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Purpose: The incidence of cavernous malformations (CMs) is estimated at 0.37 to 0.5% of the general population. Their natural history has remained unclearfor many years, mainly because of the difficulty of diagnosing this lesion with computed tomography scanning and angiography in the past. This lack of knowledge has made treatment decisions difficult. Indeed, the use of Radiosurgery is nowadays controversial. The purpose of this paper is to shed light on the effectiveness of Gamma Knife in high risk CMs. Methods: We retrospectively reviewed our experience during the past 15 years with data collected from a prospectively maintained database. Seventeen women and fifteen men, with a mean age of 40 years, underwent Gamma Knife Radiosurgery (GKRS) for high surgical risk CMs. Thirty-two CMs were treated from 1994 to 2006. These lesions were located in: brainstem (21), thalamus/basal ganglia (3) and hemispheric eloquent areas. Gamma Knife radiosurgery was used as a primary treatment in 29 patients and as a second treatment in 3 patients after a failed microsurgery. All patients had experienced at least one symptomatic bleeding before treatment. The median malformation volume was 1.9 ml. The median marginal dose was 11.29 Gy, and the mean maximum dose was 16.99 Gy. The follow up review was conducted with sequential MRIs and personal/telephone interviews. The pre-GKRS hemorrhage rate was calculated from the number of bleedings in the interval between birth and the GKRS considering the malformation could be present since birth. Observation period is assumed to be the patient's lifetime. Results: The median length of follow-up was 119 months. Imaging after GKRS revealed a regression in the targeted volume in 16 CMs, stabilization in 11 CMs and in 4 the volume status is unknown. The pre-treatment annual hemorrhage rate was 3.04%, compared with 2.08% during the first 3-year latency interval, and 0.44% thereafter. Four patients developed new location-dependent neurological deficits after Radiosurgery. All of them recovered fully from these non-bleeding-related symptoms. Conclusions: Although the efficacy and safety of Radiosurgery in CMs remains unclear, it seems that some reduction in the bleeding rate occurs after a 3-year latency period. In our study, highly conformal GKRS seems to significantly minimize the adverse radiation effects. A prospective randomized trial of conservative treatment versus radiosurgery and microsurgery should be performed in order to verify their real efficacy and related side effects. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]

Objectives: Bilateral anterior capsulotomy with Gamma Knife radiosurgery is an effective treatment to treat obsessions and compulsions associated with obsessive compulsive disorder syndrome (OCD). We evaluated the long-term results in these patients in order to confirm improvement in symptoms and evolution of cognitive abilities. Method: We have treated four patients diagnosed with OCD by Gamma Knife radiosurgery with a follow-up of at least two years (2 -5 years). Bilateral lesions have been performed at the genu of the anterior part of the internal capsule. The target has been located and assessed by magnetic resonance tractography and MRI under stereotactic conditions. Two shots using the 4 mm collimator were placed on each target (maximum dose 120 Gy). Before and after the procedure test have been performed to assess obsessions and compulsions, cognitive status and quality of life. Lesions of the tracts have been evaluated by functional MRI and tractography at 9 and 18 months after radiosurgery. Results: In all cases the tract corresponding to the genu of the anterior part of the internal capsule had been blocked without damaging peripheral structures. The anterior and medial cortex of both frontal lobes showed a significant decrease in activity. In all cases an improvement greater than 50% has been observed in the evaluation test of obsessions and compulsions. Cognitive status of the patients had significantly improved as well as their self-reported quality of life. No side effects have been observed. Conclusion: Bilateral anterior capsulotomy by Gamma Knife radiosurgery is an effective and safe treatment for OCD patients. The long-term results show that the cognitive status of these patients improves as the symptoms of their disease disappear. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]