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Wakuta N, Yoshioka T, Irie Y, Tsugu H, Abe H. Ruptured distal anterior inferior cerebellar artery aneurysm years after stereotactic radiosurgery for vestibular schwannoma: A case report and literature review. Surg Neurol Int 2024; 15:213. [PMID: 38974544 PMCID: PMC11225523 DOI: 10.25259/sni_285_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
Background Aneurysmal formation after stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) is a rare complication. Its characteristics and the best treatment strategies remain controversial, and the clinical course is especially unknown because reported aneurysms are first incidentally detected, or aneurysmal rupture occurs suddenly, and they are treated immediately. Case Description A 68-year-old man who underwent SRS for VS 20 years ago presented with subarachnoid hemorrhage (SAH) due to rupture of a radiation-induced fusiform anterior inferior cerebellar artery aneurysm. He was treated with parent artery occlusion, resulting in a modified Rankin scale grade 2. This report illustrates the first case of detected aneurysm formation before rupture with retrospective magnetic resonance imaging evaluation. Conclusion We describe the possible risk of rapid progression and rupture of aneurysms, focusing on the interval from SRS to aneurysmal formation. The period of formation of SRS-induced aneurysms is suspected to vary from years to decades regardless of radiation doses; however, aneurysms estimated as pseudoaneurysms have an extremely high risk of rupture within a few years, even when small in size. If aneurysms are discovered unruptured, there are some advantages in not only the prevention of poor prognosis due to SAH but also in the availability of optional therapeutic strategies using revascularization. Long-term annual follow-up, including vessel examination, is warranted not only to assess tumor status but also for early detection of any vascular lesions.
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Affiliation(s)
- Naoki Wakuta
- Department of Neurosurgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Tsutomu Yoshioka
- Department of Neurosurgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Yukino Irie
- Department of Neurosurgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Hitoshi Tsugu
- Department of Neurosurgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery Fukuoka University Hospital, School of Medicine, Fukuoka University, Fukuoka, Japan
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Guo X, Osouli S, Shahripour RB. Review of Cerebral Radiotherapy-Induced Vasculopathy in Pediatric and Adult Patients. Adv Biol (Weinh) 2023; 7:e2300179. [PMID: 37401794 DOI: 10.1002/adbi.202300179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/04/2023] [Indexed: 07/05/2023]
Abstract
Radiation therapy (RT) causes radiation-induced vasculopathy, which requires clinicians to identify and manage this side effect in pediatric and adult patients. This article reviews previous findings about the pathophysiology of RT-induced vascular injury, including endothelial cell injury, oxidative stress, inflammatory cytokines, angiogenic pathways, and remodeling. The vasculopathy is categorized into ischemic vasculopathy, hemorrhagic vasculopathy, carotid artery injury, and other malformations (cavernous malformations and aneurysms) in populations of pediatric and adult patients separately. The prevention and management of this RT-induced side effect are also discussed. The article summarizes the distribution and risk factors of different types of RT-induced vasculopathy. This will help clinicians identify high-risk patients with corresponding vasculopathy subtypes to deduce prevention and treatment strategies accordingly.
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Affiliation(s)
- Xiaofan Guo
- Department of Neurology, Loma Linda University, Loma Linda, CA, 92354, USA
| | - Sima Osouli
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 1516745811, Iran
| | - Reza Bavarsad Shahripour
- Department of Neurology, Loma Linda University, Loma Linda, CA, 92354, USA
- Comprehensive Stroke Center, Department of Neurology, University of California San Diego, San Diego, CA, 92103, USA
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Lu D, Ping H, Wei C, Fang W, Zhang Y, Wu Y, Xue Y, Wang B, Qu Y, Zhao T. Unruptured anterior Inferior cerebellar artery aneurysm following stereotactic irradiation for vestibular schwannoma: Case report and literature review. Front Surg 2023; 10:1082265. [PMID: 36843988 PMCID: PMC9949606 DOI: 10.3389/fsurg.2023.1082265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Background The clinical features and therapeutic measures of vestibular schwannoma (VS) radiation-related aneurysm (RRA) have not been well described. We reported the first VS RRA case admitted for acute anterior inferior cerebella artery (AICA) ischemic symptoms. Literature was reviewed to present the research fruits about VS RRAs, and some therapeutic advices were given. Materials and methods A 54-year-old woman who had undergone GKS 10 years previously for a right VS was admitted to our hospital in 2018 because of sudden onset of severe vertigo and vomiting, accompanied with unsteady gait. During tumor resection, a dissecting aneurysm arose from the main trunk of AICA was encountered accidently within the tumor. The aneurysm was successfully treated with direct clip ligation, sparing the parent vessel. Data about this case were combined with those of other 11 radiation-related AICA aneurysm cases retrieved from the current literature. The following parameters were evaluated: Age, Sex, Diagnostic method, Location of aneurysm, Age of radiotherapy (Years)/Latency, Rupture, x-ray dosage, Type of radiotherapy, History of surgical resection of VS, Aneurysm Type, Morphology, Number, Treatment, Operative complications, Sequela, Outcome. VS RRAs mainly occurred in women (75%) with a median age of 62.5 years and were mainly located on AICA. Ruptured aneurysms accounted for 75.0% of the total cases. This paper reported the first VS case admitted with acute AICA ischemic symptoms. Cases with sacciform-like, irregular and fusiform-shaped aneurysms accounted for 50.0%, 25.0% and 25.0% of the total, respectively. After surgical treatment, 75.0% patients recovered, except for 3 patients who developed new ischemic consequence. Conclusion Patients should be informed of the risk of RRAs after receiving radiotherapy for VS. In these patients, RRAs should be suspected when subarachnoid hemorrhage or AICA ischemic symptoms occurred. Active intervention should be conducted considering the high instability and bleeding rate of VS RRAs.
