Hemorrhagic Risk Factors In Patients With Sporadic Cerebral Cavernous Malformations After Gamma Knife Radiosurgery

OBJECTIVE:We aimed to evaluate the hemorrhagic risk factors in patients with sporadic cerebral cavernous malformations(CCM)after gamma knife radiosurgery(GKRS)and to guide the clinical follow-up and prognostic evaluation.METHODS:From November 2010 to August 2016,73 sporadic CCM patients underwent radiosurgery at our institution and a single center retrospective study was performed based on their data.Chi-square test was used to compare the annual hemorrhage rate.Univariate and multivariate regression were used to identify significant risk factors for hemorrhage after GKRS treatment.Then all patients were divided into two groups based on different periods(whether≤2 years after GKRS).One group was two-year treatment group(clinical data within 2 years after GKRS)and another was over two-year treatment group(clinical data for 2 years or more after GKRS).Then evaluate the hemorrhagic risk factors for different periods.We define the CCM hemorrhage as requiring acute or subacute onset symptoms accompanied by radiological evidence of recent hemorrhage.RESULTS:All sporadic CCM patients were followed up more than 4 years after GKRS.The calculated annual hemorrhage rate before GKRS was 17.61%,while 3.22%after GKRS(p<0.001).There was a significant difference between the two different periods(8.90%at two-year treatment group,1.21%at over two-year treatment group,P<0.001).A history of previous hemorrhage(P=0.033,OR=4.069,95%CI=1.122-14.752)or lesion volume≥1cm~3(P=0.018,OR=4.358,95%CI=1.285-14.785)is the risk factor for sporadic CCM patients after GKRS.Within 2 years after treatment,apart from a history of previous hemorrhage(P=0.049,OR=5.639,95%CI=1.010-31.488)or lesion volume≥1cm~3(P=0.028,OR=5.761,95%CI=1.213-27.360),patients with a history of hypertension also have a higher risk of hemorrhage(P=0.035,OR=4.910,95%CI=1.114-21.639).However,there were no statistically significant differences in any factor in over two-year treatment group(P>0.05).CONCLUSIONS:GKRS seems to decrease the risk of hemorrhage in sporadic CCM patients.The patients with a history of hemorrhage or CCM lesion volume≥1cm~3are prone to have hemorrhage after GKRS treatment.In addition,the patients who with a history of hypertension are at higher risk of hemorrhage in the first 2 years after GKRS treatment.