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Cyst Formation Following Radiosurgery for AVMs: Report of 3 Cases

Published online by Cambridge University Press:  18 February 2016

Q. Al Hinai ,
D. Tampieri ,
L. Souhami ,
A. Sadikot ,
D. Sinclair  and
R. Leblanc
Q. Al Hinai
Affiliation:
Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
D. Tampieri
Affiliation:
Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, Montreal, Quebec, Canada
L. Souhami
Affiliation:
Montreal Neurological Hospital & Institut, Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
A. Sadikot
Affiliation:
Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
D. Sinclair
Affiliation:
Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
R. Leblanc*
Affiliation:
Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
*
Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, 3801 University Street, Montreal, Quebec, H3A 2B4, Canada
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Abstract:

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Background:

Stereotactically-focused radiosurgery (SRS) for the treatment of arteriovenous malformations (AVM) has been in widespread use for over two decades. Over this timeframe the indications for treatment, standardization of radiation dosage, and the results expected from treatment have been elaborated. Less well known are the long-term complications associated with SRS. We report three patients who had SRS for the treatment of AVM who developed a cyst at the site of treatment as a late complication.

Methods:

From 201 patients treated by SRS for an AVM, three developed a cyst at the treatment site. Their clinical presentation, the characteristics of the AVMs and the treatment were reviewed, as well as similar cases gleaned from the literature.

Results:

Three women, aged 28-43 years, had an AVM treated by: craniotomy and clipping of arterial feeders followed by SRS, by craniotomy for resection followed by SRS or by endo vascular embolization and SRS. The patients did well following treatment but two of them developed a symptomatic and the other an asymptomatic cyst at the treatment site 3-19 years later. The symptomatic patients underwent marsupialization of the cyst and the other is under observation.

Conclusion:

Stereotactic radiosurgery is an established and safe treatment for patients with AVMs. Delayed cyst formation can occur many years after treatment and long term follow-up is indicated in patients whose AVM has been treated with SRS.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 5 , September 2011 , pp. 734 - 740
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

