title: Fatal glioblastoma after Gamma Knife radiosurgery for arteriovenous malformation in a child.
abstract: We describe a fatal case of glioblastoma multiforme that was induced by Gamma Knife radiosurgery (GKS; Elekta AB, Stockholm, Sweden) for an arteriovenous malformation (AVM). A 4-year-old girl presented with repeated convulsions. Imaging studies revealed an AVM located in the right thalamus. One year after initial symptoms, GKS was performed to obliterate the nidus. The maximum and marginal radiation doses were 32 and 16Gy, respectively. Seventy months after GKS, the patient represented with severe headache. MRI showed a poorly demarcated tumor with heterogeneous gadolinium enhancement in the right thalamus and adjacent to the white matter of the temporal lobe. After a generalised convulsion, the patient deteriorated into a deep coma. CT scans showed severe brain swelling with intratumoral hemorrhage. An emergency craniotomy was performed, and the hematoma was removed. During this surgery, a tumor mass, which was found adjacent to the hematoma, was resected. Microscopic examination revealed glioblastoma multiforme. Despite intensive treatment, the patient died 1month after surgery. A GKS-induced secondary tumor is a rare but serious complication. It is important to be aware of the adverse effects of GKS, including secondary neoplasms, before its clinical application, especially in young patients.
authors.affiliation: Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. Electronic address: tomoichi@cc.okayama-u.ac.jp.
authors.forename: Tomotsugu
authors.initials: T
authors.lastname: Ichikawa
authors.affiliation: Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kurozumi
authors.affiliation: Department of Pathology, Okayama University Hospital, Okayama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yanai
authors.affiliation: Department of Neurological Surgery, Japanese Red Cross Okayama Hospital, Okayama, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Onoda
authors.affiliation: Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Date
mesh_terms: D001165:Arteriovenous Malformations / Q000601:surgery*; D001932:Brain Neoplasms / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D002533:Cerebral Angiography; D002675:Child, Preschool; D003287:Contrast Media; D017809:Fatal Outcome; D005260:Female; D005682:Gadolinium; D005909:Glioblastoma / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D009381:Neoplasms, Radiation-Induced / Q000473:pathology / Q000628:therapy; D010784:Photomicrography; D016634:Radiosurgery / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Arteriovenous malformations; Gamma Knife radiosurgery; Glioblastoma multiforme; Radiation-induced neoplasms