encapsulated hematoma, and tumorigenesis have recently been recognized, and the associated risks, clinical courses, and outcomes are under investigation. SRS-based therapeutic strategies for relatively large AVMs, including staged GKRS and a combination of GKRS and embolization, continue to be developed, though their advantages and disadvantages warrant further investigation. The role of GKRS in managing unruptured AVMs remains controversial since a prospective trial showed no benefit of treatment, necessitating further consideration of this issue. 2) Regarding DAVFs, GKRS achieves 41–90% obliteration rates at the second post-GKRS year with a hemorrhage rate below 5%. Debate continues as to whether GKRS might serve as a first-line solo therapeutic modality given its latency period. Although the post-GKRS outcomes are thought to differ among lesion locations, further outcome analyses regarding DAVF locations are required. 3) GKRS is generally accepted as an alternative for small or medium-sized CMs in which surgery is considered to be too risky. The reported hemorrhage rates ranged from 0.5–5% after GKRS. Higher dose treatments (>15 Gy) were performed during the learning curve, while, with the current standard treatment, a dose range of 12–15 Gy is generally selected, and has resulted in acceptable complication rates (< 5%). Nevertheless, further elucidation of long-term outcomes is essential.Keywords: arteriovenous malformation, cavernous malformation, dural arteriovenous fistula, gamma knife radiosurgery, stereotactic radiosurgeryhttps://www.dovepress.com/gamma-knife-radiosurgery-for-brain-vascular-malformations-current-evid-peer-reviewed-article-TCRMarteriovenous malformationcavernous malformationdural arteriovenous fistulagamma knife radiosurgerystereotactic radiosurgery |
| spellingShingle | Hasegawa H Yamamoto M Shin M Barfod BE Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks Therapeutics and Clinical Risk Management arteriovenous malformation cavernous malformation dural arteriovenous fistula gamma knife radiosurgery stereotactic radiosurgery |
| title | Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks |
| title_full | Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks |
| title_fullStr | Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks |
| title_full_unstemmed | Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks |
| title_short | Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks |
| title_sort | gamma knife radiosurgery for brain vascular malformations current evidence and future tasks |
| topic | arteriovenous malformation cavernous malformation dural arteriovenous fistula gamma knife radiosurgery stereotactic radiosurgery |
| url | https://www.dovepress.com/gamma-knife-radiosurgery-for-brain-vascular-malformations-current-evid-peer-reviewed-article-TCRM |
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