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Affiliation(s)
| | | | | | - Wei Fang
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an, China
| | - Yunze Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an, China
| | - Yingxi Wu
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an, China
| | - Yafei Xue
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an, China
| | - Bao Wang
- Correspondence: Tianzhi Zhao Yan Qu Bao Wang
| | - Yan Qu
- Correspondence: Tianzhi Zhao Yan Qu Bao Wang
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Hong CE, Cho YD, Yoo DH, Bae JW, Oh HS, Kang HS. Gamma knife radiosurgery-induced intracranial aneurysms: A case series and literature review. J Neuroradiol 2023; 50:36-39. [PMID: 36243170 DOI: 10.1016/j.neurad.2022.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Chang-Eui Hong
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Woo Bae
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
| | - Han San Oh
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Shinoda S, Muraoka S, Shimizu H, Koketsu N, Araki Y, Saito R. The prognosis and treatment effectiveness of de novo aneurysm formation after radiation therapy for brain tumor. Neurosurg Rev 2022; 45:2995-3002. [PMID: 35648321 DOI: 10.1007/s10143-022-01820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/30/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
Radiation therapy is a well-established, minimally invasive method of treating brain tumors. In recent years, the number of post-radiotherapy patients has increased, and delayed side effects are evident. De novo aneurysm formation after radiation often manifests as fatal subarachnoid hemorrhage (SAH), resulting in severe clinical outcomes. Nevertheless, the prognosis and therapeutic efficacy of radiation-induced aneurysms (RIAs) remain unclear. Using the PubMed database from 1980 to 2021, we screened 45 articles (53 individual cases) on RIAs; approximately 70% of RIAs were diagnosed after rupture. Of 38 ruptured RIAs, 12 (31.6%) had modified Rankin scale (mRS) 5-6. On the other hand, all unruptured RIAs (15 cases) recovered without neurological deficits (p = 0.012). Ten of the 39 ruptured RIAs were treated surgically, and 22 were treated endovascularly. There was no significant difference in mRS between treatment modalities (p = 0.393), but conservative therapy was significantly related to unfavorable outcomes (p = 0.025). To improve clinical outcomes, RIAs need to be diagnosed before rupture. Surgeons should be aware of de novo aneurysm formation in patients long after radiation therapy.
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Affiliation(s)
- Satoshi Shinoda
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Shinsuke Muraoka
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan. .,Department of Neurosurgery, Kariya Toyota General Hospital, Sumiyoshi Cho 5-15, Kariya, Aichi, Japan.
| | - Hiroyuki Shimizu
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Naoki Koketsu
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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You H, Bai Y, Yu T, Zeng T, Huang N, Mei W, Jiang C, Kang D, Wu X, Chen F. Higher Prevalence and Age Susceptibility of Intracranial Aneurysm in Patients With Acoustic Neuroma. Front Neurol 2020; 11:591526. [PMID: 33224100 PMCID: PMC7667236 DOI: 10.3389/fneur.2020.591526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: The purpose of this study was to verify whether the prevalence of intracranial aneurysm (IA) in patients with acoustic neuroma is greater than that in age- and sex-matched controls and to evaluate the independent risk factors related to the occurrence of IA. Methods: We retrospectively analyzed 231 patients diagnosed with acoustic neuroma at our institute between 2015 and 2019 and 489 controls from the medical examination center. Cerebrovascular angiography was acquired from all subjects to assess the presence of IA or not. The prevalence of IA and risk factors associated with a higher IA occurrence were compared, respectively. Results: Cerebral aneurysms were detected in 23 patients (10.0%) and 11 controls (2.2%). The prevalence of IA was significantly different between patients with acoustic neuroma and controls (p < 0.001), and the difference was mainly reflected in the age of 50 and above. In the subgroup analysis, there were distinct differences in several clinical features including age, hypertension, and tumor volume, and cystic change between patients coexisted with IA or not. However, age was a unique independent risk factor for coexistence of IA in patients with acoustic neuroma after multivariate logistic regression (OR 1.050, 95% CI 1.008-1.093, p = 0.019). Conclusions: Our results demonstrate that patients with acoustic neuroma have a higher prevalence of IA than the general population. Older age is correlated with greater occurrence of IA in these patients.
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Affiliation(s)
- Honghai You
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yue Bai
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ting Yu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Tiefa Zeng
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Nan Huang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wenzhong Mei
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Changzhen Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiyue Wu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fuxiang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Paolucci A, Schisano L, Pluderi M, Grimoldi N, Caranci F, Angileri A, Arrichiello A, Costa A. Giant intracranial aneurysm following radiation therapy: literature review with a novel case discussion. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020005. [PMID: 33245075 PMCID: PMC8023079 DOI: 10.23750/abm.v91i10-s.10281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this paper is to report the results of our review of the literature of published cases of intracranial aneurysms appearing after radiotherapy, and to present our case to add it to the current literature, in order to discuss the role of inflammation. METHODS We searched the PubMed database using combinations of the following MeSH terms: intracranial aneurysm, radiosurgery, radiotherapy, inflammatory changes in aneurysmal walls from 1967 to 2019. RESULTS 51 studies, for a total cohort of 60 patients, are described. The median latency between the radiation treatment and the diagnosis was 9,83 years, ranging from a minimum of 0,33 to a maximum of 33. The modality of rays' administration was variable, and the dosage ranged from a minimum of 12 grays to a maximum of 177,2 grays. The anterior circulation appeared to be more frequently involved, and the most compromised vessel was the internal carotid artery. Radiation-induced vascular diseases have already been described in literature as well as RT-induced cellular and structural changes such as necrosis, macrophage or mononuclear cell infiltration, and several data support the role of inflammation in the development and remodelling of intracranial aneurysms, that, on one hand, favours them and, on the other, is necessary to their healing after endovascular treatment. CONCLUSIONS Our team suggested a new insight in the management of these vascular lesions, which corresponds to a lower threshold when deciding whether or not to treat, and a longer and stricter follow-up.
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Affiliation(s)
| | - Luigi Schisano
- Operative Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano .
| | - Mauro Pluderi
- Operative Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
| | - Nadia Grimoldi
- Operative Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano .
| | - Ferdinando Caranci
- Department of Diagnostic Radiology and Radiotherapy, Federico II University of Naples, Naples, Italy .
| | - Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.
| | - Antonio Arrichiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy Via Festa del Perdono 7, 20122, Milan, Italy .
| | - Antonella Costa
- Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.
