Gamma knife surgery for intracranial cavernous hemangioma.

OBJECT: The purpose of this study was to assess the benefits of radiosurgery for cavernous hemangioma. METHODS: Sixty-five cavernous hemangiomas were treated with gamma knife surgery (GKS) between October 1994 and December 2002. Forty-two patients attended follow up. The mean patient age was 37.6 years (range 7-60 years). The lesions were located in the frontal lobe in 12 cases, deep in the parietal lobe in five, in the basal ganglia in five, in the temporal in three, in the cerebellum in three, in the pons/midbrain in six, and in multiple locations in eight cases. The presenting symptoms were seizure in 12, hemorrhage in 11, and other in 19. The maximum dose was 26.78 Gy, and the mean margin dose was 14.55 Gy. The mean follow-up period after radiosurgery was 29.6 months (range 5-93 months). The tumor decreased in size in 29 cases, was unchanged in 12, and increased in size in one. In the seizure group, seizures were controlled without anticonvulsant medication in nine cases (81.8%) after 31.3 months (range 12-80 months). After 93 months, one patient developed a cyst, which was resected. Rebleeding occurred in one case (2.3%). On T2-weighted imaging changes were seen in 11 cases (26.2%), in three (7.1 %) of which neurological deterioration was correlated with imaging changes. In other cases these deficits were temporary. CONCLUSIONS: The authors found that GKS was an effective treatment modality for cavernous hemangiomas, especially for those located within the brainstem, basal ganglia, or deep portions of the brain. It can reduce seizure frequency significantly although this takes time. In the group receiving a marginal dose below 15 Gy the patients fared better than when the dose exceeded 15 Gy.

Early development and rupture of de novo aneurysm--case report.

A 38-year-old non-smoker man presented with a ruptured aneurysm one month after clipping of a previous aneurysm. He was first admitted because of sudden onset of severe headache. Brain computed tomography showed subarachnoid hemorrhage. Angiography showed an aneurysm of the left anterior choroidal artery which was surgically clipped. Two weeks later, he was discharged without neurological deficits. One month after the initial hemorrhage, he was readmitted to the emergency room with stuporous mentality. Repeat angiography showed two aneurysms of the A2 portion of the left anterior cerebral artery which were not demonstrated by the initial angiography. The diagnosis was de novo aneurysms. The larger aneurysm was clipped and the other was coated. De novo aneurysm should be suspected if a patient with a previously clipped aneurysm complains of typical headache or any suggestive symptoms or signs of cranial nerve dysfunction, especially if known risk factors are present.