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Article ; Online: Fetal Dose Evaluation for Pregnant Patients on Leksell Gamma Knife Perfexion/Icon.

Hamáčková, Lucie / Novotný, Josef / Šimonová, Gabriela / Liščák, Roman / Chytka, Tomáš

Stereotactic and functional neurosurgery

2024 Volume 102, Issue 2, Page(s) 65–73

Abstract: Introduction: It is a normal procedure to avoid the application of ionizing radiation during pregnancy. In very rare occasions, treatment can be performed, but doses to the fetus must be evaluated and reported, and the patient must sign informed consent. ...

Abstract	Introduction: It is a normal procedure to avoid the application of ionizing radiation during pregnancy. In very rare occasions, treatment can be performed, but doses to the fetus must be evaluated and reported, and the patient must sign informed consent. There can occur two types of damage caused by ionizing radiation - deterministic and stochastic effects. Deterministic effects may occur after reaching a certain threshold (100 mGy for this study); meanwhile, stochastic effects have no limit and their probability rises with dose. This study focuses on deterministic effects. Case presentations: This study compares the dose measured on phantom for the area of the pelvis and the dose measured on 3 patients with dosimeters positioned on the pelvis irradiated on Leksell Gamma Knife Perfexion/Icon. The mean dose for measurement on phantom for the pelvis was 0.73 ± 0.76 mGy, and for the patients, it was 1.28 mGy, 0.493 mGy, and 0.549 mGy which is 80 times lower, 200 times lower, and 180 times lower than the threshold for deterministic effects, respectively. Conclusion: The measurement carried on phantom served as the base for drafting informed consent and provided initial proof that treatment can be safely delivered. Measurements performed on patients only confirmed that irradiation of pregnant patients on Leksell Gamma Knife Perfexion/Icon is safe relative to the deterministic effects. Nevertheless, pregnant patients should be treated with ionizing radiation only in very extraordinary situations.
MeSH term(s)	Humans ; Pregnancy ; Female ; Radiosurgery/methods ; Phantoms, Imaging
Language	English
Publishing date	2024-01-10
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	645069-6
ISSN	1423-0372 ; 1011-6125
ISSN (online)	1423-0372
ISSN	1011-6125
DOI	10.1159/000535366
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Article: Gamma knife radiosurgery for local recurrence of glioblastoma.

Guseynova, Khumar / Liscak, Roman / Simonova, Gabriela / Novotny, Josef

Neuro endocrinology letters

2018 Volume 39, Issue 4, Page(s) 281–287

Abstract: Objective: Local recurrence of glioblastoma is observed in most patients after standard oncologic treatment (surgery, chemotherapy and radiotherapy). Stereotactic radiosurgery with the Leksell Gamma Knife (SRS with LGK) was used to treat recurrent ... ...

Abstract	Objective: Local recurrence of glioblastoma is observed in most patients after standard oncologic treatment (surgery, chemotherapy and radiotherapy). Stereotactic radiosurgery with the Leksell Gamma Knife (SRS with LGK) was used to treat recurrent tumors in selected cases, and retrospective analysis of treatment outcome was performed. Methods: Altogether 126 patients were treated for glioblastoma at our center from 1992-2014. Sixty-nine patients (55%) were male and 57 (45%) female, with a median age of 56 years (range 17-80 years). Prior to LGK radiosurgery, 123 (98%) underwent surgery, 126 (100%) radiotherapy and 116 (92%) chemotherapy. The median Karnofsky score before LGK radiosurgery was 90% (range 50-100), and the median time from GBM diagnosis to LGK radiosurgery was 12 months (range 1-96 months). The median tumor volume was 3.75 cm3 (range 0.04-37.10 cm3). LGK radiosurgery was performed in a single fraction with a median minimal tumor dose of 12 Gy (range 10-25 Gy) on a median 50% (range 40-86%) isodose line. Two and more LGK radiosurgeries were performed in 19 (15%) cases, a median interval of 9.6 months (range 2-45 months) from the initial LGK radiosurgery. The median prescribed dose in these patients was 12.6 Gy (range 10-15 Gy), and the median volume 5.8 cm3 (range 0.1-13.7 cm3). Results: The median survival from GBM diagnosis was 20 months (range 6-237 months). The median survival after LGK radiosurgery was 7 months (range 1-223 months). The one year survival after LGK radiosurgery was 27%, 2 years 8%, and more than 3 years 4%. Tumor regression on MR images was observed in 17% of patients at a median interval of 7 months. The median interval to tumor progression on MR images after LGK treatment was 8.5 months. No treatment-related radionecrosis with expansive behaviour was detected after radiosurgery. Conclusion: We show that LGK radiosurgery is a safe palliative treatment modality in patients with recurrent GBM.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms/radiotherapy ; Female ; Glioblastoma/radiotherapy ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/radiotherapy ; Palliative Care ; Radiosurgery ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2018-12-10
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	135951-4
ISSN	0172-780X
ISSN	0172-780X
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Article ; Online: Ovine red cell concentrates for transfusion research - is the storage lesion comparable to human red cell concentrates?