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Taniguchi T, Toyooka T, Miyama M, Takeuchi S, Otani N, Wada K. Ruptured Dissecting Aneurysm of the Carotid Artery 12 Years after Gamma Knife Therapy for Pituitary Adenoma. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:32-37. [PMID: 37503454 PMCID: PMC10370617 DOI: 10.5797/jnet.cr.2020-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/15/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a rare case of carotid artery dissection leading to fatal epistaxis 12 years after Gamma knife surgery. Case Presentation A 65-year-old woman underwent Gamma knife surgery for remnant pituitary adenoma adjacent to the left cavernous sinus after transsphenoidal tumor removal. After 12 years, she developed repetitive critical hematemesis subsequent to cardiopulmonary arrest, and a dissecting aneurysm of the cavernous segment of the left internal carotid artery (ICA) was identified by cerebral angiography after resuscitation and massive blood transfusion. Effective hemostasis was confirmed by endovascular embolization to occlude the affected carotid artery. She was transferred to a rehabilitation facility 1 month after onset. Conclusion The etiology of this pathology may have been a collapsed vasa vasorum or fibrosis of adventitia on the carotid wall adjacent to the irradiated site. We need to suspect this rare but serious pathology in patients with histories of irradiation of the cavernous region who develop massive hematemesis of unknown origin.
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Affiliation(s)
- Takahiko Taniguchi
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masataka Miyama
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Naoki Otani
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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Radiation-Induced Brain Aneurysms: Institutional Experience and State of the Art in the Contemporary Literature. World Neurosurg 2019; 135:339-351. [PMID: 31605840 DOI: 10.1016/j.wneu.2019.09.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Brain aneurysms (BAs) are the most common intracranial vascular condition, with an overall incidence of 1%-2%. Among the common causes of their initial formation and growth, the role of radiation therapy (RT) has been reported in some studies. The aim of the present study is to report the most relevant features of BA related to a previous cranial RT. METHODS Data deriving from 1 patient treated for RT-induced BA in our institution were added to reports of another 66 BAs retrieved from the literature. The following parameters were evaluated: age, sex, location, primary lesion, clinical presentation, dosage/amount of radiation delivered, type of treatment for the BA, dimension, morphology, chemotherapy, comorbidities, risk factors, and number of BAs. RESULTS The most commonly involved vessel was the internal carotid artery (34%). In general, the anterior circulation showed higher vulnerability compared with the posterior circulation and middle cerebral artery (56.7%). The average latency between RT and the first imaging showing the BA was 9.01 ± 6.85 years. Vessels coursing in the posterior cranial fossa showed a significant univariate association with lower X-ray dosages (P = 0.014) compared with the other locations. No statistically significant correlation between the continuous variables age, latency of BA appearance, RT delivered dose, and dimension of the BA was shown. CONCLUSIONS The apparent higher fragility of the vascular structures of the posterior cranial fossa was statistically outlined, and the X-ray dosage, the primary condition target of the RT, the age of the patients, and no statistically significant correlation were outlined. Biological factors could play a significant role.
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Kikuchi J, Takeuchi Y, Sugi K, Negoto T, Yoshitomi M, Hirohata M, Morioka M. Gamma knife surgery-induced aneurysm rupture associated with tissue plasminogen activator injection: A case report and literature review. Surg Neurol Int 2019; 10:150. [PMID: 31528485 PMCID: PMC6744794 DOI: 10.25259/sni_210_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/23/2019] [Indexed: 11/04/2022] Open
Abstract
Background Cases involving delayed development of intracranial aneurysms related to gamma knife surgery (GKS) have been recently reported. Here, we present a rare case of GKS-induced aneurysm rupture after intravenous injection of tissue plasminogen activator (t-PA) for occlusion of the middle cerebral artery (MCA). To the best of our knowledge, this is the first case in which t-PA-induced rupture of a GKS-related unruptured aneurysm. Case Description A 56-year-old woman underwent GKS for left trigeminal neuralgia. Eighteen years later, she suddenly experienced MCA occlusion with consciousness disturbance and right hemiparesis. She received an intravenous injection of t-PA and then was transferred to our hospital. We confirmed residual thrombus, and she underwent mechanical thrombectomy successfully. A postthrombectomy brain computed tomography scan revealed subarachnoid hemorrhage with a hematoma in the left cerebellar hemisphere. Cerebral angiography revealed a small irregular-shaped aneurysm at the branching site of the left circumflex branch at the distal position of the anterior inferior cerebellar artery, which was not detected on initial imaging. Coil embolization was performed. One month after the ischemic attack, she was transferred to a rehabilitation hospital, with a modified Rankin Scale score of 5. Conclusions The tendency to rupture is greater for GKS-induced aneurysms than for intrinsic unruptured aneurysms, according to previous reports. When performing acute treatment for cerebral infarction in patients with a history of GKS, the presence of aneurysms should be evaluated and we should keep in mind that GKS aneurysms are very small and tend to rupture.
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Affiliation(s)
- Jin Kikuchi
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, Kurume, Fukuoka, Japan
| | - Yasuharu Takeuchi
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, Kurume, Fukuoka, Japan
| | - Keisuke Sugi
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, Kurume, Fukuoka, Japan
| | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, Kurume, Fukuoka, Japan
| | - Munetake Yoshitomi
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, Kurume, Fukuoka, Japan
| | - Masaru Hirohata
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, Kurume, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-machi, Kurume, Fukuoka, Japan
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Yoshikawa S, Asano T, Watanabe M, Ishii T, Ohtake H, Fujiwara J, Sekine M, Uehara T, Hamamoto K, Yuhashi K, Matsumoto S, Asabe S, Miyatani H, Matsuura K, Mashima H. Rupture of Hepatic Pseudoaneurysm Formed Nine Years after Carbon Ion Radiotherapy for Hepatocellular Carcinoma. Intern Med 2019; 58:2639-2643. [PMID: 31178501 PMCID: PMC6794180 DOI: 10.2169/internalmedicine.2682-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
An 83-year-old man with a history of carbon ion radiotherapy for hepatocellular carcinoma nine years ago presented to a primary care hospital with a fever and abdominal pain. He underwent computed tomography, which revealed the rupture of a hepatic pseudoaneurysm close to the fiducial marker for carbon ion radiotherapy and bleeding into the bile duct. He was successfully treated with transcatheter arterial embolization. Thereafter, re-rupture occurred from a site proximal to the first rupture, and this was treated similarly. It is necessary to be alert for not only tumor recurrence but also pseudoaneurysm occurrence after carbon ion radiotherapy.
