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Mula-Hussain L, Lum K, Alaslani O, Bebedjian R, Grimard L, Sinclair J, Dos Santos MP. Perimesencephalic subarachnoid hemorrhage as a rare delayed complication of radiation therapy in a patient with parotid basaloid squamous cell carcinoma. J Med Imaging Radiat Sci 2024; 55:354-359. [PMID: 38418293 DOI: 10.1016/j.jmir.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
In this case report, we address a rare entity of parotid cancer: basaloid squamous cell carcinoma, which was surgically unresectable and had thus far only been treated with radiation therapy. Following twenty years of continuous remission, our patient presented with an acute perimesencephalic subarachnoid hemorrhage. The cause of the acute perimesencephalic subarachnoid hemorrhage was a delayed complication of radiation therapy.
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Affiliation(s)
- Layth Mula-Hussain
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Keanu Lum
- Department of Radiology, Radiation Oncology and Medical Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Ottawa, ON, Canada
| | - Ohoud Alaslani
- Department of Radiology, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Razmik Bebedjian
- Department of Medicine, Neurology Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Laval Grimard
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital; Ottawa, ON, Canada
| | - John Sinclair
- Department of Surgery, Neurosurgery Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Marlise P Dos Santos
- Department of Radiology, Radiation Oncology and Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Associate Professor of Radiology, University of Ottawa; Clinician Investigator, Neurosciences Program, Ottawa Hospital Research Institute; Scientist, Brain and Mind Research Institute; Ottawa ON, Canada.
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2
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Shinoda S, Muraoka S, Shimizu H, Koketsu N, Araki Y, Saito R. The prognosis and treatment effectiveness of de novo aneurysm formation after radiation therapy for brain tumor. Neurosurg Rev 2022; 45:2995-3002. [PMID: 35648321 DOI: 10.1007/s10143-022-01820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/30/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
Radiation therapy is a well-established, minimally invasive method of treating brain tumors. In recent years, the number of post-radiotherapy patients has increased, and delayed side effects are evident. De novo aneurysm formation after radiation often manifests as fatal subarachnoid hemorrhage (SAH), resulting in severe clinical outcomes. Nevertheless, the prognosis and therapeutic efficacy of radiation-induced aneurysms (RIAs) remain unclear. Using the PubMed database from 1980 to 2021, we screened 45 articles (53 individual cases) on RIAs; approximately 70% of RIAs were diagnosed after rupture. Of 38 ruptured RIAs, 12 (31.6%) had modified Rankin scale (mRS) 5-6. On the other hand, all unruptured RIAs (15 cases) recovered without neurological deficits (p = 0.012). Ten of the 39 ruptured RIAs were treated surgically, and 22 were treated endovascularly. There was no significant difference in mRS between treatment modalities (p = 0.393), but conservative therapy was significantly related to unfavorable outcomes (p = 0.025). To improve clinical outcomes, RIAs need to be diagnosed before rupture. Surgeons should be aware of de novo aneurysm formation in patients long after radiation therapy.
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Affiliation(s)
- Satoshi Shinoda
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Shinsuke Muraoka
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan. .,Department of Neurosurgery, Kariya Toyota General Hospital, Sumiyoshi Cho 5-15, Kariya, Aichi, Japan.
| | - Hiroyuki Shimizu
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Naoki Koketsu
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Abstract
Both the onset of various malignancies as well as the treatment of cancer can lead to neurologic symptoms which can be difficult to diagnose. In this review, we highlight the varied ways in which neurologic sequelae of cancer and its treatment manifest in children. Initial neurologic presentation may be secondary to mass effect or to immune-mediated paraneoplastic syndromes. Treatment effects on the nervous system may arise from surgery, chemotherapy, radiation, or bone marrow transplantation. In addition, the rapidly expanding field of immunotherapies for cancer has generated numerous new approaches to eradicating cancer including monoclonal antibodies, checkpoint inhibitors, and chimeric antigen receptor T cells (CAR-T cells), which have neurologic side effects mediated by immune responses that are also being recognized. Here we review common consult questions to the neurologist and our general approach to these scenarios including altered mental status, headaches, seizures, and sensorimotor complaints, considering the multifactorial nature of each.
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Affiliation(s)
- Caren Armstrong
- Department of Neurology, Johns Hopkins Hospital, 200 N Wolfe St Suite 2158, Baltimore, MD, 21287, USA
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins Hospital, 200 N Wolfe St Suite 2158, Baltimore, MD, 21287, USA.
