Operative intervention for delayed symptomatic radionecrotic masses developing following stereotactic radiosurgery for cerebral arteriovenous malformations—case analysis and literature review

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• 作者：Mansoor Foroughi (1)
  Andras A. Kemeny (2)
  Martin Lehecka (3)
  Juliana Wons (3)
  Lisa Kajdi (3)
  Richard Hatfield (1)
  Sidney Marks (4)
  
• 关键词：Radionecrosis ; Arteriovenous malformation ; Gamma knife ; Stereotactic radiosurgery ; Complications ; SPECT
• 刊名：Acta Neurochirurgica
• 出版年：2010
• 出版时间：May 2010
• 年：2010
• 卷：152
• 期：5
• 页码：803-815
• 全文大小：473KB
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• 作者单位：Mansoor Foroughi (1)
  Andras A. Kemeny (2)
  Martin Lehecka (3)
  Juliana Wons (3)
  Lisa Kajdi (3)
  Richard Hatfield (1)
  Sidney Marks (4)
  
  1. Department of Neurosurgery, University Hospital of Wales Cardiff, Heath Park, Cardiff, CF14 4XW, UK
  2. Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
  3. Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
  4. Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
  

文摘

Case report We report two cases of operative intervention that was beneficial in the treatment of delayed symptomatic radionecrotic masses that had developed following stereotactic radiosurgery (SRS) using the gamma knife (GK) for the treatment of cerebral arteriovenous malformations (AVM). Discussion Case 1 involved a small craniotomy for decompression of a large cerebral multiloculated cyst, which had become symptomatic 84?months following gamma knife treatment for a left frontal lobe AVM. Case 2 involved surgical excision of an occipital radionecrotic mass 72?months following GK treatment for an occipital AVM. This patient had suffered from longstanding symptomatic cerebral oedema, which on occasions had become life threatening. Case 2 is also the first report of a radionecrotic mass occurring post-SRS for an AVM, which conversely appeared to demonstrate increased uptake on single photon emission computed tomography (SPECT) scan. The first literature review of such delayed symptomatic radionecrotic lesions is presented. There appears to be a late onset of symptoms (average 55?months, range 12-11?months) associated with such radionecrosis. Drainage of such cysts or excision of the mass lesion appears to be consistently beneficial to the patients and appears to be uncomplicated. Conclusion We recommend early surgical intervention for such delayed symptomatic radionecrotic masses that do not resolve following non-operative management. We also recommend caution in interpretation of SPECT scan results when attempting to differentiate radionecrosis from neoplasia.