The role of radiosurgery in preventing haemorrhage in brainstem cavernous malformations remains a subject of debate. This study aimed to evaluate whether radiosurgery provides a protective benefit against haemorrhage in these patients. This multicentre, prospective observational study was conducted in 17 centres and enrolled eligible patients with brainstem cavernous malformations consecutively. Data collected included clinical baseline information, radiosurgery planning details, periodic follow-up evaluations and any adverse radiation effects. The primary outcome of the study was the incidence of first prospective haemorrhage, and the secondary outcome was the development of new or worsening neurological dysfunctions. The impact of radiosurgery was assessed using multivariate Cox regression analysis. From March 2016 to August 2018, the study enrolled 377 patients: 280 in the observation group receiving standard care alone and 97 in the radiosurgery group receiving both radiosurgery and standard care. The overall cohort consisted of 173 females (45.9%) with a mean age of 40.5 years (range, 18-68 years), and there were no significant differences in baseline characteristics between the two groups. After a median follow-up period of 70 months, haemorrhage occurred in 25.0% (n = 70) of patients in the observation group and 10.3% (n = 10) of patients in the radiosurgery group. Multivariate Cox regression analysis identified radiosurgery as an independent protective factor against haemorrhage (hazard ratio 0.379, 95% confidence interval 0.195-0.738, P = 0.004). Following 1:2 propensity score matching, the incidence of prospective haemorrhage was 24.9% (45/181) in the observation group compared with 10.3% (10/97) in the radiosurgery group (hazard ratio 0.379, 95% confidence interval 0.190-0.755, P = 0.006). Adverse radiation effects were observed in 12 patients (12.4%), with none being permanent. Additionally, new or worsening neurological dysfunctions were significantly more common in the observation group (28.9%) compared with the radiosurgery group (16.5%) (P = 0.016). These results suggest that radiosurgery is associated with a low rate of haemorrhage in patients with brainstem cavernous malformations and could provide a benefit in selected patients. However, further research is required to confirm these findings. In a prospective cohort study, Li et al. found that patients with brainstem cavernous malformations who received radiosurgery plus standard medical care had lower rates of haemorrhage, and of new or worsening neurological dysfunction, than patients who received standard medical care alone.

Familial cerebral cavernous malformation (FCCM) is a rare autosomal dominant inherit vascular disorder of the central nerves system. The authors reviewed the literature and presented four members who harbored FCCM within a Chinese family: A 14-year-old male (proband, III-1) was admitted to our hospital for a sudden onset of headache and dizziness; his elder parental cousin(III-3) without any symptoms nor other medical history but multiple brain lesions were detected by magnetic resonance imaging (MRI); his mother(II-2), a 38-year-old female, presented with recurrent headaches for more than 2 years. All of the three patients above were treated upfront with Gamma Knife radiosurgery (GKS). Besides, the proband’s paternal uncle (II-3) had previously undergone surgery and cerebral cavernous malformation (CCM) was confirmed by the pathological examination. All the patients above are now leading a normal life with the condition and follow-up periodically.

BACKGROUND Cavernomas are rare in the brainstem and account for 18-35% of central nervous cavernomas and can cause recurrent hemorrhages, devastating neurological deficits and mortality. OBJECTIVES To summarize the experience of microsurgical treatment of brainstem cavernomas and to investigate curative effect of microsurgical treatment of brainstem cavernomas. MATERIALS AND METHODS A retrospective analysis clinical data of 37 patients with brainstem cavernomas seen between 2003 and 2007. The analysis included age distribution, hemorrhage rates, clinical presentation, location of the lesions, and preoperative and postoperative Karnofsky Performance Scale (KPS) scores. The surgical indications, the timing of surgery and the surgical techniques were also assessed. RESULTS All the 37 patients received microsurgical resections, there was no surgery-related mortality. Histopathological examination confirmed the diagnosis of cavernoma. Postoperatively, 20 patients had functional improvement, 15 patients had no change in the neurological status, and two patients deteriorated. Early surgery was associated with better outcomes. Mean followed up period was 21.5 months (range 6-36 months). During the follow-up 20 patients had resumed activities of daily living (KPS scores of 90-100), 10 patients were able to self-care with some efforts (KPS scores of 70-80), five patients needed considerable assistance (KPS score of 50-60) and two patients suffered hemiparesis (KPS scores of 40). None of the patient had recurrent hemorrhage. CONCLUSIONS Brainstem cavernomas can safely be resected. Successful resection of brainstem cavernomas can be achieved by optimal surgical approaches, feasible entry zone and meticulous microsurgical techniques. The goal of surgical intervention should be the total resection of the lesion without any deteriorative in the neurological deficits.

Objective To investigate the technique,effectiveness and prognosis of microsurgical treatment of brainstem cavernomas.Method A retrospective study was done on 13 patients with brainstem cavernomas.The clinical presentation,neuroradiological data,surgical approach,therapeutic efficacy and follow-up data were reviewed.Results All cavernomas of the cases were removed under microscope without death toll.Intraoperative electrophysiological monitoring of the floor of the fourth ventricle was used.The cavernomas were revealed by histopathological examinations.Postoperatively,the functional disorders of nervous system were improved in 8 cases.The neurological functions were similar to those of preoperative situation in 2 cases. 3 cases were deteriorated alter operation. All patients were followed-up for 6-24 months,8 cases had resumed normal lire,2 cases were able to self-care with some efforts,and 3 cases had hemiparalysis.There was no recurrence.Conclusion Microsurgery is an effective treatment for brainstem cavernomas.

OBJECTIVE:To evaluate whether the sustained expression by adenovirus-mediated gene (sFLK-1) transfer can enhance the treatment efficacy of gamma knife radiosurgery.METHODS:The mouse sFLK-1 gene was cloned to construct the recombinant adenovirus. The gliomata growing in BALB/c female nude mice with an initial mean volume of (109.3 +/- 20.5) mm3 were treated with gamma knife alone (13 Gy on day 12), sFLK-1 adenovirus alone (1 x 10(9) plaque-forming units, PFU was given to two mouse tail vein by injections, 7 and 14 days), gamma knife associated with sFLK-1 adenovirus or control adenovirus (1 x 10(9) PFU was given to two mouse tail vein by injections, 13 and 17 days). After the completion of therapy, the tumor size was recorded. The microvessel density (MVD) and tumor apoptosis were evaluated by immunohistochemical means.RESULTS:As comparing with three other control groups, the combination treatment group with sFLK-1 gene therapy and gamma knife not only significantly reduced tumor volume and prolonged the life span of tumor burden mice as well. In addition, the average tumor weights were lower in sFLK-1 combined with gamma knife group than in any other control group. Immunohistochemical analysis of glioma demonstrated a decreased MVD and a high apoptosis cell rate in sFLK-1 combined with gamma knif group.CONCLUSION:The antitumor effect of gamma knife can be potentiated by sFLK-1 gene therapy. Thus the combination of sFLK-1 gene therapy and gamma knife results an additive effect of antitumor. The observation may provide an important strategy for treatment cancer metastasis.