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Affiliation(s)
- Shuhei Yoshikawa
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Takeharu Asano
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Mizuki Watanabe
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Takehiro Ishii
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Haruka Ohtake
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Junichi Fujiwara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Masanari Sekine
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Takeshi Uehara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Kohei Hamamoto
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Japan
| | - Kazuhito Yuhashi
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Shinichi Asabe
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Hiroyuki Miyatani
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
| | - Katsuhiko Matsuura
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Japan
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Maruyama F, Tanaka T, Kajiwara I, Irie K, Ishibashi T, Tochigi S, Hasegawa Y, Murayama Y. Refractory De Novo Multiple Cerebral Aneurysms After Radiotherapy and Multistaged "Open" Surgical Treatment for Low-Grade Glioma During Long-Term Follow-Up: A Case Report and Review of the Literature. World Neurosurg X 2019; 3:100031. [PMID: 31225523 PMCID: PMC6584479 DOI: 10.1016/j.wnsx.2019.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background Radiation-induced aneurysms have been previously reported; however, multiple and repeated de novo aneurysm formation chronologically and anatomically during long-term follow-up have not yet been observed. The pathogenesis of persistent radiation-induced vasculopathy is not fully understood. Case Description A 31-year-old woman presented with intraventricular hemorrhage due to rupture of a right internal carotid artery (ICA) aneurysm that developed 17 years after surgical resection of a low-grade glioma in the right frontal lobe and postoperative radiotherapy (focal, 50 Gy/25 fractions). During glioma follow-up, salvage surgery with adjuvant gamma knife therapy and chemotherapy (ranimustine, vincristine, temozolomide) were performed for recurrence of the glioma. The aneurysm was treated with endovascular coil embolization. However, she experienced repeated intraventricular hemorrhages, and angiography revealed a de novo ICA aneurysm. The de novo aneurysms were treated with endovascular surgery using coil embolization and stenting. At 2 years after the third hemorrhage, the surgical wound became dehiscent, probably due to wound infection, thus epicranial soft tissue reconstruction using vascularized skin flap was performed. Despite multistaged endovascular surgery for the ICA aneurysm, she experienced repeated subarachnoid and intraventricular hemorrhages. Angiography revealed a de novo aneurysm of the right posterior cerebral artery and basilar trunk. She underwent coil embolization and stenting. Despite active management with endovascular surgery and close follow-up, she died after an eighth consecutive intraventricular and intracerebral hemorrhage caused by a de novo large aneurysm of the posterior cerebral artery. Conclusions To the best of our knowledge, the present study is the first to report on of refractory and recurring de novo aneurysms treated by multistaged endovascular surgery during a long-term follow-up after radiotherapy and multistaged craniotomy for glioma.
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Affiliation(s)
- Fumiaki Maruyama
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan.,Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Ikki Kajiwara
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Koreaki Irie
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Satoru Tochigi
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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13
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Internal carotid artery aneurysms diagnosed after stereotactic radiosurgery for a growth hormone-secreting pituitary adenoma: a case report and literature review. Acta Neurochir (Wien) 2019; 161:1191-1195. [PMID: 30955084 DOI: 10.1007/s00701-019-03840-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
Radiation therapy is associated with the subsequent development of cerebral aneurysms; however, stereotactic radiosurgery (SRS)-associated aneurysm cases have not been well documented, with only 18 cases reported to date. We present a case of intracranial aneurysms with the rupture occurring 20 years after SRS for a growth hormone-producing pituitary adenoma. This is the first report of aneurysms diagnosed following transsphenoidal surgery and SRS for pituitary adenoma. We believe that the aneurysm reported here is a consequence of the SRS treatment, and thus this may be a very rare long-term complication following radiation treatments.
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14
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Patro SN, Iancu D, Al Mansoori T, Lesiuk H, Vassilyadi M. Endovascular glue embolization of a radiation-induced lenticulostriate artery pseudoaneurysm in a pediatric patient with optic pathway glioma: Case report and review of literature. Interv Neuroradiol 2018; 24:499-508. [PMID: 29848144 DOI: 10.1177/1591019918773303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Radiation-associated vascular changes most commonly present in the form of stenosis, thrombosis and occlusion. However, development of intracranial aneurysms secondary to radiation is far less common and often manifests with rupture. These aneurysms are difficult to treat and associated with high morbidity and mortality when ruptured compared with saccular aneurysms unrelated to radiation treatment. Both surgical and endovascular options are available for treatment of these aneurysms. We present a young patient with a radiation-induced intracranial pseudoaneurysm arising from the lenticulostriate branch of the left middle cerebral artery (MCA); this developed 1 year 4 months after 59.4 Gy of focused radiation to the suprasellar pilomyxoid astrocytoma. The patient successfully underwent endovascular glue embolization of the aneurysm and occlusion of the lenticulostriate artery after unsuccessful trapping of the aneurysm and occlusion of the parent artery using coils. She developed transient hemiparesis of the right side following the procedure, which was managed conservatively. We performed a complete review of the literature dealing with the radiation-induced intracranial aneurysms, their presentation, treatment and outcome.