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Paolucci A, Schisano L, Pluderi M, Grimoldi N, Caranci F, Angileri A, Arrichiello A, Costa A. Giant intracranial aneurysm following radiation therapy: literature review with a novel case discussion. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020005. [PMID: 33245075 PMCID: PMC8023079 DOI: 10.23750/abm.v91i10-s.10281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this paper is to report the results of our review of the literature of published cases of intracranial aneurysms appearing after radiotherapy, and to present our case to add it to the current literature, in order to discuss the role of inflammation. METHODS We searched the PubMed database using combinations of the following MeSH terms: intracranial aneurysm, radiosurgery, radiotherapy, inflammatory changes in aneurysmal walls from 1967 to 2019. RESULTS 51 studies, for a total cohort of 60 patients, are described. The median latency between the radiation treatment and the diagnosis was 9,83 years, ranging from a minimum of 0,33 to a maximum of 33. The modality of rays' administration was variable, and the dosage ranged from a minimum of 12 grays to a maximum of 177,2 grays. The anterior circulation appeared to be more frequently involved, and the most compromised vessel was the internal carotid artery. Radiation-induced vascular diseases have already been described in literature as well as RT-induced cellular and structural changes such as necrosis, macrophage or mononuclear cell infiltration, and several data support the role of inflammation in the development and remodelling of intracranial aneurysms, that, on one hand, favours them and, on the other, is necessary to their healing after endovascular treatment. CONCLUSIONS Our team suggested a new insight in the management of these vascular lesions, which corresponds to a lower threshold when deciding whether or not to treat, and a longer and stricter follow-up.
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Affiliation(s)
| | - Luigi Schisano
- Operative Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano .
| | - Mauro Pluderi
- Operative Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
| | - Nadia Grimoldi
- Operative Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano .
| | - Ferdinando Caranci
- Department of Diagnostic Radiology and Radiotherapy, Federico II University of Naples, Naples, Italy .
| | - Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.
| | - Antonio Arrichiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy Via Festa del Perdono 7, 20122, Milan, Italy .
| | - Antonella Costa
- Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. Via Francesco Sforza 35, 20122, Milano, Italy.
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Radiation-Induced Brain Aneurysms: Institutional Experience and State of the Art in the Contemporary Literature. World Neurosurg 2019; 135:339-351. [PMID: 31605840 DOI: 10.1016/j.wneu.2019.09.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Brain aneurysms (BAs) are the most common intracranial vascular condition, with an overall incidence of 1%-2%. Among the common causes of their initial formation and growth, the role of radiation therapy (RT) has been reported in some studies. The aim of the present study is to report the most relevant features of BA related to a previous cranial RT. METHODS Data deriving from 1 patient treated for RT-induced BA in our institution were added to reports of another 66 BAs retrieved from the literature. The following parameters were evaluated: age, sex, location, primary lesion, clinical presentation, dosage/amount of radiation delivered, type of treatment for the BA, dimension, morphology, chemotherapy, comorbidities, risk factors, and number of BAs. RESULTS The most commonly involved vessel was the internal carotid artery (34%). In general, the anterior circulation showed higher vulnerability compared with the posterior circulation and middle cerebral artery (56.7%). The average latency between RT and the first imaging showing the BA was 9.01 ± 6.85 years. Vessels coursing in the posterior cranial fossa showed a significant univariate association with lower X-ray dosages (P = 0.014) compared with the other locations. No statistically significant correlation between the continuous variables age, latency of BA appearance, RT delivered dose, and dimension of the BA was shown. CONCLUSIONS The apparent higher fragility of the vascular structures of the posterior cranial fossa was statistically outlined, and the X-ray dosage, the primary condition target of the RT, the age of the patients, and no statistically significant correlation were outlined. Biological factors could play a significant role.
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Maruyama F, Tanaka T, Kajiwara I, Irie K, Ishibashi T, Tochigi S, Hasegawa Y, Murayama Y. Refractory De Novo Multiple Cerebral Aneurysms After Radiotherapy and Multistaged "Open" Surgical Treatment for Low-Grade Glioma During Long-Term Follow-Up: A Case Report and Review of the Literature. World Neurosurg X 2019; 3:100031. [PMID: 31225523 PMCID: PMC6584479 DOI: 10.1016/j.wnsx.2019.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background Radiation-induced aneurysms have been previously reported; however, multiple and repeated de novo aneurysm formation chronologically and anatomically during long-term follow-up have not yet been observed. The pathogenesis of persistent radiation-induced vasculopathy is not fully understood. Case Description A 31-year-old woman presented with intraventricular hemorrhage due to rupture of a right internal carotid artery (ICA) aneurysm that developed 17 years after surgical resection of a low-grade glioma in the right frontal lobe and postoperative radiotherapy (focal, 50 Gy/25 fractions). During glioma follow-up, salvage surgery with adjuvant gamma knife therapy and chemotherapy (ranimustine, vincristine, temozolomide) were performed for recurrence of the glioma. The aneurysm was treated with endovascular coil embolization. However, she experienced repeated intraventricular hemorrhages, and angiography revealed a de novo ICA aneurysm. The de novo aneurysms were treated with endovascular surgery using coil embolization and stenting. At 2 years after the third hemorrhage, the surgical wound became dehiscent, probably due to wound infection, thus epicranial soft tissue reconstruction using vascularized skin flap was performed. Despite multistaged endovascular surgery for the ICA aneurysm, she experienced repeated subarachnoid and intraventricular hemorrhages. Angiography revealed a de novo aneurysm of the right posterior cerebral artery and basilar trunk. She underwent coil embolization and stenting. Despite active management with endovascular surgery and close follow-up, she died after an eighth consecutive intraventricular and intracerebral hemorrhage caused by a de novo large aneurysm of the posterior cerebral artery. Conclusions To the best of our knowledge, the present study is the first to report on of refractory and recurring de novo aneurysms treated by multistaged endovascular surgery during a long-term follow-up after radiotherapy and multistaged craniotomy for glioma.
