A Case of Very Large Cyst Formation with Gamma Knife Radiosurgery for an Arteriovenous Malformation

Kim, M.S.; Lee, S.I.; Sim, Jae Hong

doi:10.1159/000056453

Cited by 28 publications

(10 citation statements)

References 6 publications

(6 reference statements)

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“…Also, concurrent cyst formation is considered to be relevant with radiation injury. It was observed in 8 patients (3.4%), and 0.4-4.0% of patients have reportedly developed the symptom [9][10][11][12][13][14][15]. With a longer follow-up, the rate increases up to 7.9-28.1% [9,11].…”

Section: Discussionmentioning

confidence: 96%

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Gamma Knife^®Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer

et al. 2010

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Section: Discussionmentioning

confidence: 96%

“…These patients were treated with a large target volume (median 27.6 cm 3 ) and with a high prescription dose (median 25 Gy), seemingly causing damage to the surrounding normal brain structures. On the other hand, a high nidal obliteration rate was indicated (median 93%) [4,7,9,[11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Gamma Knife^®Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer

et al. 2010

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“…19 Placement of an Ommaya reservoir under local anesthesia is recommended for such cases. 10 Neurological symptoms tend to improve immediately after aspiration of the cyst content. Control of cyst growth is also obtained by repeat aspiration in most cases, although the long-term outcome remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Proposed mechanism for cyst formation and enlargement following Gamma Knife Surgery for arteriovenous malformations

Shuto¹,

Ohtake²,

Matsunaga³

2012

JNS

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Object The authors retrospectively studied the mechanism of cyst formation and enlargement after Gamma Knife surgery (GKS) for arteriovenous malformations (AVMs). Methods Eighteen patients in whom cyst formation developed following GKS for AVM were retrospectively identified among 775 patients who underwent GKS for AVM at Yokohama Rosai Hospital. The study group was composed of 12 male and 6 female patients ranging in age from 17 to 47 years. Results Chronic encapsulated expanding hematoma was associated with the cyst in 5 patients. The AVM nidus volume at the time of GKS ranged from 1.9 to 36 cm3, and the prescription radiation dose was 18–25 Gy. Complete obliteration of the AVM nidus was obtained in 13 patients and partial obliteration in 5 patients. Cyst formation was detected between 2.6 and 15 years after GKS. Craniotomy was performed in 10 patients, including 2 patients in whom the incompletely obliterated nidus was removed at the same time, and an Ommaya reservoir was placed in 2 patients. Spontaneous regression of the cyst was observed in 1 patient. Serial MR imaging was performed in the other patients because the size of the cyst was stable or the lesion was asymptomatic. Histological examination of the cyst wall revealed linear hemosiderin deposits with gliosis. The nodular lesion, which was enhanced on MR images, contained granulation tissue with chronic hemorrhage from newly developed capillary vessels. Conclusions Cysts developing after GKS for AVM enlarge mainly due to repeated minor hemorrhages from a reddish nodular angiomatous lesion that develops within an adjacent brain area. Thus, the optimal treatment is wide opening of the cyst with removal of the associated angiomatous lesion by craniotomy.

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“…If the cyst apparently increases in size and becomes symptomatic, surgery is indicated. Placement of an Ommaya reservoir under local anesthesia is recommended for such cases [14] . Neurological symptoms improve immediately after aspiration of the cyst content.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Late Complications following Gamma Knife Surgery for Arteriovenous Malformations

Shuto

Matsunaga²,

Suenaga³

2011

Stereotact Funct Neurosurg

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Background: To establish the surgical indications and strategy for late complications following gamma knife surgery (GKS) for arteriovenous malformations (AVMs). Methods: Ten male and 7 female patients aged 17–52 years (mean 28.0 years) were retrospectively identified among 686 patients who underwent GKS for AVM at our hospital. Ten patients showed cyst formation (group A), 2 patients had expanding hematoma (group B), and 5 patients had both cyst and expanding hematoma (group C). Results: The mean nidus volume was 10.1 ml (range 0.1–36 ml), and the mean prescription dose at the nidus margin was 19.9 Gy (range 18–28 Gy). Complete obliteration of the nidus was obtained in 12 patients, partial obliteration in 4, and no change in 1. Cyst formation (group A) was asymptomatic in 5 patients, and symptomatic in 5 patients, manifesting as headache, hemianopia, aphasia, and motor weakness. Expanding hematoma (groups B and C) was associated with surrounding brain edema and was symptomatic in all 7 patients. Cyst opening in 1 patient and placement of an Ommaya reservoir in 2 patients were necessary in group A. Both patients in group B underwent craniotomy. Four of the 5 patients in group C required craniotomy. Another patient in group C was lost to follow-up and the final outcome was unknown. Conclusions: Cyst formation is one of the late complications of GKS for AVM. Some cysts show spontaneous regression but others gradually increase in size and become symptomatic, although relatively large asymptomatic cysts are also known. Predicting the future course of a cyst is difficult. Surgery such as placement of an Ommaya reservoir should be considered for symptomatic cases. Expanding hematoma always increases in size and becomes symptomatic, so removal by craniotomy is necessary. Surrounding brain edema decreases rapidly after surgery and neurological symptoms quickly resolve.

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A Case of Very Large Cyst Formation with Gamma Knife Radiosurgery for an Arteriovenous Malformation

Cited by 28 publications

References 6 publications

Gamma Knife^®Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer

Gamma Knife^®Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer

Proposed mechanism for cyst formation and enlargement following Gamma Knife Surgery for arteriovenous malformations

Surgical Treatment for Late Complications following Gamma Knife Surgery for Arteriovenous Malformations

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A Case of Very Large Cyst Formation with Gamma Knife Radiosurgery for an Arteriovenous Malformation

Cited by 28 publications

References 6 publications

Gamma Knife&reg;Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer

Gamma Knife&reg;Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer

Proposed mechanism for cyst formation and enlargement following Gamma Knife Surgery for arteriovenous malformations

Surgical Treatment for Late Complications following Gamma Knife Surgery for Arteriovenous Malformations

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Product

Resources

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Gamma Knife^®Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer

Gamma Knife^®Radiosurgical Strategy for Pediatric High-Grade Arteriovenous Malformations: Advantages of Staged Radiosurgery Prior to Targeting Nidus Proximal to the Drainer