Simonova, Gabriela / Wellburn, Rebecca / Fung, Yoke Lin / Fraser, John F / Tung, John-Paul

Vox sanguinis

2020 Volume 116, Issue 5, Page(s) 524–532

Abstract: Background and objectives: Sheep are increasingly being used as a large in vivo animal model of blood transfusion because they provide several advantages over small animals. Understanding the effects of storage duration on ovine (ov) red cell ... ...

Abstract	Background and objectives: Sheep are increasingly being used as a large in vivo animal model of blood transfusion because they provide several advantages over small animals. Understanding the effects of storage duration on ovine (ov) red cell concentrates (RCCs) and how these changes compare with stored human (hu) RCCs is necessary to facilitate clinical translation of research findings. Materials and methods: OvRCCs (n = 5) collected and processed in standard human blood collection packs, and equivalent huRCCs provided by Australian Red Cross Lifeblood (n = 5), were stored at 2-6°C for 42 days, with samples collected weekly. Haemolysis index was determined by measuring supernatant haemoglobin concentration. Biochemical parameters were evaluated using a blood gas analyser. Energy metabolites and biologically active lipids were measured using commercial assays. Osmotic fragility was determined by lysis in various saline concentrations. Extracellular vesicles were characterized by nanoparticle tracking analysis. Results: Ovine red blood cells (RBCs) are double in number, smaller in size and more fragile than human RBCs. Haematological values were unchanged throughout storage. In contrast, biochemical and metabolic values, and haemolysis index in three of the five ovRCCs exceeded huRCCs licensing criteria by day 42. Accumulation of extracellular vesicles and biologically active lipids was comparable between huRCCs and ovRCCs. Conclusion: This study documents similarities and differences in the storage lesion of ovRCCs and huRCCs. This new information will guide the design of ovine transfusion models to enhance translation of findings to human transfusion settings.
MeSH term(s)	Animals ; Blood Preservation/methods ; Blood Preservation/standards ; Blood Transfusion/methods ; Blood Transfusion/standards ; Disease Models, Animal ; Erythrocytes/metabolism ; Humans ; Sheep/blood
Language	English
Publishing date	2020-10-26
Publishing country	England
Document type	Journal Article
ZDB-ID	80313-3
ISSN	1423-0410 ; 0042-9007
ISSN (online)	1423-0410
ISSN	0042-9007
DOI	10.1111/vox.13020
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Article ; Online: Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results.

Simonova, Gabriela / Kozubikova, Petra / Liscak, Roman / Novotny, Josef

Journal of neurosurgery. Pediatrics

2016 Volume 18, Issue 1, Page(s) 58–64

Abstract: OBJECTIVE The purpose of this study was to evaluate long-term treatment results, radiation-related toxicity, and prognostic factors for the progression-free survival (PFS) of patients with pilocytic astrocytomas treated by means of stereotactic ... ...