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Affiliation(s)
- Fumiaki Maruyama
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan.,Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Ikki Kajiwara
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Koreaki Irie
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Satoru Tochigi
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University Kashiwa Hospital, Kashiwa-shi, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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Patro SN, Iancu D, Al Mansoori T, Lesiuk H, Vassilyadi M. Endovascular glue embolization of a radiation-induced lenticulostriate artery pseudoaneurysm in a pediatric patient with optic pathway glioma: Case report and review of literature. Interv Neuroradiol 2018; 24:499-508. [PMID: 29848144 DOI: 10.1177/1591019918773303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Radiation-associated vascular changes most commonly present in the form of stenosis, thrombosis and occlusion. However, development of intracranial aneurysms secondary to radiation is far less common and often manifests with rupture. These aneurysms are difficult to treat and associated with high morbidity and mortality when ruptured compared with saccular aneurysms unrelated to radiation treatment. Both surgical and endovascular options are available for treatment of these aneurysms. We present a young patient with a radiation-induced intracranial pseudoaneurysm arising from the lenticulostriate branch of the left middle cerebral artery (MCA); this developed 1 year 4 months after 59.4 Gy of focused radiation to the suprasellar pilomyxoid astrocytoma. The patient successfully underwent endovascular glue embolization of the aneurysm and occlusion of the lenticulostriate artery after unsuccessful trapping of the aneurysm and occlusion of the parent artery using coils. She developed transient hemiparesis of the right side following the procedure, which was managed conservatively. We performed a complete review of the literature dealing with the radiation-induced intracranial aneurysms, their presentation, treatment and outcome.
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Affiliation(s)
- Satya Narayana Patro
- 1 Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Daniela Iancu
- 1 Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Taleb Al Mansoori
- 1 Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Howard Lesiuk
- 2 Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Michael Vassilyadi
- 3 Department of Paediatric Neurosurgery, Children's Hospital of Eastern Ontario University of Ottawa, Ottawa, Canada
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Umekawa M, Hasegawa H, Shin M, Kawashima M, Nomura S, Nakatomi H, Saito N. Radiosurgery-Induced Anterior Inferior Cerebellar Artery Pseudoaneurysm Treated with Trapping and Bypass. World Neurosurg 2018; 116:209-213. [PMID: 29729463 DOI: 10.1016/j.wneu.2018.04.161] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is an established modality for treatment of vestibular schwannomas (VSs). However, its long-term vascular complications have not been well studied. Among 360 patients who underwent SRS for VS in our institution and lived for >5 years thereafter, we identified only 1 patient who exhibited a complication secondary to a late-onset aneurysm for an estimated incidence of 0.3%. CASE DESCRIPTION A 78-year-old man who had undergone SRS 19 years previously for a right VS presented with right peripheral facial palsy. Radiographic examinations revealed a distal anterior inferior cerebellar artery (AICA) fusiform aneurysm that was embedded in the tumor and progressively enlarged over 17 months. Although the right AICA perfused a large area of the cerebellum, the aneurysm was successfully treated with AICA trapping in conjunction with an occipital artery-AICA bypass. CONCLUSIONS Distal AICA pseudoaneurysm formation is a rare but potentially severe late complication after SRS for VS. This pathology was successfully treated with AICA trapping with occipital artery-AICA bypass.
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Affiliation(s)
- Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Seiji Nomura
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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Graffeo CS, Perry A, Link MJ, Daniels DJ. Pediatric Craniopharyngiomas: A Primer for the Skull Base Surgeon. J Neurol Surg B Skull Base 2018; 79:65-80. [PMID: 29404243 PMCID: PMC5796826 DOI: 10.1055/s-0037-1621738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pediatric craniopharyngioma is a rare sellar-region epithelial tumor that, in spite of its typically benign pathology, has the potential to be clinically devastating, and presents a host of formidable management challenges for the skull base surgeon. Strategies in craniopharyngioma care have been the cause of considerable controversy, with respect to both philosophical and technical issues. Key questions remain unresolved, and include optimizing extent-of-resection goals; the ideal radiation modality and its role as an alternative, adjuvant, or salvage treatment; appropriate indications for expanded endoscopic endonasal surgery as an alternative to transcranial microsurgery; risks and benefits of skull base techniques in a pediatric population; benefits of and indications for intracavitary therapies; and the preferred management of common treatment complications. Correspondingly, we sought to review the preceding basic science and clinical outcomes literature on pediatric craniopharyngioma, so as to synthesize overarching recommendations, highlight major points of evidence and their conflicts, and assemble a general algorithm for skull base surgeons to use in tailoring treatment plans to the individual patient, tumor, and clinical course. In general terms, we concluded that safe, maximal, hypothalamic-sparing resection provides very good tumor control while minimizing severe deficits. Endoscopic endonasal, intraventricular, and transcranial skull base technique all have clear roles in the armamentarium, alongside standard craniotomies; these roles frequently overlap, and may be further optimized by using the approaches in adaptive combinations. Where aggressive subtotal resection is achieved, patients should be closely followed, with radiation initiated at the time of progression or recurrence-ideally via proton beam therapy, although three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and stereotactic radiosurgery are very appropriate in a range of circumstances, governed by access, patient age, disease architecture, and character of the recurrence. Perhaps most importantly, outcomes appear to be optimized by consolidated, multidisciplinary care. As such, we recommend treatment in highly experienced centers wherever possible, and emphasize the importance of longitudinal follow-up-particularly given the high incidence of recurrences and complications in a benign disease that effects a young patient population at risk of severe morbidity from hypothalamic or pituitary injury in childhood.
