title: Fatal case of intracerebral hemorrhage during gamma knife treatment for metastases.
abstract: This case report presents a patient suffering acute fatal intracranial-intratumoral hemorrhage during a gamma knife treatment session. Acute hemorrhage during a radiosurgery session is extremely rare and a plausible cause for this case is discussed along with a literature review of previously reported incidents. The patient was a 71-year-old male presenting with three large intracranial lesions and an underlying primary renal cell carcinoma malignancy. Because of a severe kyphotic deformity resulting from ankylosing spondylitis, the patient was placed in a moderate Trendelenburg position to allow his head to fit into the gamma knife unit during the radiosurgery session. The two left-sided lesions were to be treated with 20 Gy to the 50% isodose line, and the right-sided lesion with 16 Gy to the 40% isodose line. Anesthesia was available throughout the treatment session to aid with pain control. The gamma knife treatment was aborted because the patient suffered a generalized seizure while in the unit. Immediate head CT of the patient revealed large acute hemorrhages into all three intracranial masses. This proved to be a fatal complication. It is likely that this positioning contributed to the hemorrhage. The clinical history of this patient is provided as well as a review of the literature on acute intracranial hemorrhage associated with radiosurgical therapy.
authors.affiliation: The Johns Hopkins University School of Medicine, Department of Neurosurgery, Meyer Building 8-161, 600 North Wolfe Street, Baltimore, MD 21287, United States. wanderso@jhmi.edu
authors.forename: William S
authors.initials: WS
authors.lastname: Anderson
authors.forename: Laurel E
authors.initials: LE
authors.lastname: Moore
authors.forename: Eric
authors.initials: E
authors.lastname: Ford
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D017809:Fatal Outcome; D018475:Head-Down Tilt; D006801:Humans; D007431:Intraoperative Complications; D007680:Kidney Neoplasms / Q000473:pathology; D008297:Male; D011877:Radionuclide Imaging; D016634:Radiosurgery / Q000009:adverse effects*; D012640:Seizures / Q000209:etiology; D013167:Spondylitis, Ankylosing / Q000150:complications; D014057:Tomography, X-Ray Computed