Abstract	OBJECTIVE The purpose of this study was to evaluate long-term treatment results, radiation-related toxicity, and prognostic factors for the progression-free survival (PFS) of patients with pilocytic astrocytomas treated by means of stereotactic radiosurgery with a Leksell Gamma Knife. METHODS A total of 25 patients with pilocytic astrocytomas underwent Gamma Knife surgery during the period 1992-2002. The median target volume was 2700 mm(3) (range 205-25,000 mm(3)). The 18 patients treated with 5 daily fractions received a median minimum target dose of 25 Gy. Doses for the 2 patients treated with 10 fractions over 5 days (2 fractions delivered on the same day at least 6 hours apart) were 23 and 28 Gy. For the 5 patients treated with a single fraction, the minimum target dose ranged from 13 to 20 Gy (median 16 Gy). RESULTS Complete regression occurred in 10 patients (40%) and partial regression in 10 patients (40%). The 10-year overall survival rate was 96% and the 10-year PFS rate was 80%. Target volume appeared to be a significant prognostic factor for PFS (p = 0.037). Temporary Grade 3 toxicity appeared in 2 patients (8%), and these patients were treated with corticosteroids for 2 months. Permanent Grade 4 toxicity appeared in 2 patients (8%) and was associated with neurocognitive dysfunction. In these 2 individuals, the neurocognitive dysfunction was also felt to be in part the result of the additional therapeutic interventions (4 in one case and 6 in the other) required to achieve durable control of their tumors. CONCLUSIONS Radiosurgery represents an alternative treatment modality for small residual or recurrent volumes of pilocytic astrocytomas and provides long-term local control. Target volume appears to be the most important factor affecting PFS.
MeSH term(s)	Adolescent ; Astrocytoma/diagnostic imaging ; Astrocytoma/radiotherapy ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/radiotherapy ; Child ; Child, Preschool ; Disease-Free Survival ; Female ; Humans ; Male ; Radiosurgery/methods ; Radiosurgery/trends ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2016-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2015.10.PEDS14443
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Article: Význam radiochirurgie v lécbe mozkových metastáz.

Simonová, Gabriela / Liscák, Roman

Casopis lekaru ceskych

2011 Volume 150, Issue 4-5, Page(s) 273–277

Abstract: Brain metastases are diagnosed in about 30% adult patients with generalized carcinomas, their accompanying severe neurological symptoms cause worsening quality of patient's life. The development of magnetic resonance imaging and stereotactically guided ... ...

Title translation	Significance of radiosurgery in the treatment of brain metastases.
Abstract	Brain metastases are diagnosed in about 30% adult patients with generalized carcinomas, their accompanying severe neurological symptoms cause worsening quality of patient's life. The development of magnetic resonance imaging and stereotactically guided radiosurgery and radiotherapy enable to apply relatively high doses to well defined intracranial target volumes. Progression free survival after irradiation of brain lesions depends on several prognostic factors. Radiosurgery using gamma knife is an effective treatment with low rate of postradiation complications.
MeSH term(s)	Brain Neoplasms/secondary ; Brain Neoplasms/surgery ; Disease-Free Survival ; Humans ; Kaplan-Meier Estimate ; Prognosis ; Radiosurgery
Language	Czech
Publishing date	2011
Publishing country	Czech Republic
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	413441-2
ISSN	1805-4420 ; 0008-7335
ISSN (online)	1805-4420
ISSN	0008-7335
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Article ; Online: Development and validation of ELISAs for the quantitation of interleukin (IL)-1β, IL-6, IL-8 and IL-10 in ovine plasma.

Bouquet, Mahé / Passmore, Margaret R / See Hoe, Louise E / Tung, John-Paul / Simonova, Gabriela / Boon, Ai-Ching / Fraser, John F

Journal of immunological methods

2020 Volume 486, Page(s) 112835

Abstract: There is growing evidence that inflammation underpins many common diseases. Inflammatory/immunomodulatory/immune mediators, such as cytokines, are key modulators of inflammation and mediate both immune cell recruitment and complex intracellular ... ...