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Affiliation(s)
- Satya Narayana Patro
- 1 Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Daniela Iancu
- 1 Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Taleb Al Mansoori
- 1 Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Howard Lesiuk
- 2 Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Michael Vassilyadi
- 3 Department of Paediatric Neurosurgery, Children's Hospital of Eastern Ontario University of Ottawa, Ottawa, Canada
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15
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Umekawa M, Hasegawa H, Shin M, Kawashima M, Nomura S, Nakatomi H, Saito N. Radiosurgery-Induced Anterior Inferior Cerebellar Artery Pseudoaneurysm Treated with Trapping and Bypass. World Neurosurg 2018; 116:209-213. [PMID: 29729463 DOI: 10.1016/j.wneu.2018.04.161] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is an established modality for treatment of vestibular schwannomas (VSs). However, its long-term vascular complications have not been well studied. Among 360 patients who underwent SRS for VS in our institution and lived for >5 years thereafter, we identified only 1 patient who exhibited a complication secondary to a late-onset aneurysm for an estimated incidence of 0.3%. CASE DESCRIPTION A 78-year-old man who had undergone SRS 19 years previously for a right VS presented with right peripheral facial palsy. Radiographic examinations revealed a distal anterior inferior cerebellar artery (AICA) fusiform aneurysm that was embedded in the tumor and progressively enlarged over 17 months. Although the right AICA perfused a large area of the cerebellum, the aneurysm was successfully treated with AICA trapping in conjunction with an occipital artery-AICA bypass. CONCLUSIONS Distal AICA pseudoaneurysm formation is a rare but potentially severe late complication after SRS for VS. This pathology was successfully treated with AICA trapping with occipital artery-AICA bypass.
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Affiliation(s)
- Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Seiji Nomura
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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16
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Lee BS, Witek AM, Moore NZ, Bain MD. Treatment of an Anterior Inferior Cerebellar Artery Aneurysm With Microsurgical Trapping and In Situ Posterior Inferior Cerebellar Artery to Anterior Inferior Cerebellar Artery Bypass: Case Report. Oper Neurosurg (Hagerstown) 2017; 15:418-424. [DOI: 10.1093/ons/opx275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/23/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Anterior inferior cerebellar artery (AICA) aneurysms are rare lesions whose treatment can involve microsurgical and/or endovascular techniques. Such treatment can be challenging and may carry a significant risk of neurological morbidity.
OBJECTIVE
To demonstrate a case involving a complex AICA aneurysm that was treated with a unique microsurgical approach involving trapping the aneurysm and performing in Situ bypass from the posterior inferior cerebellar artery (PICA) to the distal AICA. The nuances of AICA aneurysms and revascularization strategies are discussed.
METHODS
The aneurysm and the distal segments of AICA and PICA were exposed with a retrosigmoid and far lateral approach. A side-to-side anastomosis was performed between the adjacent caudal loops of PICA and AICA. The AICA aneurysm was then treated by trapping the aneurysm-bearing segment of the parent vessel between 2 clips.
RESULTS
A postoperative angiogram demonstrated a patent PICA-AICA bypass and complete occlusion of the AICA aneurysm. There were no complications, and the patient made an excellent recovery.
CONCLUSION
The combination of parent vessel sacrifice and bypass remains an excellent option for certain difficult-to-treat aneurysms. This case involving PICA-AICA bypass to treat an AICA aneurysm serves as an example of the neurosurgeon's ability to develop unique solutions that take advantage of individual anatomy.
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Affiliation(s)
- Bryan S Lee
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Alex M Witek
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Nina Z Moore
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Mark D Bain
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
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17
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Kamide T, Mohri M, Misaki K, Uchiyama N, Nakada M. Intracranial aneurysm formation after radiotherapy for medulloblastoma. Surg Neurol Int 2016; 7:S880-S882. [PMID: 27999713 PMCID: PMC5154203 DOI: 10.4103/2152-7806.194501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background: The development of an intracranial aneurysm after radiotherapy is rare but secondary effect of cranial irradiation in a primary disease treatment. Case Description: The patient was a 17-year-old male adolescent who was diagnosed as having a posterior fossa medulloblastoma when he was 8 years old. He had undergone tumor resection with radiotherapy and chemotherapy. A distal posterior inferior cerebellar artery aneurysm was identified by magnetic resonance imaging 8 years after radiotherapy and grew rapidly throughout the next 1 year. The patient underwent microsurgical clipping and was discharged without deficit. Conclusion: This experience demonstrates that physicians caring for patients who have undergone intracranial radiotherapy should carefully consider the possibility of an aneurysmal formation when conducting follow-up imaging.
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Affiliation(s)
- Tomoya Kamide
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masanao Mohri
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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18
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Lv X, Ge H, He H, Jiang C, Li Y. Anterior inferior cerebellar artery aneurysms: Segments and results of surgical and endovascular managements. Interv Neuroradiol 2016; 22:643-648. [PMID: 27485045 PMCID: PMC5564350 DOI: 10.1177/1591019916656474] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/02/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anterior inferior cerebellar artery (AICA) aneurysms are rare and published clinical experience with these aneurysms is limited. OBJECTIVE The objective of this article is to report angiographic characteristics and results associated with premeatal, meatal and postmeatal segments, surgical and endovascular therapies. METHODS A literature review was performed through PubMed using "anterior inferior cerebellar artery aneurysm" through January 2016. Clinical data, angiograms, management techniques, and patient outcomes were reviewed for 47 collected cases in 30 previous reports. RESULTS Of these aneurysms, 21 (44.7%) were associated with meatal segment, 10 (21.3%) were postmeatal and 16 (34.0%) were premeatal. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy (77.8%). Patient outcomes of meatal aneurysms presented with more neuropathies (51.7%) and cerebellar symptoms (14.3%) (p = 0.049). Four cases of meatal aneurysm with preoperative cranial nerve deficits (two VII and two VIII) showed improvement after surgery. Endovascular treatment achieved outcomes similar to surgical treatment (p = 0.327). CONCLUSIONS AICA aneurysms have a predilection for meatal segment. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy. Patient outcomes of meatal aneurysms presented with more neuropathies and cerebellar symptoms. Endovascular treatment achieved outcomes similar to surgical treatment.