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Affiliation(s)
| | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - David J. Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Dho YS, Kim DG, Chung HT. Ruptured de novo Aneurysm following Gamma Knife Surgery for Arteriovenous Malformation: Case Report. Stereotact Funct Neurosurg 2017; 95:379-384. [PMID: 29190619 DOI: 10.1159/000481666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
Abstract
Stereotactic radiosurgery is a well-known treatment tool for arteriovenous malformations (AVMs). The method has high validity and minimal invasiveness, but late-onset problems involving tumor formation and vasculopathy induced by radiation have been reported. We present a rare case of a radiation-induced ruptured de novo aneurysm following Gamma Knife surgery (GKS) for an AVM. A 17-year-old, right-handed male underwent GKS for AVM at the left parietal lobe. After 3 years, a follow-up angiogram showed a residual AVM at the angular gyrus. Then, a 2nd GKS was performed for the residual lesion. Six years after the 1st GKS, the AVM disappeared on the angiogram. Seven years later, he suffered a sudden onset of headache. A left carotid angiogram revealed a ruptured aneurysm at the M2-M3 junction of the middle cerebral artery parietal branch. Coil embolization was performed, and the aneurysm was occluded. The patient was discharged without any neurologic deficits.
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Affiliation(s)
- Yun-Sik Dho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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11
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Kamide T, Mohri M, Misaki K, Uchiyama N, Nakada M. Intracranial aneurysm formation after radiotherapy for medulloblastoma. Surg Neurol Int 2016; 7:S880-S882. [PMID: 27999713 PMCID: PMC5154203 DOI: 10.4103/2152-7806.194501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background: The development of an intracranial aneurysm after radiotherapy is rare but secondary effect of cranial irradiation in a primary disease treatment. Case Description: The patient was a 17-year-old male adolescent who was diagnosed as having a posterior fossa medulloblastoma when he was 8 years old. He had undergone tumor resection with radiotherapy and chemotherapy. A distal posterior inferior cerebellar artery aneurysm was identified by magnetic resonance imaging 8 years after radiotherapy and grew rapidly throughout the next 1 year. The patient underwent microsurgical clipping and was discharged without deficit. Conclusion: This experience demonstrates that physicians caring for patients who have undergone intracranial radiotherapy should carefully consider the possibility of an aneurysmal formation when conducting follow-up imaging.
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Affiliation(s)
- Tomoya Kamide
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masanao Mohri
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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12
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Santiago-Sim T, Fang X, Hennessy ML, Nalbach SV, DePalma SR, Lee MS, Greenway SC, McDonough B, Hergenroeder GW, Patek KJ, Colosimo SM, Qualmann KJ, Hagan JP, Milewicz DM, MacRae CA, Dymecki SM, Seidman CE, Seidman JG, Kim DH. THSD1 (Thrombospondin Type 1 Domain Containing Protein 1) Mutation in the Pathogenesis of Intracranial Aneurysm and Subarachnoid Hemorrhage. Stroke 2016; 47:3005-3013. [PMID: 27895300 PMCID: PMC5134902 DOI: 10.1161/strokeaha.116.014161] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/24/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A ruptured intracranial aneurysm (IA) is the leading cause of a subarachnoid hemorrhage. This study seeks to define a specific gene whose mutation leads to disease. METHODS More than 500 IA probands and 100 affected families were enrolled and clinically characterized. Whole exome sequencing was performed on a large family, revealing a segregating THSD1 (thrombospondin type 1 domain containing protein 1) mutation. THSD1 was sequenced in other probands and controls. Thsd1 loss-of-function studies in zebrafish and mice were used for in vivo analyses and functional studies performed using an in vitro endothelial cell model. RESULTS A nonsense mutation in THSD1 was identified that segregated with the 9 affected (3 suffered subarachnoid hemorrhage and 6 had unruptured IA) and was absent in 13 unaffected family members (LOD score 4.69). Targeted THSD1 sequencing identified mutations in 8 of 507 unrelated IA probands, including 3 who had suffered subarachnoid hemorrhage (1.6% [95% confidence interval, 0.8%-3.1%]). These THSD1 mutations/rare variants were highly enriched in our IA patient cohort relative to 89 040 chromosomes in Exome Aggregation Consortium (ExAC) database (P<0.0001). In zebrafish and mice, Thsd1 loss-of-function caused cerebral bleeding (which localized to the subarachnoid space in mice) and increased mortality. Mechanistically, THSD1 loss impaired endothelial cell focal adhesion to the basement membrane. These adhesion defects could be rescued by expression of wild-type THSD1 but not THSD1 mutants identified in IA patients. CONCLUSIONS This report identifies THSD1 mutations in familial and sporadic IA patients and shows that THSD1 loss results in cerebral bleeding in 2 animal models. This finding provides new insight into IA and subarachnoid hemorrhage pathogenesis and provides new understanding of THSD1 function, which includes endothelial cell to extracellular matrix adhesion.
