Brain Cavernous Malformation

Abstract

A 51-year-old female, presented with headache and seizures, was treated with upfront (primary); Linac-based SRS for right, frontal, parenchymal cavernous malformation. The target volume of 2.4 cc received a marginal dose of 14.0 Gy normalized to 80% isodose line. At 6 months post-SRS, the patient reported improvement of headache. At last radiological follow-up (125 months post-SRS), follow MRI showed reduction in the size of cavernous malformation. The radiosurgery treatment had no complications, and the patient had sustainable control of seizures, with lower doses of anticonvulsant medications, at last clinical follow-up 156 months post-SRS.

• Demographics: Female; 51 years

• Initial Presentation: Headache and seizures for 6 months before radiosurgery treatment

• Diagnosis: Cerebral parenchymal cavernous malformation

• Pre-radiosurgery Treatment: Anticonvulsant pharmacological therapies (drug combination)

• Pre-radiosurgery Presentation: Headache and seizures (left-sided focal seizures with secondary generalization)

• Radiosurgery Treatment:

  Upfront (primary); linac-based SRS for right, frontal, parenchymal cavernous malformation

• Radiosurgery Dosimetry:

  • Target volume: 2.4 cc

  • Marginal dose: 14.0 Gy

  • Marginal isodose: 80%

  • Maximum dose: 17.6 Gy

  • Minimum dose: 13.0 Gy

  • Average dose: 16.7 Gy

  • Number of isocenters: 1…

• Follow-Up Period: 156 months post-SRS

• Clinical Outcome:

  • 6 months post-SRS:

    • Improved headache

    • Decreased seizures frequency and severity with medications

  • 24 months post-SRS: Controlled seizures with medications

  • 36 months post-SRS: Controlled seizures with lower doses of medications

  • 48 months post-SRS: Sustainable control of seizures with lower doses of medications

  • 75 months post-SRS: Sustainable control of seizures with lower doses of medications

  • 106 months post-SRS: Sustainable control of seizures with lower doses of medications

  • 156 months post-SRS: Sustainable control of seizures with lower doses of medications

• Complications: None

• Radiological Outcome:

  • 36 months post-SRS (MRI): Stationary size of cavernous malformation

  • 75 months post-SRS (MRI): Stationary size of cavernous malformation

  • 106 months post-SRS (MRI): Decreased size of cavernous malformation

  • 125 months post-SRS (MRI): Stationary decreased size of cavernous malformation

• Post-radiosurgery Treatment: Continued anti-convulsant medications