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Affiliation(s)
- Xianli Lv
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huijian Ge
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongwei He
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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19
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Wu YH, Lin SS, Chen HH, Chang FC, Liang ML, Wong TT, Yen SH, Chen YW. Radiotherapy-related intracranial aneurysm: case presentation of a 17-year male and a meta-analysis based on individual patient data. Childs Nerv Syst 2016; 32:1641-52. [PMID: 27306914 DOI: 10.1007/s00381-016-3144-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to investigate the incidence, clinical profiles, latency, and outcomes of radiotherapy (RT)-related intracranial aneurysms, rare but often fatal complications of cranial irradiation. METHODS We reviewed all published individual patient data regardless of language, using survival analysis to make statistical inferences. RESULTS We examined a total of 58 patients with RT-related intracranial aneurysms, including one unpublished case presented here, of whom 74.1 % presented with rupture. In the study, 29.3 % were younger than 18 years. The mean age at which patients received the first course of RT was 34.8 ± 22.8 years old. The mean latency between initiating RT and presenting with aneurysm was 10.4 ± 8.5 years. Rapid death ensured in 24 % shortly after presentation. The only significant predictor of death was rupture. In those with a single aneurysm, 43.1 % were located at the internal carotid artery, while 15.5 % of patients had multiple aneurysms. A male-to-female ratio of 1.87, 0.5, and 1.32 was found in patients younger than age 52, 52 years of age or older, and all 58 patients, respectively. Older age when receiving RT and presentation with ruptured aneurysm were significantly associated with shorter latency. CONCLUSIONS RT-related intracranial aneurysms presented differently from classical ones based on age, sex, site, multiplicity, and type. Sex ratios differed with age. The younger age group showed a longer latency of occurrence of an aneurysm. Older patients and those who develop ruptured aneurysms presented earlier. Since rupture may affect outcome, early detection of aneurysms before rupture may save lives.
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Affiliation(s)
- Yuan-Hung Wu
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Shuan Lin
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hsin-Hung Chen
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Chi Chang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Muh-Lii Liang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tai-Tong Wong
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Sang-Hue Yen
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Wei Chen
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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20
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Parag S, Arif Z, Chittoor R. Radiotherapy-related intracranial aneurysms: A role for conservative management. Surg Neurol Int 2016; 7:S387-90. [PMID: 27313964 PMCID: PMC4901822 DOI: 10.4103/2152-7806.183496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/18/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Radiotherapy-related intracranial aneurysms are a recognized but rare phenomenon and often present following rupture leading to subarachnoid hemorrhage. Treatment poses a particular dilemma and both endovascular, and surgical approaches have been used with varied success. We present the case of a radiotherapy-related aneurysm treated conservatively with a favorable outcome. CASE DESCRIPTION A 37-year-old man was diagnosed with a left temporal lobe mass for which he underwent an uneventful craniotomy and debulking. Histology revealed Grade III anaplastic astrocytoma following which he received radiotherapy. Three years later, he presented with subacute headache and transient dysphasia. Computed tomography and catheter angiography revealed a fusiform aneurysm of the supramarginal branch of the left middle cerebral artery with probable intra-aneurysmal thrombus. Adjacent vessels also showed mild vasculitic changes. Trial balloon occlusion of the parent vessel resulted in profound dysphasia and was therefore abandoned. Bypass surgery or stent placement was deemed to have too high a risk of neurological deficit, and keeping in mind, the diagnosis of anaplastic astrocytoma, conservative management was pursued with partial thrombosis noted on serial imaging and stable appearances subsequently at 42 months' follow-up. CONCLUSION Conservative management can be pursued in selective cases of radiotherapy-related aneurysms, particularly if the risk of treating is too high and in the context of intracranial malignancy with limited lifespan.
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Affiliation(s)
- Sayal Parag
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London
| | - Zafar Arif
- Department of Neurosurgery, Hull Royal Infirmary, Hull, United Kingdom
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21
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MURAKAMI M, KAWARABUKI K, INOUE Y, OHTA T. Ruptured Pseudoaneurysm after Gamma Knife Surgery for Vestibular Schwannoma. Neurol Med Chir (Tokyo) 2015; 56:38-42. [PMID: 26667081 PMCID: PMC4728148 DOI: 10.2176/nmc.cr.2015-0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 10/14/2015] [Indexed: 11/23/2022] Open
Abstract
Ruptured aneurysms of anterior inferior cerebellar artery (AICA) after radiotherapy for vestibular schwannoma (VS) are rare, and no definite treatment has been established for distal AICA pseudoaneurysms. We describe a 61-year-old man who underwent Gamma Knife surgery (GKS) for left VS. Follow-up magnetic resonance imaging (MRI) revealed partial regression of the tumor. Twelve years after GKS, he suffered from subarachnoid hemorrhage. Initial angiogram showed no vascular lesions; second left vertebral angiogram, 10 days after admission, demonstrated a pseudoaneurysm in the lateral pontine segment of the left AICA. The proximal portion of the AICA was occluded by a coil. Postoperative MRI revealed an infarction on the left side of the pons and brachium pontis. Although the patient suffered from mild postoperative cerebellar ataxia and facial and abducens nerve palsy, he was discharged 1 month postoperatively requiring no assistance with activities of daily living. Twelve months later, he recovered satisfactorily with a modified Rankin Scale grade of 1, and no recanalization of the aneurysm was found on MR angiography. Endovascular parent artery occlusion for ruptured aneurysms at distal AICA carries the risk of brain stem infarction, but should be considered when no other option is available such as after radiotherapy for VS.
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Affiliation(s)
- Mamoru MURAKAMI
- Department of Neurosurgery, Fukuchiyama City Hospital, Fukuchiyama, Kyoto
| | | | - Yasuo INOUE
- Department of Neurosurgery, Maizuru Medical Center, Maizuru, Kyoto
| | - Tsutomu OHTA
- Department of Neurosurgery, Fukuchiyama City Hospital, Fukuchiyama, Kyoto
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22
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Incidentally Discovered Unruptured AICA Aneurysm After Radiosurgery for Vestibular Schwannoma. Otol Neurotol 2015; 36:1428-31. [DOI: 10.1097/mao.0000000000000807] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Mascitelli JR, McNeill IT, Mocco J, Berenstein A, DeMattia J, Fifi JT. Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation. J Neurointerv Surg 2015; 8:e19. [PMID: 25964373 DOI: 10.1136/neurintsurg-2015-011736.rep] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/04/2022]
Abstract
Distal anterior inferior cerebellar artery (AICA) pseudoaneurysms are very rare lesions. Although cases have been previously reported, only a few have been reported as a result of vestibular schwannoma (VS) radiation, none have been reported as a result of VS resection, and only one has been reported as treated with parent vessel occlusion (PVO) with n-butyl cyanoacrylate (nBCA). We report a case of a 65-year-old man with a history of right-sided VS surgery and radiation who presented years later with a ruptured pseudoaneurysm of the distal right AICA and was treated with endovascular PVO using nBCA. The aneurysm was completely obliterated and the patient had no worsening of symptoms or neurological exam. The case illustrates a very rare complication of VS surgery and radiation as well as an effective treatment for distal AICA aneurysms.
