De Novo Formation of Cavernoma After Radiosurgery for Adult Cerebral Arteriovenous Malformation -Case Report-

Motegi, Hiroaki; Kuroda, Satoshi; Ishii, Nobuaki; Aoyama, Hidefumi; Terae, Satoshi; Shirato, Hiroki; Iwasaki, Yoshinobu

doi:10.2176/nmc.48.397

Cited by 50 publications

(24 citation statements)

References 22 publications

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“…Cavernous malformation development can occur after either conventional radiation 16 or stereotactic radiosurgery, 15,17 though all patients with radiation-induced cerebral CMs in this study had undergone conventional fractionated radiation. A prior systematic review of 76 patients with radiation-induced CMs showed a mean patient age of 11.7 years with a latency of 8.9 years after radiation until CM detection, 16 quite consistent with results seen in our study.…”

Section: Discussionmentioning

confidence: 81%

The natural history of cerebral cavernous malformations in children

Gross

Orbach

et al. 2016

PED

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OBJECT Cerebral cavernous malformations (CMs) are a source of neurological morbidity from seizures and focal neurological deficits due to mass effect and hemorrhage. Although several natural history reports exist for adults with CMs, similar data for pediatric patients are limited. METHODS The authors reviewed hospital databases to identify children with CMs who had not been treated surgically and who had clinical and radiological follow-up. Annual hemorrhage rates were calculated in lesion-years, and risk factors were assessed using the Cox proportional hazards model. RESULTS In a cohort of 167 patients with 222 CMs, the mean patient age at the time of diagnosis was 10.1 years old (SD 6.0). Ninety patients (54%) were male. One hundred four patients (62%) presented with hemorrhage from at least 1 CM, 58 (35%) with seizures with or without CM hemorrhage, and 43 (26%) with incidental lesions. Twenty-five patients (15%) had multiple CMs, 17 (10%) had a family history of CMs, and 33 (20%) had radiologically apparent developmental venous anomalies (DVAs). The overall annual hemorrhage rate was 3.3%. Permanent neurological morbidity was 29% per hemorrhage, increasing to 45% for brainstem, thalamic, or basal ganglia CM and decreasing to 15% for supratentorial lobar or cerebellar lesions. The annual hemorrhage rate for incidental CMs was 0.5%; for hemorrhagic CMs, it was 11.3%, increasing to 18.2% within the first 3 years. Hemorrhage clustering within 3 years was statistically significant (HR 6.1, 95% CI 1.72–21.7, p = 0.005). On multivariate analysis, hemorrhagic presentation (HR 4.63, 95% CI 1.53–14.1, p = 0.007), brainstem location (HR 4.42, 95% CI 1.57–12.4, p = 0.005), and an associated radiologically apparent DVA (HR 2.91, 95% CI 1.04–8.09, p = 0.04) emerged as significant risk factors for hemorrhage, whereas age, sex, CM multiplicity, and CM family history did not. CONCLUSIONS Prior hemorrhage, brainstem location, and associated DVAs are significant risk factors for symptomatic hemorrhage in children with CMs. Hemorrhage clustering within the first 3 years of a bleed can occur, a potentially important factor in patient management and counseling.

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Section: Discussionmentioning

confidence: 81%

The natural history of cerebral cavernous malformations in children

Gross

Orbach

et al. 2016

PED

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“…We interpret 'expanding hematoma' to represent granulation tis- sue at the site of the obliterated AVM with hemorrhage [10,16] . Histological examination of expanding hematoma and cavernous angioma has been reported [10,11] . However, in our series, no cavernous angioma-like lesion was found.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Late Complications following Gamma Knife Surgery for Arteriovenous Malformations

Shuto

Matsunaga²,

Suenaga³

2011

Stereotact Funct Neurosurg

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Background: To establish the surgical indications and strategy for late complications following gamma knife surgery (GKS) for arteriovenous malformations (AVMs). Methods: Ten male and 7 female patients aged 17–52 years (mean 28.0 years) were retrospectively identified among 686 patients who underwent GKS for AVM at our hospital. Ten patients showed cyst formation (group A), 2 patients had expanding hematoma (group B), and 5 patients had both cyst and expanding hematoma (group C). Results: The mean nidus volume was 10.1 ml (range 0.1–36 ml), and the mean prescription dose at the nidus margin was 19.9 Gy (range 18–28 Gy). Complete obliteration of the nidus was obtained in 12 patients, partial obliteration in 4, and no change in 1. Cyst formation (group A) was asymptomatic in 5 patients, and symptomatic in 5 patients, manifesting as headache, hemianopia, aphasia, and motor weakness. Expanding hematoma (groups B and C) was associated with surrounding brain edema and was symptomatic in all 7 patients. Cyst opening in 1 patient and placement of an Ommaya reservoir in 2 patients were necessary in group A. Both patients in group B underwent craniotomy. Four of the 5 patients in group C required craniotomy. Another patient in group C was lost to follow-up and the final outcome was unknown. Conclusions: Cyst formation is one of the late complications of GKS for AVM. Some cysts show spontaneous regression but others gradually increase in size and become symptomatic, although relatively large asymptomatic cysts are also known. Predicting the future course of a cyst is difficult. Surgery such as placement of an Ommaya reservoir should be considered for symptomatic cases. Expanding hematoma always increases in size and becomes symptomatic, so removal by craniotomy is necessary. Surrounding brain edema decreases rapidly after surgery and neurological symptoms quickly resolve.

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“…[2][3][4][5][6][7][8][9][10] The clinical features included: Adult onset except on patient younger than 20 years, male gender, high frequency of headache and seizure, high frequency of frontal or parietal lobe location, and presence of peri-lesional edema. Our patient had a past history of acute lymphoblastic leukemia, which can cause intracranial hemorrhage.…”

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confidence: 99%