Abstract	There is growing evidence that inflammation underpins many common diseases. Inflammatory/immunomodulatory/immune mediators, such as cytokines, are key modulators of inflammation and mediate both immune cell recruitment and complex intracellular signalling pathways. Ovine models of disease are increasingly utilized in pre-clinical research, however existing methods for measuring cytokine levels are limited. We established and validated enzyme-linked immunosorbent assays (ELISAs) targeting interleukin (IL)-1β, IL-6, IL-8 and IL-10 in sheep plasma. These ELISAs showed high sensitivity and specificity with intra- and inter-assay CV's below 10%, and recovery rates between 82 and 123%. Sensitivity for IL-1β, IL-6, IL-8 and IL-10 were 117.6 pg/mL, 443.1 pg/mL, 30.9 pg/mL, and 64.3 pg/mL, respectively. ELISA test result reproducibility decreased significantly after 12 weeks of plasma storage at -80 °C. Therefore, for accurate cytokine measurements, plasma samples need to be tested within three months of sample collection to account for cytokine protein degradation. These ELISAs offer a reliable and convenient method to identify inflammatory cytokine changes in sheep, allowing key insights into the disease pathogenesis of these ruminants.
MeSH term(s)	Animals ; Blood Specimen Collection ; Cold Temperature ; Enzyme-Linked Immunosorbent Assay ; Inflammation Mediators/blood ; Interleukin-10/blood ; Interleukin-1beta/blood ; Interleukin-6/blood ; Interleukin-8/blood ; Protein Denaturation ; Protein Stability ; Reproducibility of Results ; Sheep, Domestic ; Time Factors
Chemical Substances	Inflammation Mediators ; Interleukin-1beta ; Interleukin-6 ; Interleukin-8 ; Interleukin-10 (130068-27-8)
Language	English
Publishing date	2020-08-20
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Validation Study
ZDB-ID	120142-6
ISSN	1872-7905 ; 0022-1759
ISSN (online)	1872-7905
ISSN	0022-1759
DOI	10.1016/j.jim.2020.112835
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Article: Development and validation of ELISAs for the quantitation of interleukin (IL)-1β, IL-6, IL-8 and IL-10 in ovine plasma

Bouquet, Mahé / Passmore, Margaret R / See Hoe, Louise E / Tung, John-Paul / Simonova, Gabriela / Boon, Ai-Ching / Fraser, John F

Journal of immunological methods. 2020 Nov., v. 486

2020

Abstract	There is growing evidence that inflammation underpins many common diseases. Inflammatory/immunomodulatory/immune mediators, such as cytokines, are key modulators of inflammation and mediate both immune cell recruitment and complex intracellular signalling pathways. Ovine models of disease are increasingly utilized in pre-clinical research, however existing methods for measuring cytokine levels are limited. We established and validated enzyme-linked immunosorbent assays (ELISAs) targeting interleukin (IL)-1β, IL-6, IL-8 and IL-10 in sheep plasma. These ELISAs showed high sensitivity and specificity with intra- and inter-assay CV's below 10%, and recovery rates between 82 and 123%. Sensitivity for IL-1β, IL-6, IL-8 and IL-10 were 117.6 pg/mL, 443.1 pg/mL, 30.9 pg/mL, and 64.3 pg/mL, respectively. ELISA test result reproducibility decreased significantly after 12 weeks of plasma storage at −80 °C. Therefore, for accurate cytokine measurements, plasma samples need to be tested within three months of sample collection to account for cytokine protein degradation. These ELISAs offer a reliable and convenient method to identify inflammatory cytokine changes in sheep, allowing key insights into the disease pathogenesis of these ruminants.
Keywords	animal diseases ; animal models ; enzyme-linked immunosorbent assay ; frozen storage ; inflammation ; interleukin-10 ; interleukin-1beta ; interleukin-6 ; interleukin-8 ; pathogenesis ; protein degradation ; sheep ; signal transduction ; storage temperature
Language	English
Dates of publication	2020-11
Publishing place	Elsevier B.V.
Document type	Article
ZDB-ID	120142-6
ISSN	1872-7905 ; 0022-1759
ISSN (online)	1872-7905
ISSN	0022-1759
DOI	10.1016/j.jim.2020.112835
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Article: Recovery of organ-specific tissue oxygen delivery at restrictive transfusion thresholds after fluid treatment in ovine haemorrhagic shock.

Dyer, Wayne B / Simonova, Gabriela / Chiaretti, Sara / Bouquet, Mahe / Wellburn, Rebecca / Heinsar, Silver / Ainola, Carmen / Wildi, Karin / Sato, Kei / Livingstone, Samantha / Suen, Jacky Y / Irving, David O / Tung, John-Paul / Li Bassi, Gianluigi / Fraser, John F

Intensive care medicine experimental

2022 Volume 10, Issue 1, Page(s) 12

Abstract: Background: Fluid resuscitation is the standard treatment to restore circulating blood volume and pressure after massive haemorrhage and shock. Packed red blood cells (PRBC) are transfused to restore haemoglobin levels. Restoration of microcirculatory ... ...