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Affiliation(s)
- Teresa Santiago-Sim
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Xiaoqian Fang
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Morgan L Hennessy
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Stephen V Nalbach
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Steven R DePalma
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Ming Sum Lee
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Steven C Greenway
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Barbara McDonough
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Georgene W Hergenroeder
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Kyla J Patek
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Sarah M Colosimo
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Krista J Qualmann
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - John P Hagan
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Dianna M Milewicz
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Calum A MacRae
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Susan M Dymecki
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Christine E Seidman
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - J G Seidman
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Dong H Kim
- From the Department of Neurosurgery (T.S.-S., X.F., G.W.H., K.J.P., S.M.C., K.J.Q., J.P.H., D.H.K.) and Division of Medical Genetics, Department of Internal Medicine (D.M.M.), The University of Texas Medical School at Houston; Department of Genetics, Harvard Medical School, Boston, MA (M.L.H., S.V.N., S.R.D., S.C.G., B.M., S.M.D., C.E.S., J.G.S.); Department of Neurosurgery (S.V.N.), Department of Medicine (M.S.L., C.A.M.), and Cardiovascular Division (C.E.S.), Brigham and Women's Hospital, Boston, MA; and Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.).
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13
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Wu YH, Lin SS, Chen HH, Chang FC, Liang ML, Wong TT, Yen SH, Chen YW. Radiotherapy-related intracranial aneurysm: case presentation of a 17-year male and a meta-analysis based on individual patient data. Childs Nerv Syst 2016; 32:1641-52. [PMID: 27306914 DOI: 10.1007/s00381-016-3144-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to investigate the incidence, clinical profiles, latency, and outcomes of radiotherapy (RT)-related intracranial aneurysms, rare but often fatal complications of cranial irradiation. METHODS We reviewed all published individual patient data regardless of language, using survival analysis to make statistical inferences. RESULTS We examined a total of 58 patients with RT-related intracranial aneurysms, including one unpublished case presented here, of whom 74.1 % presented with rupture. In the study, 29.3 % were younger than 18 years. The mean age at which patients received the first course of RT was 34.8 ± 22.8 years old. The mean latency between initiating RT and presenting with aneurysm was 10.4 ± 8.5 years. Rapid death ensured in 24 % shortly after presentation. The only significant predictor of death was rupture. In those with a single aneurysm, 43.1 % were located at the internal carotid artery, while 15.5 % of patients had multiple aneurysms. A male-to-female ratio of 1.87, 0.5, and 1.32 was found in patients younger than age 52, 52 years of age or older, and all 58 patients, respectively. Older age when receiving RT and presentation with ruptured aneurysm were significantly associated with shorter latency. CONCLUSIONS RT-related intracranial aneurysms presented differently from classical ones based on age, sex, site, multiplicity, and type. Sex ratios differed with age. The younger age group showed a longer latency of occurrence of an aneurysm. Older patients and those who develop ruptured aneurysms presented earlier. Since rupture may affect outcome, early detection of aneurysms before rupture may save lives.
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Affiliation(s)
- Yuan-Hung Wu
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Shuan Lin
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hsin-Hung Chen
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Chi Chang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Muh-Lii Liang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tai-Tong Wong
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Sang-Hue Yen
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Wei Chen
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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14
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Parag S, Arif Z, Chittoor R. Radiotherapy-related intracranial aneurysms: A role for conservative management. Surg Neurol Int 2016; 7:S387-90. [PMID: 27313964 PMCID: PMC4901822 DOI: 10.4103/2152-7806.183496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/18/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Radiotherapy-related intracranial aneurysms are a recognized but rare phenomenon and often present following rupture leading to subarachnoid hemorrhage. Treatment poses a particular dilemma and both endovascular, and surgical approaches have been used with varied success. We present the case of a radiotherapy-related aneurysm treated conservatively with a favorable outcome. CASE DESCRIPTION A 37-year-old man was diagnosed with a left temporal lobe mass for which he underwent an uneventful craniotomy and debulking. Histology revealed Grade III anaplastic astrocytoma following which he received radiotherapy. Three years later, he presented with subacute headache and transient dysphasia. Computed tomography and catheter angiography revealed a fusiform aneurysm of the supramarginal branch of the left middle cerebral artery with probable intra-aneurysmal thrombus. Adjacent vessels also showed mild vasculitic changes. Trial balloon occlusion of the parent vessel resulted in profound dysphasia and was therefore abandoned. Bypass surgery or stent placement was deemed to have too high a risk of neurological deficit, and keeping in mind, the diagnosis of anaplastic astrocytoma, conservative management was pursued with partial thrombosis noted on serial imaging and stable appearances subsequently at 42 months' follow-up. CONCLUSION Conservative management can be pursued in selective cases of radiotherapy-related aneurysms, particularly if the risk of treating is too high and in the context of intracranial malignancy with limited lifespan.
