Delayed hemorrhage from completely obliterated arteriovenous malformation after gamma knife radiosurgery.
A 43-year-old female was treated with gamma knife radiosurgery (GKS) for right frontal arteriovenous malformation (AVM) manifesting as absence seizures. Complete nidus obliteration was confirmed on angiography 4 years after GKS. However, she experienced recurrence of her previous seizures and delayed hemorrhage occurred within the treated nidus, despite absence of abnormalities by repeated angiography 81 months after GKS. She was treated conservatively and discharged home without neurological deficits. The risk of hemorrhage from obliterated AVM is significantly reduced but not eliminated after radiosurgery. Recanalization of thrombus that is too small to detect by neuroimaging may result in delayed hemorrhage.
Matsumoto
Hiroaki
H
Department of Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan. hiroaki-matsu@umin.ac.jp
Takeda
Tetsuji
T
Kohno
Kanehisa
K
Yamaguchi
Yoshiaki
Y
Kohno
Keiji
K
Takechi
Akihiko
A
Ishii
Daizo
D
Abiko
Masaru
M
Sasaki
Ushio
U
D000328:Adult; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000098:blood supply*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D016634:Radiosurgery; D012008:Recurrence; D012075:Remission, Spontaneous; D014057:Tomography, X-Ray Computed