Intracranial Aneurysm and Vasculopathy after Surgery and Radiation Therapy for Craniopharyngioma: Case Report

Pereira, Paulo; Cerejo, António; Cruz, Jorge; Vaz, Ruí

doi:10.1097/00006123-200204000-00042

Cited by 49 publications

(26 citation statements)

References 21 publications

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“…Disease pathogenesis differs in radionecrosis, 9 and post-XRT hemorrhagic stroke, though less common, carries its own order of confounding risk factors, including aneurysmal disease. 18,19 …”

Section: Scopementioning

confidence: 99%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

229

180

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Background and Purpose-Cerebrovascular disease can complicate head and neck radiotherapy and result in transient ischemic attack and ischemic stroke. Although the incidence of radiation vasculopathy is predicted to rise with improvements in median cancer survival, the pathogenesis, natural history, and management of the disease are ill defined. Methods-We examined studies on the epidemiology, imaging, pathogenesis, and management of medium-and large-artery intra-and extra-cranial disease after head and neck radiotherapy. Controlled prospective trials and larger retrospective trials from the last 30 years were prioritized. Results-The relative risk of transient ischemic attack or ischemic stroke is at least doubled by head and neck radiotherapy.Chronic radiation vasculopathy affecting medium and large intra-and extra-cranial arteries is characterized by increasing rates of hemodynamically significant stenosis with time from radiotherapy. Disease expression is the likely consequence of the combined radiation insult to the intima-media (accelerating atherosclerosis) and to the adventitia (injuring the vasa vasorum). Optimal medical treatment is not established. Carotid endarterectomy is confounded by the need to operate across scarred tissue planes, whereas carotid stenting procedures have resulted in high restenosis rates. Conclusions-Head and neck radiotherapy significantly increases the risk of transient ischemic attack and ischemic stroke.Evidence-based guidelines for the management of asymptomatic and symptomatic (medium-and large-artery) radiation vasculopathy are lacking. Long-term prospective studies remain a priority, as the incidence of the problem is anticipated to rise with improvements in postradiotherapy patient survival. (Stroke. 2011;42:2410-2418.)

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Section: Scopementioning

confidence: 99%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

229

180

View full text Add to dashboard Cite

show abstract

“…1,3,4,8,10 However, in our literature review, we found only 1 case of GKS-induced de novo intracranial aneurysm. 11 Although no angiography was performed prior to GKS, and therefore the existence of the aneurysm prior to GKS cannot be excluded, Takao et al 11 present a reasonably convincing case that the pseudoaneurysm was causally linked to treatment.…”

Section: Discussionmentioning

confidence: 75%

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

Park¹,

Ahn²,

Lee³

et al. 2009

JNS

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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.

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“…Even though radiotherapy is clearly beneficial in decreasing the recurrence rate in cases of subtotally resected craniopharyngiomas, the risks should be clearly articulated to the families and neurosurgeons before starting such treatment. 10,13 In the past, WBRT and proton beam therapy were used for the treatment of craniopharyngiomas. 8 In the modern era, single-or multifraction stereotactic radiosurgery would probably be employed.…”

Section: Discussionmentioning

confidence: 99%

Primitive neuroectodermal tumor after radiation therapy for craniopharyngioma

Chan

Herrera²,

Neckrysh³

et al. 2011

FOC

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The authors report a case of primitive neuroectodermal tumor induced by radiation therapy of craniopharyngioma. This African-American male patient originally presented with craniopharyngioma, for which he underwent resection and whole-brain radiation therapy. Eight years later, at the age of 20 years, he returned with a left facial droop and left hemiparesis. A right basal ganglia mass was identified and resected. Histopathological examination identified the lesion as primitive neuroectodermal tumor. Although radiation therapy has shown to be beneficial in decreasing the recurrence rate in subtotally resected craniopharyngioma, the risks of radiation treatment should be clearly communicated to the patients, their families, and neurosurgeons before starting such treatment. This report expands the spectrum of reported radiation-induced neoplasms in the CNS.

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Intracranial Aneurysm and Vasculopathy after Surgery and Radiation Therapy for Craniopharyngioma: Case Report

Cited by 49 publications

References 21 publications

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

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

Primitive neuroectodermal tumor after radiation therapy for craniopharyngioma

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