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Affiliation(s)
- Sayal Parag
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London
| | - Zafar Arif
- Department of Neurosurgery, Hull Royal Infirmary, Hull, United Kingdom
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15
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Gripp DA, Nakasone FJ, Maldaun MVC, de Aguiar PHP, Mathias LR. Giant pseudoaneurysm originated from distal middle cerebral artery dissection treated by trapping under sensitive evoked potential and motor evoked potential monitoring: Case report and discussion. Surg Neurol Int 2016; 7:S214-8. [PMID: 27127710 PMCID: PMC4828946 DOI: 10.4103/2152-7806.179573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/10/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Dissecting giant pseudoaneurysm of the middle cerebral artery (MCA) is a rare lesion often presenting challenges to neurosurgical teams dealing with this specific pathology. Giant pseudoaneurysm originating from a dissecting distal segment of the MCA treated with aneurysm trapping under motor and sensitive evoked potential monitoring with a successful outcome is presented in the article followed by a brief discussion on the subject. CASE DESCRIPTION A case of a previously healthy young female patient admitted at the emergency room of Santa Paula Hospital with a history of a sudden headache and syncope, dysphasia, and Grade 4 right hemiparesis due to a large brain hemorrhage secondary to a 25 mm ruptured pseudoaneurysm originated from a distal left MCA dissecting segment is described. Because the patient risked neurological worsening, aneurysm was treated with parent and efferent vessel trapping technique and no changes on the sensitive and motor evoked potential (MEP) from baseline informed on this decision. Hemorrhage was completely drained after aneurysm was secured. CONCLUSION Neurophysiological sensitive and MEP monitoring, on this specific case was a valuable tool and informed on the decision of trapping of this large vascular lesion.
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16
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Akai T, Torigoe K, Fukushima M, Iizuka H, Hayashi Y. De Novo Aneurysm Formation Following Gamma Knife Surgery for Arteriovenous Malformation: A Case Report. J Neurol Surg Rep 2015; 76:e105-8. [PMID: 26251783 PMCID: PMC4520975 DOI: 10.1055/s-0035-1549223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/13/2015] [Indexed: 10/26/2022] Open
Abstract
Background Stereotactic radiosurgery plays a critical role in the treatment of central nervous system neoplasm and cerebrovascular malformations. This procedure is purportedly less invasive, but problems occurring later including tumor formation, necrosis, and vasculopathy-related diseases have been reported. Clinical Presentation We report on a 65-year-old man who had experienced a de novo aneurysm in an irradiated field and an acute onset of right hemiparesis and aphasia. He had undergone gamma knife radiosurgery to treat an arteriovenous malformation 15 and 12 years prior, with 18 and 22 Gy marginal doses. At current admission, radiologic studies showed a de novo aneurysm in the irradiated field without recurrence of malformation. The aneurysm was resected. Histologic findings showed a disruption of the internal elastic lamina accompanied by fibrous degeneration. Conclusion Stereotactic radiosurgery is a promising treatment tool, but long-term risks have not been fully researched. The treatment procedure for benign lesions should be chosen prudently.
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Affiliation(s)
- Takuya Akai
- Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan
| | - Keiichiro Torigoe
- Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan
| | - Manna Fukushima
- Pathology and Laboratory Medicine, Kanazawa Medical University, Kanazawa, Japan
| | - Hideaki Iizuka
- Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Kanazawa University, Kanazawa, Japan
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17
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Murphy ES, Xie H, Merchant TE, Yu JS, Chao ST, Suh JH. Review of cranial radiotherapy-induced vasculopathy. J Neurooncol 2015; 122:421-9. [PMID: 25670390 DOI: 10.1007/s11060-015-1732-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Abstract
Cranial radiation can impact the cerebral vasculature in many ways, with a wide range of clinical manifestations. The incidence of these late effects including cerebrovascular accidents (CVAs), lacunar lesions, vascular occlusive disease including moyamoya syndrome, vascular malformations, and hemorrhage is not well known. This article reviews the preclinical findings regarding the pathophysiology of late radiation-induced vascular damage, and discusses the clinical incidence and risk factors for each type of vasculopathy. The pathophysiology is complex and dependent on the targeted blood vessels, and upregulation of pro-inflammatory and hypoxia-related genes. The risk factors for adult CVAs are similar to those for patients not exposed to cranial radiotherapy. For children, risks for late vascular complications include young age at radiotherapy, radiotherapy dose, NF1, tumor location, chemotherapy, and endocrine abnormalities. The incidence of late vascular complications of radiotherapy may be impacted by improved technology, therapeutic interventions, and appropriate follow up.
