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Report of the first use of stereotactic radiosurgery for the treatment of a cavernous malformation of the brain at Camden-Clark Medical Center - October 2011

Full radiation therapy services, including stereotactic brain and body radiosurgery, have been available to treat primary and metastatic lesions of the brain and spine at Camden-Clark Medical Center (CCMC). This report describes the first use of this modality specifically for the treatment of a benign vascular lesion of the brain known as a cavernous malformation at CCMC.

Cavernous malformations account for some 8-15% of vascular malformations of the brain and spine. These lesions may remain asymptomatic, but they often present with neurological symptoms of headache and, most commonly,

seizure as a result of small amounts of hemorrhage over months or years. Rarely, cavernous malformations can present with a significant hematoma and severe neurological deficit.

Symptomatic patients are usually evaluated for surgery. Recently, however, stereotactic radiosurgery (SRS) has become an accepted alternative to surgical resection for lesions deep in the brain or those located within or beneath eloquent cortex. This treatment modality also provides an alternative for those patients with symptomatic lesions who have medical co-morbidities that render them unfit for surgery.

First, the patient is examined by the neurosurgeon, who orders the necessary radiographic studies. Based on these findings, the different management options are discussed in detail with the patient. Those who are good candidates for radiosurgery are then evaluated by the radiation oncologist.

SRS is an outpatient treatment, and is usually performed in a single session. On the morning of the SRS treatment, the neurosurgeon places a head-ring under local anesthesia for immobilization and to serve as a reference coordinate system for the image-guided procedure. Alternatively, a non-invasive immobilization system is also available for selected patients.

Then, CT-simulation, MRI/CT image fusion is performed to outline the target. Then the plan is developed by the
neurosurgeon and the radiation oncologist, working jointly as a team with the expert medical physicist. The actual treatment is delivered by an experienced therapist team using the Varian Trilogy machine, with such precision that is comparable to Gammaknife radiosurgery. Then, the head-ring or the non-invasive mask is removed and the patient is discharged home.

Radiosurgery is expected to achieve seizure-free rates of about 65% with minimal risk of treatment-related side effects. It is an excellent non-surgical alternative for carefully selected patients with cavernous malformations, and one that is now available to our patients.
Gabor Altdorfer, M.D.


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