Moyamoya syndrome associated with γ knife surgery for cerebral arteriovenous malformation: case report.
A 30-year-old female developed moyamoya syndrome after gamma knife surgery (GKS) for cerebral arteriovenous malformation (AVM), and was treated with bypass surgery. She suffered from flittering scotoma, right transient hemianopsia, and headache for 1 year. Cerebral angiography revealed a Spetzler-Martin grade III AVM located in the left occipital lobe. After staged embolization, GKS was performed with a minimum dose of 20 Gy to the periphery of the nidus at the 50% isodose level of the maximum target dose. Gradual nidus regression was achieved, and the clinical symptoms disappeared completely. However, at 30 months after GKS, the patient suffered transient ischemic attack. Cerebral angiography showed left middle cerebral artery occlusion with moyamoya vessels. The patient underwent direct and indirect bypass surgery. After surgery, the patient was free from ischemic symptoms. Chronic inflammation and long-term changes in expression of cytokines and growth factors after GKS may have triggered this case.
Department of Neurosurgery, Kamiiida Daiichi General Hospital, Nagoya, Aichi, Japan.
Yoichi
Y
Uozumi
Masaki
M
Sumitomo
Mikio
M
Maruwaka
Yoshio
Y
Araki
Takashi
T
Izumi
Shigeru
S
Miyachi
Takenori
T
Kato
Toshinori
T
Hasegawa
Yoshihisa
Y
Kida
Sho
S
Okamoto
Toshihiko
T
Wakabayashi
D000328:Adult; D002548:Cerebral Revascularization / Q000379:methods; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000503:physiopathology; D009072:Moyamoya Disease / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D009778:Occipital Lobe / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D011829:Radiation Dosage; D011859:Radiography; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D020293:Vasculitis, Central Nervous System / Q000150:complications / Q000276:immunology / Q000503:physiopathology