Cerebral space-occupying cysts following radiation and chemotherapy of malignant gliomas

Abstract

Eight cases of cerebral cyst formation among 50 patients (= 16%) with malignant supratentorial gliomas treated by surgery, megavoltage radiation, and multiple-agent chemotherapy are reported. Five of them developed signs of intracranial hypertension or progressive neurological deficit, while in three patients cerebral cysts were detected by CT without clinical deterioration. At operation or autopsy, or both, the large fluid-filled, smooth-walled cysts were lined by glio-mesenchymal scar tissue with no or little tumour recurrence in five, while three patients showed large recurrent tumour masses associated with necrosis and cyst formation. Clinical signs or CT evidence, or both, of cerebral cysts developed 4 to 12 months (average 10 months) after the first craniotomy, and 3 to 9 months after termination of radiotherapy, usually after the second to fourth course of polychemotherapy. The cystic cavities which are attributed to increased necrosis and other effects of radiation and cytostatic treatment, may mimic tumour progression or recurrence, and cerebral abscess, but are usually recognized by CT. Surgical treatment produced transient clinical improvement in 5 patients, but usually did not prevent the fatal outcome of the disease, which in these paticrosis and other effects of radiation and cytostatic treatment, may mimic tumour progression or recurrence, and cerebral abscess, but are usually recognized by CT. Surgical treatment produced transient clinical improvement in 5 patients, but usually did not prevent the fatal outcome of the disease, which in these paticrosis and other effects of radiation and cytostatic treatment, may mimic tumour progression or recurrence, and cerebral abscess, but are usually recognized by CT. Surgical treatment produced transient clinical improvement in 5 patients, but usually did not prevent the fatal outcome of the disease, which in these patients occurred 3 weeks to 6 months after surgical treatment of cyst formation, their life span ranging from 9 to 22 months. The pathogenesis and clinical problems related to cerebral cysts arising following multimodality treatment of malignant brain tumours are discussed.

Correlation of neuropathologic findings, computerized tomographic and high-resolution ultrasound scans of canine avian sarcoma virus-induced brain tumors

“…Acute hemorrhage has previously been shown to be highly echogenic and sharply circumscribed corresponding histologically to the dimensions of the clot (31,33,34,69). Hypodense areas appear within glioblastomas and are often seen by CT following treatment (24,65,77,105). However, the mean density of such a hypodense area does not distinguish cyst from central necrosis or solid tumor (65).…”

Occurrence and Therapy of Space-Occupying Cystic Lesions after Brain Tumor Surgery

“…Especially primary and metastatic brain tumors may be accompanied by cystic lesions which may become large enough to cause compression of surrounding brain resulting in signs and symptoms of either raised intracranial pressure or focal neurological deficits. Apart from these ªprimaryº cysts, representing a part of the untreated tumor, space-occupying cystic lesions may also develop in a variable time after resection with or without following radiation-/chemotherapy of particular intracranial tumors [1,2,7,9,10,11]. This rare late complication of these procedures is detected mainly after the patient deteriorates with focal neurological deficits or raised intracranial pressure, mimicking tumor recurrence.…”

“…This rare late complication of these procedures is detected mainly after the patient deteriorates with focal neurological deficits or raised intracranial pressure, mimicking tumor recurrence. The pathomechanism of the cyst formation remains unclear, but a causal relationship to preceding radiation therapy, chemotherapy, infectious or bleeding complications is presumed [1,7,10].…”

“…According to the variety of location, size and configuration among other characteristic factors of such cystic lesions, a wide spectrum of more or less invasive therapeutic options can be applied [1,2,7,8,10,11].…”

Brain Tumors with Cysts Treated with Gamma Knife Radiosurgery: Is Microsurgery Indicated?

“…Reduction in cyst size may be accomplished by therapy directed at the tumor, including resection, radiation, chemotherapy, or a combination of these. However, cysts may recur after brain tumor treatment and in some instances may develop as a consequence of treatment [3,4], which may necessitate frequent operative procedures. Stereotactic placement of an Ommaya reservoir avoids multiple brain punctures and permits aspiration of the cyst in an outpatient setting.…”