References

1.Jagannathan, J, Petit, J, Balsara, K, Hudes, R, Chin, L. Long-term survival after gamma knife radiosurgery for primary and metastatic brain tumors. Am J Clin Oncol. 2004; 27:441–4.CrossRefGoogle ScholarPubMed
2.Kimura, T, Sako, K, Tohyama, Y, et al.Diagnosis and treatment of progressive space-occupying radiation necrosis following stereotactic radiosurgery for brain metastasis: value of proton magnetic resonance spectroscopy. Acta Neurochir (Wien). 2003; 145:557–64.CrossRefGoogle ScholarPubMed
3.Okun, MS, Stover, NP, Subramanian, T, et al: Complications of gamma knife surgery for Parkinson disease. Arch Neurol. 2001; 58:1995–2002.CrossRefGoogle ScholarPubMed
4.Plowman, P. Stereotactic radiosurgery VIII. The classification of postradiation reactions. Br J Neurosurg. 1999; 13:256–64.CrossRefGoogle ScholarPubMed
5.Shenouda, G, Souhami, L, Podgorsak, EB, et al.Radiosurgery and accelerated radiotherapy for patients with glioblastoma. Can J Neurol Sci. 1997; 24:110–15.CrossRefGoogle ScholarPubMed
6.Statham, P, Macpherson, P, Johnston, R, Forster, DM, Adams, JH, Todd, NV. Cerebral radiation necrosis complicating stereotactic radiosurgery for artero venous malformation. J Neurol Neurosurg Psychiatry. 1990; 53:476–9.CrossRefGoogle Scholar
7.Takenaka, N, Imanishi, T, Sasaki, H, et al.Delayed radiation necrosis with extensive brain edema after gamma knife radiosurgery for multiple cerebral cavernous malformations. Case report. Neurol Med Chir (Tokyo). 2003; 43:391–5.CrossRefGoogle ScholarPubMed
8.Tandon, N, Vollmer, DG, New, PZ, et al.Fulminant radiation-induced necrosis after stereotactic radiation therapy to the posterior fossa. Case report and review of the literature. J Neurosurg. 2001;95:507–12.CrossRefGoogle Scholar
9.Feindel, W, Yamamoto, YL, Hodge, CP. Intracarotid fluorescein angiography. A new method for examination of the epicerebral circulation in man. Can Med Assoc J. 1967; 96:1–7.Google ScholarPubMed
10.Forster, DMC. Complication management. Presented at the 2nd Annual Congress of the International Stereotactic Radiosurgery Society. Boston, June 14-17, 1995.Google Scholar
11.Lindquist, C. Complication management. Presented at the 2nd Congress of the International Stereotactic Radiosurgery Society. Boston, Mass, 1995.Google Scholar
12.Yamamoto, M, Jimbo, M, Hara, M, Saito, I, Mori, K. Gamma knife radiosurgery for arteriovenous malformations: Long-term follow-up results focusing on complications occurring more than 5 years after irradiation. Neurosurgery. 1996; 38:906–14.CrossRefGoogle ScholarPubMed
13.Tanaka, T. two cases of cyst formation after Gamma knife radiosurgery for AVM. Presented at the 5th International Workshop on Cerebrovascular surgery. Fukuoka, Japan. 1997, 3–5.Google Scholar
14.Kihlström, L, Guo, W, Karlsson, B, Lindquist, C, Lindqvist, M. Magnetic resonance imaging of obliterated arteriovenous malformations up to 23 years after radiosurgery. J Neurosurg. 1997; 86:589–93.CrossRefGoogle ScholarPubMed
15.Radanowicz-Harttmann, V, Bachli, H, Gratzl, O. Late complication of radiosurgery of AVMs with the gamma knife: A case report. Acta Neurochir (Wien). 1998; 140:194–5.CrossRefGoogle ScholarPubMed
16.Kim, MS, Lee, SI, Sim, JH. A case of very large cyst formation with Gamma Knife radiosurgery for an arteriovenous malformation. Stereotact Funct Neurosurg. 1999; 72[Suppl l]:168–74.CrossRefGoogle ScholarPubMed
17.Flickinger, JC, Kondziloka, D, Lunsford, LD, et al.A multiple-institutional analysis of complication and outcomes after arteriovenous malformation radiosurgery. Int J Radiat Oncol Biol Phys. 1999; 44:67–74.CrossRefGoogle Scholar
18.Pollock, B, Brown, R. Management of cysts arising after radiosurgery to treat intracranial arteriovenous malformations. Neurosurgery. 2001 August; Vol. 49, No. 2:259–65.Google ScholarPubMed
19.Pan, H, Sheehan, J, Stroila, M, Steiner, M, Steiner, L. Late cyst formation following gamma knife surgery of arteriovenous malformations. J Neurosurg. 2005 Jan;102 Suppl:124–7.CrossRefGoogle ScholarPubMed
20.Izawa, M, Chernov, M, Hayashi, M, et al.Management and prognosis of cysts developed on long-term follow-up after Gamma Knife radiosurgery for intracranial arteriovenous malformations. Surg Neurol. 2007 Oct; 68(4):400–6.CrossRefGoogle ScholarPubMed
21.Wolak, ML, Murphy, EC, Powell, SZ. Tumefactive cyst with a vascular blush as a late complication after combined embolization and stereotactic radiosurgery treatments for a cerebral arteriovenous malformation. Acta Neurochir (Wien). 2007; 149(7):705–12.CrossRefGoogle ScholarPubMed
22.Buis, DR, Meijer, OW, van den Berg, R, et al.Clinical outcome after repeated radiosurgery for brain arteriovenous malformations. Radiother Oncol. 2010 May; 95(2):250–6.CrossRefGoogle ScholarPubMed
23.Izawa, M, Hayashi, M, Chernov, M, et al.Long-term complications after gamma knife surgery for arteriovenous malformations. J Neurosurg. 2005; Suppl 102:34–7.CrossRefGoogle ScholarPubMed
24.Schlienger, M, Atlan, D, Lefkopoulos, D, et al.Linac radiosurgery for cerebral arteriovenous malformations: results in 169 patients. Int J Radiat Oncol Biol Phys. 2000; 46:1135–12.CrossRefGoogle ScholarPubMed
25.Yamamoto, M, Hara, M, Ide, M, Ono, Y, Jimbo, M, Saito, I. Radiation-related adverse effects observed on neuro-imaging several years after radiosurgery for cerebral arteriovenous malformations. Surg Neurol. 1998; 49:385–98.CrossRefGoogle ScholarPubMed
26.Yamamoto, M, Ide, M, Jimbo, M, Hamazaki, M, Ban, S. Late cyst convolution after gamma knife radiosurgery for cerebral arteriovenous malformations. Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:166–78CrossRefGoogle ScholarPubMed
27.Nakamura, H, Boku, N, Jokura, H, Takahashi, Y, Yoshimoto, T. Intracerebral cyst formation following stereotactic radiosurgery for AVM: Report of six cases. Presented at the 6th Annual Meeting of the Japanese Society of Stereotactic Radiosurgery. Nagoya, July 26, 1997.Google Scholar
28.Hara, M, Nakamura, M, Shiokawa, Y, et al.Delayed cyst formation after radiosurgery for cerebral arteriovenous malformations: Two case reports. Minim Invasive Neurosurg. 1998; 41:40–5.CrossRefGoogle ScholarPubMed
29.Elwell, V, Koo Ng, N, Dhanjal, M, Peterson, D. Cerebral cyst formation in pregnancy following gamma knife surgery of an underlying arteriovenous malformation. Br J Neurosurg. 2008 Dec; 22(6):808–9.CrossRefGoogle ScholarPubMed
30.Pollock, BE, Gorman, DA, Coffey, RJ. Patient outcomes after arteriovenous malformation radiosurgical management: results based on a 5- to 14-year follow-up study. Neurosurgery. 2003 Jun; 52(6):1291–6.CrossRefGoogle ScholarPubMed