Operation for delayed symptomatic brain oedema after treatment of an arteriovenous malformation by embolization and radiosurgery.
A patient with a Spetzler-Martin-grade-III AVM, initially embolized and then stereotactically irradiated, who - with a latency of several months - showed progressive neurological deterioration, is reported. Magnetic resonance imaging revealed enormous ipsilateral brain oedema, which did not respond to dexamethasone. Upon further neurological deterioration the former AVM nidus plus an adjacent rim of brain tissue were removed and the patient recovered considerably. It is concluded that embolization in conjunction with irradiation may impair the blood-brain-barrier with resulting long-term oedema in the surrounding brain, and that surgical treatment should be considered in selected cases.
Schaller
C
C
Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany. carlo.schaller@ukb.uni-bonn.de
Liefner
M
M
Ansari
S
S
Al Moutaery
K
K
D000328:Adult; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000601:surgery*; D001812:Blood-Brain Barrier / Q000293:injuries* / Q000503:physiopathology / Q000528:radiation effects; D001921:Brain / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001929:Brain Edema / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003907:Dexamethasone / Q000627:therapeutic use; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D016634:Radiosurgery / Q000009:adverse effects*; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
D003907:Dexamethasone