Gamma Knife Surgery Demonstrates Effectiveness in Long-Term Treatment of Hemorrhage in Brain Spanning Hemangioma Drastic Risk

Sep 26, 2024

MRI showing the size change of right midbrain spongiform hemangioma after gamma knife radiography (GKS). After surgery, brain spongiform hemangioma was gradually reduced, resulting in volume reduction and lesion loss.

A research team at Seoul National University Hospital has published a study showing that gamma knife radiation surgery has shown positive long-term treatment effects in patients with Cerebral Cavernous Malformation (CCM). In particular, the study showed a significant decrease in annual bleeding rates after surgery, which is expected to increase the importance of gamma knife radiation surgery in the treatment of brain spongy hemangiomas in the future.

Brain spongiform hemangiomas are the second most common vascular malformations in the brain, and can mainly cause symptoms such as cerebral hemorrhage, neurological deficits, headaches, and convulsions. Conservative treatment is recommended if asymptomatic, and microsurgery or radiosurgery is considered if symptoms are caused. Recently, the number of asymptomatic patients has been increasing through medical examinations, but the natural course of hemangiomas at brain sponges has not yet been fully elucidated, which has led to controversy over the optimal treatment. However, studies dealing with long-term treatment outcomes for more than 10 years of gamma-knife radiation surgery were insufficient.

In response, Professor Baek Sun-ha's team at Seoul National University Hospital (Myeong Ho-sung Clinical Instructor) announced on the 26th that they analyzed the long-term prognosis of 79 patients (96 lesions) who could be followed up for more than 10 years out of 233 patients with brain spongy hemangiomas who underwent gamma knife radiation surgery from 1998 to 2012.

The team analyzed the annual bleeding rate (AHR), the degree of neurological recovery, radiation-related side effects (ARE), and changes in lesion size before and after gamma knife radiation surgery. The average follow-up period was 14 years.

As a result of the study, patients with pre-gammonuclear knife surgery bleeding rate of 21.4% in the 79 patients group (GKS(S) followed for more than 10 years decreased significantly to 3.8% in the second year after surgery and 1.4% in the 10th year, and remained at 2.3% thereafter. In particular, for patients with spongy hemangiomas located in the brain stem, the preoperative bleeding rate was 27.2%, but it decreased to 6.0% in the second year after surgery and 3.5% in the 10th year, greatly reducing the risk of bleeding.

Of the patients who showed neurological deficits at follow-up, 74.3% recovered symptoms at the last observation, and most lesions (81.3%) were found to be reduced in size. Radiation-related side effects occurred in 6.4% of patients, but no deaths occurred due to this.

As a risk factor for bleeding, previous bleeding experience and brain stem lesion location were identified as significant factors. Cox regression analysis showed that the risk of bleeding was significantly increased in the presence of a previous history of bleeding (HR, 8.38; P = 0.043), and the risk of bleeding was high when the lesion was located in the brain stem (HR, 3.10; P = 0.014).

In a 2016 study published by Taslimi et al., the risk of rebleeding in patients with a history of preoperative bleeding was reported as 32.3% in brain stem lesions and 6.3% in non-brain stem lesions. In the present study, the risk of rebleeding in brain stem lesions after gamma knife radiation surgery was significantly reduced to 4.9% and 1.1% in non-brain stem lesions.

The research team emphasized that the study suggests that gamma knife radiation surgery is an effective long-term treatment in terms of bleeding rates and radiation-related side effects as an early treatment for brain spongy hemangiomas. In particular, he explained that if there is a history of bleeding or there is a lesion in the brain stem, it has been shown that the risk of bleeding in the long term can be reduced by performing gamma-knife radiosurgery rather than conservative treatment.

Professor Baek Sun-ha said, "This study has demonstrated that gamma knife radiation surgery is a safe and effective long-term treatment for patients with hemangiomas in brain spongiform encephalopathy"This treatment should be actively considered, especially for patients with a history of bleeding or lesions in the brain stem." The study was published in the recent issue of the English journal 『Journal of Korean Medical Science" published by the Korean Medical Association.