J Neurol Surg A Cent Eur Neurosurg 2013; 74(S 01): e261-e265
DOI: 10.1055/s-0033-1349334
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Acute Onset of Hemiparesis After Gamma Knife Radiosurgery for Arteriovenous Malformation Caused by Hyperacute Thrombosis of Draining Vein: A Case Report

A. S. Ramesh
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
,
Arivazhagan Arimappamagan
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
,
Dhananjaya Bhat
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
,
H. R. Arvinda
2   Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
,
Sampath Somanna
1   Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
› Author Affiliations
Further Information

Publication History

14 October 2012

22 March 2013

Publication Date:
01 August 2013 (online)

Abstract

Background Complications after gamma knife radiosurgery (GKRS) have been attributed most commonly to radiation-induced damage to the brain. Early occlusion of the draining veins has been postulated as one of the rare causes of complications after GKRS, which often occurs at or beyond 6 months after GKRS.

Clinical Presentation We present a very rare incidence of acute onset of hemiparesis caused by a draining vein occlusion within 24 hours after GKRS for arteriovenous malformation. The patient developed hemiparesis within one day after GKRS, which partially improved with steroids. Radiologic investigations revealed an early occlusion of a draining vein, resulting in occlusive hyperemia and neurologic deficit.

Conclusion Early draining vein occlusion is an important cause of postradiosurgery complications, and it can rarely occur within days.

 
  • References

  • 1 Pollock BE. Occlusive hyperemia: a radiosurgical phenomenon?. Neurosurgery 2000; 47 (5) 1178-1182 , discussion 1182–1184
  • 2 Chin LS, Lazio BE, Biggins T, Amin P. Acute complications following gamma knife radiosurgery are rare. Surg Neurol 2000; 53 (5) 498-502 , discussion 502
  • 3 Starke RM, Komotar RJ, Hwang BY , et al. A comprehensive review of radiosurgery for cerebral arteriovenous malformations: outcomes, predictive factors, and grading scales. Stereotact Funct Neurosurg 2008; 86 (3) 191-199
  • 4 Yen CP, Khaled MA, Schwyzer L, Vorsic M, Dumont AS, Steiner L. Early draining vein occlusion after gamma knife surgery for arteriovenous malformations. Neurosurgery 2010; 67 (5) 1293-1302 , discussion 1302
  • 5 Lindquist C, Guo WY, Karlsson B, Steiner L. Radiosurgery for venous angiomas. J Neurosurg 1993; 78 (4) 531-536
  • 6 al-Rodhan NR, Sundt Jr TM, Piepgras DG, Nichols DA, Rüfenacht D, Stevens LN. Occlusive hyperemia: a theory for the hemodynamic complications following resection of intracerebral arteriovenous malformations. J Neurosurg 1993; 78 (2) 167-175
  • 7 Celix JM, Douglas JG, Haynor D, Goodkin R. Thrombosis and hemorrhage in the acute period following Gamma Knife surgery for arteriovenous malformation. Case report. J Neurosurg 2009; 111 (1) 124-131
  • 8 Abdulrauf SI, Malik GM, Awad IA. Spontaneous angiographic obliteration of cerebral arteriovenous malformations. Neurosurgery 1999; 44 (2) 280-287 , discussion 287–288
  • 9 Pasqualin A, Vivenza C, Rosta L, Scienza R, Da Pian R, Colangeli M. Spontaneous disappearance of intracranial arterio-venous malformations. Acta Neurochir (Wien) 1985; 76 (1-2) 50-57
  • 10 Sawlani V, Handique A, Phadke RV. Spontaneous regression of cerebral AVM due to thrombosis of draining vein—angiographic and MRI demonstration. J Neurol Sci 2004; 223 (2) 195-198
  • 11 Panciani PP, Fontanella M, Carlino C, Bergui M, Ducati A. Progressive spontaneous occlusion of a cerebellar AVM: pathogenetic hypothesis and review of literature. Clin Neurol Neurosurg 2008; 110 (5) 502-510
  • 12 Shimizu S, Irikura K, Miyasaka Y , et al. Rupture of pial arteriovenous malformation associated with early thrombosis of the draining system following stereotactic radiosurgery—case report. Neurol Med Chir (Tokyo) 2001; 41 (12) 599-602