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Affiliation(s)
- Erin S Murphy
- Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave., T28, Cleveland, OH, 44195, USA,
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18
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Fujita K, Tamura M, Masuo O, Sasaki T, Yamoto T, Fukai J, Nakao N. Ruptured internal carotid artery aneurysm presenting with catastrophic epistaxis after repeated stereotactic radiotherapies for anterior skull base tumor: case reports and review of the literature. J Neurol Surg Rep 2014; 75:e200-5. [PMID: 25485213 PMCID: PMC4242894 DOI: 10.1055/s-0034-1383859] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 05/07/2014] [Indexed: 12/14/2022] Open
Abstract
Objectives Radiation-induced aneurysm is a rare complication for head and neck tumors. Only seven cases of an aneurysm after stereotactic radiosurgery and/or stereotactic radiotherapy (SRT) have been described. We report two patients with a ruptured internal carotid artery (ICA) aneurysm presenting with catastrophic epistaxis after repeated SRT for an anterior skull base tumor. Results Two male patients received repeated SRT in various combinations following surgery for an anterior skull base tumor. They presented with significant epistaxis due to rupture of the aneurysm of the ICA 6 and 77 months after the final SRT, respectively. The aneurysms were located within the radiation field. Preoperative angiography had revealed no aneurysms. Thus the aneurysms in these cases were most likely induced by the repeated SRT. Conclusions This is a proven report of aneurysm formation following repeated SRT without conventional radiotherapy. SRT may be very effective to control malignant skull base tumors. However, the possible development of radiation-induced aneurysm of the ICA should be considered in the case of repeated SRT. The surviving patients who have received SRT should undergo sequential follow-up for possible vascular involvement.
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Affiliation(s)
- Koji Fujita
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Manabu Tamura
- Tokyo Women's Medical University, Institute of Advanced Biomedical Engineering and Science, Tokyo, Japan
| | - Osamu Masuo
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takahiro Sasaki
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Toshikazu Yamoto
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Junya Fukai
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | - Naoyuki Nakao
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
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19
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Matsumoto H, Minami H, Yamaura I, Yoshida Y. Radiation-induced cerebral aneurysm treated with endovascular coil embolization. A case report. Interv Neuroradiol 2014; 20:448-53. [PMID: 25207908 DOI: 10.15274/inr-2014-10039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/02/2014] [Indexed: 11/12/2022] Open
Abstract
Radiation-induced cerebral aneurysms are rare. We describe a case of radiation-induced cerebral aneurysm successfully treated with endovascular coil embolization. A 39-year-old man received 60 Gy of radiation to a pineal germinoma at eight years old. The left internal carotid artery (ICA) aneurysm which developed within the irradiated field and stenotic change in the left ICA due to radiation-induced vasculopathy were detected incidentally. Because these aneurysms show a high risk of rupture and mortality, and even small aneurysms are prone to rupture, any such suspected aneurysm should be treated with surgical or endovascular procedures. Endovascular treatment is probably useful if the aneurysm is inaccessible to direct surgery. Special attention must be paid to treatment because of stenotic changes in cerebral vessels within the irradiated field.
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Affiliation(s)
- Hiroaki Matsumoto
- Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan -
| | - Hiroaki Minami
- Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan
| | - Ikuya Yamaura
- Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan
| | - Yasuhisa Yoshida
- Department of Neurosurgery, Eisyokai Yoshida Hospital; Kobe, Japan
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Intracranial Aneurysms in Previously Irradiated Fields: Literature Review and Case Report. World Neurosurg 2014; 81:511-9. [DOI: 10.1016/j.wneu.2013.10.044] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/24/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022]
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Passacantilli E, Anichini G, Cannizzaro D, Fusco F, Pedace F, Lenzi J, Santoro A. Awake craniotomy for trapping a giant fusiform aneurysm of the middle cerebral artery. Surg Neurol Int 2013; 4:39. [PMID: 23607061 PMCID: PMC3622374 DOI: 10.4103/2152-7806.109652] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/21/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Giant fusiform aneurysms of the distal middle cerebral artery (MCA) are rare lesions that, because of the absence of an aneurysm neck and the presence of calcified walls and partial thrombosis, can be difficult to clip without sacrificing the parent vessel. Moreover, when the aneurysm is located in the dominant hemisphere, it is not possible to test language and cognitive functions during surgical intervention, making the closure of the parent vessel extremely dangerous. CASE DESCRIPTION A 46-year-old woman presented with a one-year history of frontal headache without neurological deficit. A magnetic resonance imaging and an angiography showed a giant fusiform aneurysm of the left M2 tract. Because of the location and the absence of a neck, the aneurysm was considered difficult to coil and not amenable to preoperative balloon occlusion; thus, the patient was a candidate for surgical treatment. After a preoperative psychological evaluation, patient underwent awake craniotomy with the asleep-awake-asleep technique. A standard left pterional approach was performed to expose the internal carotid artery, the MCA and the aneurysm originating from the frontal branch of the MCA. Neurological examination responses remained unchanged during temporary parent artery occlusion, and trapping was successfully performed. CONCLUSIONS Awake craniotomy is a useful option in intracranial aneurysm surgery because it permits neurological testing before vessels are permanently clipped or sacrificed. With the asleep-awake-asleep technique, it is possible to perform a standard pterional craniotomy, which allows good exposure of the vascular structures without cerebral retraction.