Abstract	Background: Fluid resuscitation is the standard treatment to restore circulating blood volume and pressure after massive haemorrhage and shock. Packed red blood cells (PRBC) are transfused to restore haemoglobin levels. Restoration of microcirculatory flow and tissue oxygen delivery is critical for organ and patient survival, but these parameters are infrequently measured. Patient Blood Management is a multidisciplinary approach to manage and conserve a patient's own blood, directing treatment options based on broad clinical assessment beyond haemoglobin alone, for which tissue perfusion and oxygenation could be useful. Our aim was to assess utility of non-invasive tissue-specific measures to compare PRBC transfusion with novel crystalloid treatments for haemorrhagic shock. Methods: A model of severe haemorrhagic shock was developed in an intensive care setting, with controlled haemorrhage in sheep according to pressure (mean arterial pressure 30-40 mmHg) and oxygen debt (lactate > 4 mM) targets. We compared PRBC transfusion to fluid resuscitation with either PlasmaLyte or a novel crystalloid. Efficacy was assessed according to recovery of haemodynamic parameters and non-invasive measures of sublingual microcirculatory flow, regional tissue oxygen saturation, repayment of oxygen debt (arterial lactate), and a panel of inflammatory and organ function markers. Invasive measurements of tissue perfusion, oxygen tension and lactate levels were performed in brain, kidney, liver, and skeletal muscle. Outcomes were assessed during 4 h treatment and post-mortem, and analysed by one- and two-way ANOVA. Results: Each treatment restored haemodynamic and tissue oxygen delivery parameters equivalently (p > 0.05), despite haemodilution after crystalloid infusion to haemoglobin concentrations below 70 g/L (p < 0.001). Recovery of vital organ-specific perfusion and oxygen tension commenced shortly before non-invasive measures improved. Lactate declined in all tissues and correlated with arterial lactate levels (p < 0.0001). The novel crystalloid supported rapid peripheral vasodilation (p = 0.014) and tended to achieve tissue oxygen delivery targets earlier. PRBC supported earlier renal oxygen delivery (p = 0.012) but delayed peripheral perfusion (p = 0.034). Conclusions: Crystalloids supported vital organ oxygen delivery after massive haemorrhage, despite haemodilution to < 70 g/L, confirming that restrictive transfusion thresholds are appropriate to support oxygen delivery. Non-invasive tissue perfusion and oximetry technologies merit further clinical appraisal to guide treatment for massive haemorrhage in the context of Patient Blood Management.
Language	English
Publishing date	2022-04-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2740385-3
ISSN	2197-425X
ISSN	2197-425X
DOI	10.1186/s40635-022-00439-6
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Article ; Online: An Ovine Model of Hemorrhagic Shock and Resuscitation, to Assess Recovery of Tissue Oxygen Delivery and Oxygen Debt, and Inform Patient Blood Management.

Dyer, Wayne B / Tung, John-Paul / Li Bassi, Gianluigi / Wildi, Karin / Jung, Jae-Seung / Colombo, Sebastiano Maria / Rozencwajg, Sacha / Simonova, Gabriela / Chiaretti, Sara / Temple, Fergal T / Ainola, Carmen / Shuker, Tristan / Palmieri, Chiara / Shander, Aryeh / Suen, Jacky Y / Irving, David O / Fraser, John F

Shock (Augusta, Ga.)

2021 Volume 56, Issue 6, Page(s) 1080–1091

Abstract: Background: Aggressive fluid or blood component transfusion for severe hemorrhagic shock may restore macrocirculatory parameters, but not always improve microcirculatory perfusion and tissue oxygen delivery. We established an ovine model of hemorrhagic ... ...

