Chronic Encapsulated Expanding Hematomas After Stereotactic Radiosurgery for Intracranial Arteriovenous Malformations: An International Multicenter Case Series

Chronic encapsulated intracerebral haematoma following stereotactic radiosurgery for cerebral arteriovenous malformation

Chronic encapsulated intracerebral haematoma (CEIH) is a rare, delayed complication of stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations. There are no evidence-based guidelines for CEIH management. Current practice patterns range from conservative management with steroids to surgical excision. Here, we report a very delayed case of CEIH that ultimately required surgical resection 24 years following SRS. To our knowledge, this is one of the longest documented cases of recurrent haemorrhages secondary to CEIH, which failed extensive attempts at conservative treatments including steroids, hyperbaric oxygen, vitamin E and pentoxifylline. This case suggests early surgical intervention may be warranted to prevent persistent and recurrent haemorrhages.

Recurrence of chronic encapsulated hematoma following cyst formation after stereotactic radiosurgery for brain arteriovenous malformations: a case report

BACKGROUND

Delayed radiation-induced complications after stereotactic radiosurgery (SRS) for arteriovenous malformations (AVM) have scarcely been described in the literature, and their incidence, pathophysiology, and treatment remain unclear. Additionally, the literature regarding these complications is confusing. The authors present a well-documented case report describing these late complications, adding evidence to the possible common pathophysiological mechanism underlying them, and illustrating an effective treatment modality when they occur.

CASE PRESENTATION

A case of a 28-year-old male with an increasing cyst formation (CF) appearing 10 years after SRS for AVM is presented. Despite surgical treatment, due to the incomplete resection of the angiomatous nodule, recurrence as a chronic encapsulated expanding hematoma (CEEH) occurred. This relapse required a second treatment, which could have been avoided if aggressive surgical treatment had been performed initially.

CONCLUSIONS

This case highlights the continuum between CF and CEEH, challenging existing confusion in the literature. Complete resection of the angiomatous nodule associated with CF is imperative for achieving resolution and preventing recurrence.