Cerebral radiation necrosis complicating stereotactic radiosurgery for arteriovenous malformation.
A patient presented with symptoms and signs of raised intracranial pressure and increasing focal deficit 13 months after stereotactic radiosurgical treatment of an arteriovenous malformation (AVM). Computed Tomography (CT) showed a mass lesion at the site of the previous abnormality typical of radiation necrosis, but with features identical to those of a malignant neoplasm. Biopsy confirmed cerebral radiation necrosis. The radiation dose was 25 Gray to the periphery of two overlapping 14 mm collimator fields, delivered in a single dose. Treatment with steroids led to improvement in the symptoms and signs of raised intracranial pressure, but not the focal deficit. Radiation necrosis is a consequence of the large doses required to obliterate AVMs and is a limiting factor in their treatment. It is important for clinicians referring patients for stereotactic radiosurgery to be aware of this complication, and to be able to recognise and treat it.
Department of Neurosurgery, Southern General Hospital, Glasgow, United Kingdom.
P
P
Statham
P
P
Macpherson
R
R
Johnston
D M
DM
Forster
J H
JH
Adams
N V
NV
Todd
D000328:Adult; D001479:Basal Ganglia / Q000098:blood supply / Q000528:radiation effects*; D001929:Brain Edema / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000532:radiotherapy*; D009336:Necrosis; D011832:Radiation Injuries / Q000000981:diagnostic imaging*; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed