De novo intracranial aneurysm formation after Gamma Knife radiosurgery for vestibular schwannoma

Abstract

Vascular complications, including vessel occlusion and hemorrhage, can arise after radiosurgery; however, hemorrhage due to a ruptured de novo aneurysm after Gamma Knife radiosurgery (GKS) for tumor is extremely rare. To the authors' knowledge, only a single case of de novo aneurysm formation after GKS for vestibular schwannoma has been previously reported. In this study, they describe their experience with the treatment of a 74-year-old woman with subarachnoid hemorrhage limited to the cerebellopontine cistern, who had undergone GKS for vestibular schwannoma 5 years earlier. Cerebral angiography demonstrated a left distal anterior inferior cerebellar artery aneurysm; coil embolization was attempted and failed. However, self-resolution of the aneurysm was revealed on follow-up angiography.

Ruptured de novo Aneurysm following Gamma Knife Surgery for Arteriovenous Malformation: Case Report

“…The aneurysm wall showed disruption of the elastic lamina. The location and features of the aneurysm were consistent with the characteristics of a GKS-induced aneurysm [21,22,23,24,25,27]. As far as we know, this is the 3rd case of aneurysm formation and the 1st case of ruptured de novo aneurysm formation presenting with subarachnoid hemorrhage after GKS for AVM.…”

“…Seven cases of aneurysm formation after GKS have been documented in the literature [21,22,23,24,25,26,27]. Two of these cases involved using GKS for AVM [21,26].…”

“…In previous literature reports, among 7 patients who had de novo aneurysm formation after GKS, 2 patients underwent surgery, 4 patients received endovascular treatment, and another patient received conservative management to treat a thrombosis that occurred during endovascular treatment [21,22,23,24,25,26,27]. Our patient underwent endovascular treatment, which can be applied in cases of inaccessible aneurysm area and aneurysm with severe brain edema.…”

“…The demanding latency period from surgery to complete obliteration and radiation-induced changes are major disadvantages of the use of GKS for AVM [15,18,19,20,21,22,23,24,25,26,27]. Vasculopathy-related lesions, such as cysts, vessel occlusions, and aneurysms, are relatively late-onset problems of using GKS for AVM.…”

De Novo Formation and Rupture of an Intracranial Aneurysm 10 Months After Normal Findings on Conventional Magnetic Resonance Angiography in a Patient With No History of Intracranial Lesions -Case Report-

“…6,7) Local hemodynamic changes due to earlier surgical interven- tion, 22) local fragility of the arterial wall, arterial wall damage attributable to the application of temporary clips or the edge of permanent clips, and earlier gamma knife surgery are all associated with de novo aneurysms. 14) Most cases of de novo aneurysms develop within a few years of intervention, and development within 1-2 months is rare. 16,18,24) We treated a patient with de novo cerebral aneurysm which ruptured within 10 months of the acquisition of normal magnetic resonance (MR) angiography findings.…”