Download PDF
J Neurol Surg Rep 2015; 76(01): e105-e108
DOI: 10.1055/s-0035-1549223
Case Report
Georg Thieme Verlag KG Stuttgart · New York

De Novo Aneurysm Formation Following Gamma Knife Surgery for Arteriovenous Malformation: A Case Report

Takuya Akai
1   Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan
,
Keiichiro Torigoe
1   Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan
,
Manna Fukushima
2   Pathology and Laboratory Medicine, Kanazawa Medical University, Kanazawa, Japan
,
Hideaki Iizuka
1   Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan
,
Yasuhiko Hayashi
3   Department of Neurosurgery, Kanazawa University, Kanazawa, Japan
› Author Affiliations
Further Information

Publication History

22 September 2014

13 January 2015

Publication Date:
22 May 2015 (online)

   Permissions and Reprints

Abstract

Background Stereotactic radiosurgery plays a critical role in the treatment of central nervous system neoplasm and cerebrovascular malformations. This procedure is purportedly less invasive, but problems occurring later including tumor formation, necrosis, and vasculopathy-related diseases have been reported.

Clinical Presentation We report on a 65-year-old man who had experienced a de novo aneurysm in an irradiated field and an acute onset of right hemiparesis and aphasia. He had undergone gamma knife radiosurgery to treat an arteriovenous malformation 15 and 12 years prior, with 18 and 22 Gy marginal doses. At current admission, radiologic studies showed a de novo aneurysm in the irradiated field without recurrence of malformation. The aneurysm was resected. Histologic findings showed a disruption of the internal elastic lamina accompanied by fibrous degeneration.

Conclusion Stereotactic radiosurgery is a promising treatment tool, but long-term risks have not been fully researched. The treatment procedure for benign lesions should be chosen prudently.