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Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | | | - Joseph DeMattia
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
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24
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Mascitelli JR, McNeill IT, Mocco J, Berenstein A, DeMattia J, Fifi JT. Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation. BMJ Case Rep 2015; 2015:bcr-2015-011736. [PMID: 25948851 DOI: 10.1136/bcr-2015-011736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Distal anterior inferior cerebellar artery (AICA) pseudoaneurysms are very rare lesions. Although cases have been previously reported, only a few have been reported as a result of vestibular schwannoma (VS) radiation, none have been reported as a result of VS resection, and only one has been reported as treated with parent vessel occlusion (PVO) with n-butyl cyanoacrylate (nBCA). We report a case of a 65-year-old man with a history of right-sided VS surgery and radiation who presented years later with a ruptured pseudoaneurysm of the distal right AICA and was treated with endovascular PVO using nBCA. The aneurysm was completely obliterated and the patient had no worsening of symptoms or neurological exam. The case illustrates a very rare complication of VS surgery and radiation as well as an effective treatment for distal AICA aneurysms.
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Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | | | - Joseph DeMattia
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
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25
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Fujita K, Tamura M, Masuo O, Sasaki T, Yamoto T, Fukai J, Nakao N. Ruptured internal carotid artery aneurysm presenting with catastrophic epistaxis after repeated stereotactic radiotherapies for anterior skull base tumor: case reports and review of the literature. J Neurol Surg Rep 2014; 75:e200-5. [PMID: 25485213 PMCID: PMC4242894 DOI: 10.1055/s-0034-1383859] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 05/07/2014] [Indexed: 12/14/2022] Open
Abstract
Objectives Radiation-induced aneurysm is a rare complication for head and neck tumors. Only seven cases of an aneurysm after stereotactic radiosurgery and/or stereotactic radiotherapy (SRT) have been described. We report two patients with a ruptured internal carotid artery (ICA) aneurysm presenting with catastrophic epistaxis after repeated SRT for an anterior skull base tumor. Results Two male patients received repeated SRT in various combinations following surgery for an anterior skull base tumor. They presented with significant epistaxis due to rupture of the aneurysm of the ICA 6 and 77 months after the final SRT, respectively. The aneurysms were located within the radiation field. Preoperative angiography had revealed no aneurysms. Thus the aneurysms in these cases were most likely induced by the repeated SRT. Conclusions This is a proven report of aneurysm formation following repeated SRT without conventional radiotherapy. SRT may be very effective to control malignant skull base tumors. However, the possible development of radiation-induced aneurysm of the ICA should be considered in the case of repeated SRT. The surviving patients who have received SRT should undergo sequential follow-up for possible vascular involvement.
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Affiliation(s)
- Koji Fujita
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Manabu Tamura
- Tokyo Women's Medical University, Institute of Advanced Biomedical Engineering and Science, Tokyo, Japan
| | - Osamu Masuo
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takahiro Sasaki
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Toshikazu Yamoto
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Junya Fukai
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Naoyuki Nakao
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
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Matsumoto H, Minami H, Yamaura I, Yoshida Y. Radiation-induced cerebral aneurysm treated with endovascular coil embolization. A case report. Interv Neuroradiol 2014; 20:448-53. [PMID: 25207908 DOI: 10.15274/inr-2014-10039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/02/2014] [Indexed: 11/12/2022] Open
Abstract
Radiation-induced cerebral aneurysms are rare. We describe a case of radiation-induced cerebral aneurysm successfully treated with endovascular coil embolization. A 39-year-old man received 60 Gy of radiation to a pineal germinoma at eight years old. The left internal carotid artery (ICA) aneurysm which developed within the irradiated field and stenotic change in the left ICA due to radiation-induced vasculopathy were detected incidentally. Because these aneurysms show a high risk of rupture and mortality, and even small aneurysms are prone to rupture, any such suspected aneurysm should be treated with surgical or endovascular procedures. Endovascular treatment is probably useful if the aneurysm is inaccessible to direct surgery. Special attention must be paid to treatment because of stenotic changes in cerebral vessels within the irradiated field.
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Affiliation(s)
- Hiroaki Matsumoto
- Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan -
| | - Hiroaki Minami
- Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan
| | - Ikuya Yamaura
- Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan
| | - Yasuhisa Yoshida
- Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan
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27
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Intracranial Aneurysms in Previously Irradiated Fields: Literature Review and Case Report. World Neurosurg 2014; 81:511-9. [DOI: 10.1016/j.wneu.2013.10.044] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/24/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022]
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28
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Tamura M, Kogo K, Masuo O, Oura Y, Matsumoto H, Fujita K, Nakao N, Uematsu Y, Itakura T, Chernov M, Hayashi M, Muragaki Y, Iseki H. Formation and Rupture of the Internal Carotid Artery Aneurysm after Multiple Courses of Intensity-Modulated Radiation Therapy for Management of the Skull Base Ewing Sarcoma/PNET: Case Report. J Neurol Surg Rep 2013; 74:111-7. [PMID: 24303346 PMCID: PMC3836956 DOI: 10.1055/s-0033-1358379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 07/08/2013] [Indexed: 11/08/2022] Open
Abstract
Background Aneurysm formation after stereotactic irradiation of skull base tumors is rare. The formation and rupture of an internal carotid artery (ICA) aneurysm in a patient with skull base Ewing sarcoma/primitive neuroectodermal tumor (PNET), who underwent surgery followed by multiple courses of intensity-modulated radiation therapy (IMRT) and chemotherapy, is described. Case Description A 25-year-old man presented with a sinonasal tumor with intraorbital and intracranial growth. At that time cerebral angiography did not reveal any vascular abnormalities. The lesion was resected subtotally. Histopathologic diagnosis was Ewing sarcoma/PNET. The patient underwent multiple courses of chemotherapy and three courses of IMRT at 3, 28, and 42 months after initial surgery. The total biologically effective dose delivered to the right ICA was 220.2 Gy. Seven months after the third IMRT, the patient experienced profound nasal bleeding that resulted in hypovolemic shock. Angiography revealed a ruptured right C4–C5 aneurysm and irregular stenotic changes of the ICA. Lifesaving endovascular trapping of the right ICA was done. The patient recovered well after surgery but died due to tumor recurrence 6 months later. Conclusion Excessive irradiation of the ICA may occasionally result in aneurysm formation, which should be borne in mind during stereotactic irradiation of malignant skull base tumors.
