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- Title
Proposed mechanism for cyst formation and enlargement following gamma knife surgery for arteriovenous malformation.
- Authors
T. Shuto
- Abstract
Object: We retrospectively studied the mechanism of cyst formation and enlargement after Gamma Knife surgery (GKS) for arteriovenous malformation (AVM). Methods: Twenty-five patients who developed cyst formation following GKS for AVM, 15 male and 10 female patients aged 14 to 48 years, were retrospectively identified among 775 patients who underwent GKS for AVM at our institution. Results: So-called expanding hematoma was associated with the cyst in 9 patients. The nidus volume at GKS was 0.1-36 ml, and the prescription dose was 18-28 Gy. Complete obliteration of the nidus was obtained in 18 patients, and partial obliteration in 7. Cyst formation was detected from 1.1 to 15 years after GKS. Thirteen patients underwent craniotomy, including two patients in whom the incompletely obliterated nidus was removed simultaneously, and two received placement of Ommaya reservoir. Spontaneous regression of cyst was observed in one patient. Serial magnetic resonance imaging was performed in the other patients because the cyst size was stable or asymptomatic. Histological examination of the cyst wall revealed linear hemosiderin deposits with gliosis, and the nodular lesion, enhanced on magnetic resonance imaging, contained granulation tissue with chronic hemorrhage from newly developed capillary vessels. Conclusions: Cysts developing after GKS for AVM enlarge mainly due to repeated minor hemorrhage from a reddish nodular angiomatous lesion developing within the adjacent brain, suggesting that the optimal treatment is wide opening of the cyst with removal of the associated angiomatous lesion by craniotomy. Disclosure: No significant relationships.
- Subjects
ARTERIOVENOUS malformation; CYSTS (Pathology); SURGERY; THERAPEUTIC use of magnetic resonance imaging; HEMORRHAGE treatment; ARTERIOSCLEROSIS obliterans; THERAPEUTICS
- Publication
Journal of Radiosurgery & SBRT, 2013, Vol 2, p125
- ISSN
2156-4639
- Publication type
Article