Keywords

aneurysm - radiosurgery - de novo
 

  • References

  • 1 Valk PE, Dillon WP. Radiation injury of the brain. AJNR Am J Neuroradiol 1991; 12 (1) 45-62
    PubMedGoogle Scholar
  • 2 Rabin BM, Meyer JR, Berlin JW, Marymount MH, Palka PS, Russell EJ. Radiation-induced changes in the central nervous system and head and neck. Radiographics 1996; 16 (5) 1055-1072
    CrossrefPubMedGoogle Scholar
  • 3 O'Connor MM, Mayberg MR. Effects of radiation on cerebral vasculature: a review. Neurosurgery 2000; 46 (1) 138-149 ; discussion 150–151
    PubMedGoogle Scholar
  • 4 Shamisa A, Bance M, Nag S , et al. Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature. J Neurosurg 2001; 94 (5) 816-821
    CrossrefPubMedGoogle Scholar
  • 5 Kaido T, Hoshida T, Uranishi R , et al. Radiosurgery-induced brain tumor. Case report. J Neurosurg 2001; 95 (4) 710-713
    CrossrefPubMedGoogle Scholar
  • 6 Berman EL, Eade TN, Brown D , et al. Radiation-induced tumor after stereotactic radiosurgery for an arteriovenous malformation: case report. Neurosurgery 2007; 61 (5) E1099 ; discussion E1099
    CrossrefPubMedGoogle Scholar
  • 7 Shuto T, Matsunaga S, Suenaga J. Surgical treatment for late complications following gamma knife surgery for arteriovenous malformations. Stereotact Funct Neurosurg 2011; 89 (2) 96-102
    CrossrefPubMedGoogle Scholar
  • 8 Shuto T, Ohtake M, Matsunaga S. Proposed mechanism for cyst formation and enlargement following Gamma Knife Surgery for arteriovenous malformations. J Neurosurg 2012; 117 (Suppl): 135-143
    PubMedGoogle Scholar
  • 9 Yamamoto M, Ide M, Jimbo M, Ono Y. Middle cerebral artery stenosis caused by relatively low-dose irradiation with stereotactic radiosurgery for cerebral arteriovenous malformations: case report. Neurosurgery 1997; 41 (2) 474-477 ; discussion 477–478
    CrossrefPubMedGoogle Scholar
  • 10 Huang PP, Kamiryo T, Nelson PK. De novo aneurysm formation after stereotactic radiosurgery of a residual arteriovenous malformation: case report. AJNR Am J Neuroradiol 2001; 22 (7) 1346-1348
    PubMedGoogle Scholar
  • 11 Takao T, Fukuda M, Kawaguchi T , et al. Ruptured intracranial aneurysm following gamma knife surgery for acoustic neuroma. Acta Neurochir (Wien) 2006; 148 (12) 1317-1318 ; discussion 1318
    CrossrefPubMedGoogle Scholar
  • 12 Akamatsu Y, Sugawara T, Mikawa S , et al. Ruptured pseudoaneurysm following Gamma Knife surgery for a vestibular schwannoma. J Neurosurg 2009; 110 (3) 543-546
    CrossrefPubMedGoogle Scholar
  • 13 Park KY, Ahn JY, Lee JW, Chang JH, Huh SK. De novo intracranial aneurysm formation after Gamma Knife radiosurgery for vestibular schwannoma. J Neurosurg 2009; 110 (3) 540-542
    CrossrefPubMedGoogle Scholar
  • 14 Kellner CP, McDowell MM, Connolly ES , et al. Late onset aneurysm development following radiosurgical obliteration of a cerebellopontine angle meningioma. BMJ Case Rep 2014; ; May 14 (Epub ahead of print)
    PubMedGoogle Scholar
  • 15 Sunderland G, Hassan F, Bhatnagar P , et al. Development of anterior inferior cerebellar artery pseudoaneurysm after gamma knife surgery for vestibular schwannoma. A case report and review of the literature. Br J Neurosurg 2014; 28 (4) 536-538
    CrossrefPubMedGoogle Scholar
  • 16 Sciubba DM, Gallia GL, Recinos P, Garonzik IM, Clatterbuck RE. Intracranial aneurysm following radiation therapy during childhood for a brain tumor. Case report and review of the literature. J Neurosurg 2006; 105 (2, Suppl): 134-139
    PubMedGoogle Scholar
  • 17 Yamamoto M, Jimbo M, Ide M , et al. Gamma knife radiosurgery for cerebral arteriovenous malformations: an autopsy report focusing on irradiation-induced changes observed in nidus-unrelated arteries. Surg Neurol 1995; 44 (5) 421-427
    CrossrefPubMedGoogle Scholar
  • 18 Chang SD, Shuster DL, Steinberg GK, Levy RP, Frankel K. Stereotactic radiosurgery of arteriovenous malformations: pathologic changes in resected tissue. Clin Neuropathol 1997; 16 (2) 111-116
    PubMedGoogle Scholar
  • 19 Schneider BF, Eberhard DA, Steiner LE. Histopathology of arteriovenous malformations after gamma knife radiosurgery. J Neurosurg 1997; 87 (3) 352-357
    CrossrefPubMedGoogle Scholar
  • 20 Yang T, Wu SL, Liang JC, Rao ZR, Ju G. Time-dependent astroglial changes after gamma knife radiosurgery in the rat forebrain. Neurosurgery 2000; 47 (2) 407-415 ; discussion 415–416
    CrossrefPubMedGoogle Scholar
  • 21 Jahan R, Solberg TD, Lee D , et al. An arteriovenous malformation model for stereotactic radiosurgery research. Neurosurgery 2007; 61 (1) 152-159 ; discussion 159
    CrossrefPubMedGoogle Scholar
  • 22 Lunsford LD, Altschuler EM, Flickinger JC, Wu A, Martinez AJ. In vivo biological effects of stereotactic radiosurgery: a primate model. Neurosurgery 1990; 27 (3) 373-382
    CrossrefPubMedGoogle Scholar