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Affiliation(s)
- Emiliano Passacantilli
- Department of Neurology and Psychiatry, Neurosurgery, University of Rome, "Sapienza", Italy
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Huh W, Bang JS, Oh CW, Kwon OK, Hwang G. Intracranial aneurysm following cranial radiation therapy. J Cerebrovasc Endovasc Neurosurg 2012; 14:300-4. [PMID: 23346546 PMCID: PMC3543916 DOI: 10.7461/jcen.2012.14.4.300] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 11/23/2022] Open
Abstract
We report herein a case of a radiation-induced aneurysm. A 69-year-old woman presented with subarachnoid hemorrhage. Eight years previously, she had undergone cranial radiation therapy (total dose of 59.4 Gy) as adjuvant therapy after surgical resection for a chondrosarcoma that was destroying her sphenoid sinus. The patient underwent catheter angiography, which revealed an aneurysm of the anterior communicating artery and luminal narrowing and irregularity in the petrous and lacerum segments of the right internal carotid artery. We attempted surgical clipping of the aneurysm, but there was repeated bleeding. Finally the aneurysm was treated with endovascular trapping. Potentially fatal bleeding also occurred from her internal carotid artery, which had also been irradiated during the previous cranial radiation therapy. We stopped the bleeding with endovascular coil embolization. Because of diffuse vascular changes of the cerebral vessels within irradiated fields, special attention must be paid to their treatment.
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Affiliation(s)
- Won Huh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Yoon WS, Lee KS, Jeun SS, Hong YK. De novo aneurysm after treatment of glioblastoma. J Korean Neurosurg Soc 2011; 50:457-9. [PMID: 22259694 DOI: 10.3340/jkns.2011.50.5.457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 03/09/2011] [Accepted: 11/09/2011] [Indexed: 11/27/2022] Open
Abstract
A rare case of spontaneous subarachnoid hemorrhage from newly developed cerebral aneurysm in glioblastoma patient is presented. A 57-year-old man was presented with headache and memory impairment. On the magnetic resonance image and the magnetic resonance angiography, a large enhancing mass was found at right frontal subcortex and intracranial aneurysm was not found. The mass was removed subtotally and revealed as glioblastoma. He took concurrent PCV chemotherapy and radiation therapy, but the mass recurred one month later after radiotherapy. He was then treated with temozolomide for 7 cycles. Three months after the completion of temozolomide therapy, he suffered from a subarachnoid hemorrhage due to a rupture of a small de novo aneurysm at distal anterior cerebral artery. He underwent an aneurysm clipping and discharged without neurologic complication.
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Affiliation(s)
- Wan-Soo Yoon
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Incheon, Korea
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SASAGAWA Y, AKAI T, ITOU S, IIZUKA H. De Novo Aneurysm in the Feeding Artery of a Recurrent Malignant Glioma -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:306-10. [DOI: 10.2176/nmc.51.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Takuya AKAI
- Department of Neurosurgery, Kanazawa Medical University
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Morris B, Partap S, Yeom K, Gibbs IC, Fisher PG, King AA. Cerebrovascular disease in childhood cancer survivors: A Children's Oncology Group Report. Neurology 2009; 73:1906-13. [PMID: 19812380 DOI: 10.1212/wnl.0b013e3181c17ea8] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Curative therapy for childhood cancer has dramatically improved over past decades. Therapeutic radiation has been instrumental in this success. Unfortunately, irradiation is associated with untoward effects, including stroke and other cerebrovascular disease (CVD). The Children's Oncology Group (COG) has developed guidelines for screening survivors at risk for persistent or late sequelae of cancer therapy. OBJECTIVES This review summarizes the pathophysiology and relevant manifestations of radiation-induced CVD and outlines the specific patient groups at risk for early-onset stroke. The reader will be alerted to the availability of the COG recommendations for monitoring, and, when applicable, specific screening and treatment recommendations will be highlighted. METHODS A multidisciplinary task force critically reviewed the existing literature and scored the evidence to establish the current COG guidelines for monitoring health of survivors treated with head and neck irradiation. RESULTS Previous head and neck exposure to therapeutic radiation is associated with latent CVD and increased risk for stroke in some patient groups. Common manifestations of radiation-induced CVD includes steno-occlusive disease, moyamoya, aneurysm, mineralizing microangiopathy, vascular malformations, and strokelike migraines. CONCLUSION Risk for stroke is increased in survivors of pediatric CNS tumors, Hodgkin lymphoma, and acute lymphoblastic leukemia who received radiation to the brain and/or neck. As the population of survivors ages, vigilance for stroke and cerebrovascular disease needs to continue based on specific exposures during curative cancer therapy.
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Affiliation(s)
- B Morris
- Divisions of Neurology and Cancer Survivorship, St. Jude Children's Research Hospital, Memphis, TN, USA.
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