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Affiliation(s)
- Manabu Tamura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
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29
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Reynolds MR, Hawasli AH, Murphy RKJ, Ray WZ, Simpson JR, Drzymala RE, Rich KM. Acute Hemorrhage Following Gamma Knife Radiosurgery to a Clival Meningioma. JOURNAL OF SPINE & NEUROSURGERY 2013; 2:108. [PMID: 24772451 DOI: 10.4172/2325-9701.1000108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gamma Knife radiosurgery (GKS) is a primary treatment modality for small, surgically-challenging meningiomas of the skull base in carefully selected patients. Despite the overall low incidence of complications from this procedure, rare instances of hemorrhagic events following GKS have been reported. In fact, only a single, probable case of acute hemorrhage after GKS for a meningioma exists in the literature. CASE DESCRIPTION The authors present the case of a 59-year-old female treated with GKS to a clival meningioma who suffered an acute intra- and peritumoral hemorrhage within three hours after the procedure. The patient also had an ST-elevation myocardial infarction associated with the hemorrhage. At the time of her GKS she was taking aspirin and clopidogrel for treatment of coronary artery disease with multiple cardiac stents. Cerebral catheter angiography failed to reveal a source for the hemorrhage. CONCLUSION Acute hemorrhage following GKS to a meningioma is a rare, but potentially serious, complication and consideration should be given to counseling patients of this risk prior to treatment. We hypothesize that acute change to the structural integrity of the vascular endothelium after GKS may have precipitated cerebrovascular dysfunction resulting in hemorrhage. While the administration of anti-platelet therapy may have been a contributing factor to his event, it appears that the low incidence of acute tumoral bleeding after GKS does not justify routinely discontinuing anti-platelet and/or anti-coagulation in patients with severe associated medical co-morbidities.
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Affiliation(s)
- Matthew R Reynolds
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ammar H Hawasli
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rory K J Murphy
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wilson Z Ray
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph R Simpson
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA ; Departments of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert E Drzymala
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA ; Departments of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith M Rich
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA ; Departments of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
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30
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Gross BA, Ropper AE, Du R. Vascular complications of stereotactic radiosurgery for arteriovenous malformations. Clin Neurol Neurosurg 2012; 115:713-7. [PMID: 22910397 DOI: 10.1016/j.clineuro.2012.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/16/2012] [Accepted: 08/05/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although vasculopathy and de novo aneurysm formation are known complications of traditional radiation therapy, their occurrence following AVM SRS is rare and thus infrequently addressed in the literature. We sought to evaluate these phenomena through a review of our institutional experience. METHODS Our review afforded 32 patients treated with LINAC-based SRS over an eight year period. We noted obliteration rates, complication rates and long-term outcomes, with particular attention paid to follow-up angiographic studies. RESULTS After a mean follow-up of 4.3 years, the overall obliteration rate was 50%, increasing to 87% for AVMs less than 3cm. Eight patients had nine hemorrhages following SRS (25%). One occurred in the context of a de novo arterial pseudoaneurysm and another in the context of a new venous varix. Two patients with post-SRS hemorrhage had intranidal aneurysms that were not as apparent on initial angiography. Two patients that did not suffer from latency period hemorrhage developed dysplastic changes of feeding arteries, and one patient suffered from early venous thrombosis with resultant permanent hemiparesis from infarction. After a mean follow-up of 4.3 years, 8 patients were clinically improved (25%), 19 were the same (59%), and 5 were worse (16%), including 2 that died as a result of latency period hemorrhage. CONCLUSION While radiosurgery of AVMs is safe and successful in the vast majority of cases, vasculopathic complications including de novo aneurysm and varix development, early venous occlusion and stenotic vasculopathy, while infrequent, can occur. Closer long-term angiographic surveillance of these patients may thus be warranted.
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Affiliation(s)
- Bradley A Gross
- Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
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Clinical presentation and treatment of distal anterior inferior cerebellar artery aneurysms. Neurosurg Rev 2012; 35:497-503; discussion 503-4. [PMID: 22572778 DOI: 10.1007/s10143-012-0390-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 02/28/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
Aneurysms located at the distal portion of the anterior inferior cerebellar artery (AICA) are rare, and their clinical features are not fully understood. We report the clinical features and management of nine distal AICA aneurysms in nine patients treated during the past decade at Kagoshima University Hospital and affiliated hospitals. Our series includes seven women and two men. Of their nine aneurysms, eight were ruptured and one was unruptured; six were saccular and three were dissecting aneurysms. The most prevalent location was the meatal loop (n = 5) followed by the postmeatal (n = 3) and premeatal segment (n = 1) of the AICA, suggesting hemodynamic stress as an etiology of these distal AICA aneurysms. Of the nine patients, five presented with angiographic features suggestive of increased hemodynamic stress to the AICA and the common trunk of the posterior inferior cerebellar artery, with vertebral artery stenosis, marked laterality, and a primitive hypoglossal artery. We addressed eight aneurysms (eight patients) surgically; one aneurysm in one patient disappeared in the course of 3 months without surgical treatment. Of the eight surgically treated aneurysms, seven were ruptured and one was unruptured, five were clipped via lateral suboccipital craniotomy, two were trapped via lateral suboccipital craniotomy, and one was embolized. Good outcomes were obtained in six of the eight patients who underwent operation (75 %). We consider increased hemodynamic stress attributable to anatomic variations in the AICA and related posterior circulation to be the predominant contributor to the development of distal AICA aneurysms. Direct clipping and trapping yielded favorable outcomes in our series.
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