Cavernous Malformations of the Central Nervous System

To the Editor: In Smith's review article (March 14 issue)1 on cerebral cavernous malformations (CCMs) of the central nervous system, he discusses how stereotactic radiosurgery results in partial or complete responses in approximately 80% of patients. With regard to the effect of radiosurgery on CCMs, the crucial factor may lie not in these responses but in the reduction of the annual incidence of bleeding. For CCMs with symptomatic, imaging-confirmed hemorrhages, for which resection poses a high risk, the incidence of subsequent hemorrhage in one series was 12.3% per year in the first 2 years after stereotactic radiosurgery, followed by 0.76% . . .