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Radiation Oncology/CNS/Cavernous malformation

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Overview

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  • 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.

Treatment

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Stereotactic radiosurgery

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  • 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
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