Delayed Radiation Necrosis With Extensive Brain Edema After Gamma Knife Radiosurgery for Multiple Cerebral Cavernous Malformations-Case Report-

Abstract

A 39-year-old man presented with multiple intracranial cavernous malformations manifesting as intractable seizures persisting for more than 20 years. He underwent gamma knife radiosurgery (GKRS) for right frontal and left temporal cavernous malformations. He began to suffer from progressive left hemiparesis and inattention 2 years 5 months after the GKRS. Magnetic resonance imaging showed abnormal ring enhancement and extensive brain edema around the right frontal lesion. Conservative therapies such as external decompression, low-dose barbiturates, and mild hypothermia had no effect on his clinical status. Stereotactic biopsy of the ring-enhanced area demonstrated gliosis. Signs of cerebral herniation appeared, so we performed partial resection of the right frontal lobe. His symptoms recovered immediately. Subsequent hyperbaric oxygen (HBO) therapy significantly improved the extensive brain edema. Delayed radiation necrosis associated with potentially fatal brain edema may occur after GKRS for cavernous malformations. Internal decompression and subsequent HBO therapy were very effective for the treatment of these lesions.

Laser Interstitial Thermal Therapy for Focal Cerebral Radiation Necrosis: A Case Report and Literature Review

“…Clinically, Hart and Mainous [45] first used HBO more than 30 years ago to treat 69 patients with various forms of radiation-induced injury. Various others have since reported their experience with the use of HBO in RN [5,46,47,48]. Because of the retrospective nature of data collection, and a majority of patients having received varying doses of concurrent steroids, evidence to support the use of HBO in radionecrosis remains weak [44].…”

Motor function after stereotactic radiosurgery for brain metastases in the region of the motor cortex

“…7,8,16,27 In many patients radiosurgery represents the only reasonable option when tumors are located in critical brain regions such as the brainstem, diencephalon, and functional motor and speech areas. 9,11,18 Because tumors found in motor cortex represent more accessible sites for surgical removal, we sought to define the outcomes of patients who underwent primary radiosurgery instead of resection.…”

Delayed Radiation Necrosis 7 Years After Gamma Knife Surgery for Arteriovenous Malformation -Two Case Reports-

“…7) The majority of reported cases of radiation necrosis were detected within 3 years of radiosurgical intervention. 8,21,24,26) However, radiation necrosis may occur more than 5 years after GKS, as in our cases (Table 1). 3,30,32) The mechanism for such late radiation necrosis after radiosurgery remains unclear.…”