Abstract	Background: Aggressive fluid or blood component transfusion for severe hemorrhagic shock may restore macrocirculatory parameters, but not always improve microcirculatory perfusion and tissue oxygen delivery. We established an ovine model of hemorrhagic shock to systematically assess tissue oxygen delivery and repayment of oxygen debt; appropriate outcomes to guide Patient Blood Management. Methods: Female Dorset-cross sheep were anesthetized, intubated, and subjected to comprehensive macrohemodynamic, regional tissue oxygen saturation (StO2), sublingual capillary imaging, and arterial lactate monitoring confirmed by invasive organ-specific microvascular perfusion, oxygen pressure, and lactate/pyruvate levels in brain, kidney, liver, and skeletal muscle. Shock was induced by stepwise withdrawal of venous blood until MAP was 30 mm Hg, mixed venous oxygen saturation (SvO2) < 60%, and arterial lactate >4 mM. Resuscitation with PlasmaLyte® was dosed to achieve MAP > 65 mm Hg. Results: Hemorrhage impacted primary outcomes between baseline and development of shock: MAP 89 ± 5 to 31 ± 5 mm Hg (P < 0.01), SvO2 70 ± 7 to 23 ± 8% (P < 0.05), cerebral regional tissue StO2 77 ± 11 to 65 ± 9% (P < 0.01), peripheral muscle StO2 66 ± 8 to 16 ± 9% (P < 0.01), arterial lactate 1.5 ± 1.0 to 5.1 ± 0.8 mM (P < 0.01), and base excess 1.1 ± 2.2 to -3.6 ± 1.7 mM (P < 0.05). Invasive organ-specific monitoring confirmed reduced tissue oxygen delivery; oxygen tension decreased and lactate increased in all tissues, but moderately in brain. Blood volume replacement with PlasmaLyte® improved primary outcome measures toward baseline, confirmed by organ-specific measures, despite hemoglobin reduced from baseline 10.8 ± 1.2 to 5.9 ± 1.1 g/dL post-resuscitation (P < 0.01). Conclusion: Non-invasive measures of tissue oxygen delivery and oxygen debt repayment are suitable outcomes to inform Patient Blood Management of hemorrhagic shock, translatable for pre-clinical assessment of novel resuscitation strategies.
MeSH term(s)	Animals ; Blood Transfusion ; Disease Models, Animal ; Female ; Humans ; Middle Aged ; Oxygen/metabolism ; Oxygen Consumption ; Recovery of Function ; Resuscitation ; Sheep ; Shock, Hemorrhagic/therapy
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2021-05-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1185432-7
ISSN	1540-0514 ; 1073-2322
ISSN (online)	1540-0514
ISSN	1073-2322
DOI	10.1097/SHK.0000000000001805
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Zs.A 3985: Show issues

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Article: Gamma knife radiosurgery of brain cavernomas.

Liscak, Roman / Urgosik, Dusan / Simonova, Gabriela / Vymazal, Josef / Semnicka, Jitka

Acta neurochirurgica. Supplement

2013 Volume 116, Page(s) 107–111

Abstract: Purpose: Radiosurgery of cavernomas should prevent rebleeding, growth of the lesion, and deterioration of clinical symptoms. However, there is no direct diagnostic tool to verify the endpoints of treatment. At present, the positive effects of ... ...

Abstract	Purpose: Radiosurgery of cavernomas should prevent rebleeding, growth of the lesion, and deterioration of clinical symptoms. However, there is no direct diagnostic tool to verify the endpoints of treatment. At present, the positive effects of radiosurgery are identified by clinical observation and analysis of imaging changes on magnetic resonance imaging during a sufficiently long follow-up period. Methods: Between 1992 and 2000, a total of 112 patients with brain cavernomas were treated with Gamma Knife radiosurgery at our center. In all, 59 patients experienced bleeding before radiosurgery; the remainder did not. The median age of patients was 42 years, the median volume of the cavernomas was 0.9 cm(3), and the median applied marginal dose was 16 Gy. Results: After a 2-year latent interval after treatment (median follow-up 84 months), the risk of bleeding in the group of patients with bleeding before radiosurgery had decreased from 3.7 % to 0.2 %. For the patients without bleeding before radiosurgery, the annual risk of bleeding was 0.8 %. The cavernoma size decreased in 53.0 % of cases and increased in 6.4 %. Epilepsy, if present before the treatment, was alleviated in 45 % of cases. The risks of temporary or permanent morbidity caused by radiosurgery were 14.6 % and 0.9 %, respectively. Conclusion: Radiosurgery of cavernomas was associated with a low risk of permanent morbidity. The risk of rebleeding after the 2-year latent interval after radiosurgery had decreased. Treatment of cavernomas with no history of bleeding was halted at our center.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms/mortality ; Brain Neoplasms/surgery ; Female ; Hemangioma, Cavernous/mortality ; Hemangioma, Cavernous/surgery ; Humans ; Kaplan-Meier Estimate ; Longitudinal Studies ; Male ; Middle Aged ; Postoperative Complications ; Radiosurgery/methods ; Retrospective Studies ; Time Factors ; Young Adult
Language	English
Publishing date	2013
Publishing country	Austria
Document type	Journal Article
ISSN	0065-1419
ISSN	0065-1419
DOI	10.1007/978-3-7091-1376-9_17
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