Intratumoral Hemorrhage within Petrous Meningioma

Entezami, Pouya; Riccio, Alexander R.; Kenning, Tyler J.

doi:10.1016/j.wneu.2018.06.100

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…Intracranial hemorrhage (ICH) is believed to be a rare but potentially devastating side effect following SRS for malignant intracranial lesions, e.g., BM. ICH has also been described after the SRS of benign tumors, including meningiomas and schwannomas [8][9][10][11][12][13][14][15][16]. Preclinical studies demonstrated that endothelial cell damage leading to apoptosis is an early effect after the application of large single doses of radiation [17].…”

Section: Introductionmentioning

confidence: 99%

Intracranial Hemorrhage in Patients with Anticoagulant Therapy Undergoing Stereotactic Radiosurgery for Brain Metastases: A Bi-Institutional Analysis

Ehret

Kaul

Mose³

et al. 2022

Cancers

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Background: Stereotactic radiosurgery (SRS) is a well-established treatment modality for brain metastases (BM). Given the manifold implications of metastatic cancer on the body, affected patients have an increased risk of comorbidities, such as atrial fibrillation (AF) and venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep-vein thrombosis (DVT). These may require therapeutic anticoagulant therapy (ACT). Limited data are available on the risk of intracranial hemorrhage (ICH) after SRS for patients with BM who are receiving ACT. This bi-institutional analysis aimed to describe the bleeding risk for this patient subgroup. Methods: Patients with ACT at the time of single-fraction SRS for BM from two institutions were eligible for analysis. The cumulative incidence of ICH with death as a competing event was assessed during follow-up with magnetic resonance imaging or computed tomography. Results: Forty-one patients with 97 BM were included in the analyses. The median follow-up was 8.2 months (range: 1.7–77.5 months). The median and mean BM volumes were 0.47 and 1.19 cubic centimeters, respectively. The most common reasons for ACT were PE (41%), AF (34%), and DVT (7%). The ACT was mostly performed utilizing phenprocoumon (37%), novel oral anticoagulants (32%), or low-molecular-weight heparin (20%). Nine BM from a group of five patients with ICH after SRS were identified: none of them caused neurological or any other deficits. The 6-, 12-, and 18-month cumulative bleeding incidences per metastasis were 2.1%, 12.4%, and 12.4%, respectively. The metastases with previous bleeding events and those originating from malignant melanomas were found to more frequently demonstrate ICH after SRS (p = 0.02, p = 0.01). No surgical or medical intervention was necessary for ICH management, and no observed death was associated with an ICH. Conclusion: Patients receiving an ACT and single-fraction SRS for small- to medium-sized BM did not seem to have a clinically relevant risk of ICH. Previous bleeding and metastases originating from a malignant melanoma may favor bleeding events after SRS. Further studies are needed to validate our reported findings.

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Section: Introductionmentioning

confidence: 99%

Intracranial Hemorrhage in Patients with Anticoagulant Therapy Undergoing Stereotactic Radiosurgery for Brain Metastases: A Bi-Institutional Analysis

Ehret

Kaul

Mose³

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…Given the known vascularity of such lesions, several contributing mechanisms for hemorrhage have been suggested but remain poorly understood. Etiologies proposed include compensatory hypertrophy of feeding vessels, rapid and abnormal angiogenesis producing friable vessel walls, systemic processes increasing vascular fragility including hypertension and diabetes mellitus, direct vascular invasion by tumor cells, extensive intratumoral necrosis and infarction, stretching and rupture of subdural veins, and minor trauma [ 1 , 6 , 7 ]. Furthermore, recent studies have proposed potential risk factors for hemorrhagic presentation, including: age >70 or <30 years, intraventricular or convexity location, traumatic brain injury, concomitant anticoagulation, serotonin-modulating therapy, and/or high-dose estrogen replacement, and malignant-appearing, translational, or angiomatous histopathology [ 1 , 8 ].…”

Section: Introductionmentioning

confidence: 99%