Improvement of cerebral hypometabolism after resection of radiation-induced necrotic lesion in a patient with cerebral arteriovenous malformation.
A 55-year-old woman underwent radiosurgery for a left cerebral hemisphere arteriovenous malformation (AVM) and developed radiation-induced necrosis causing a massive edema in the surrounding brain tissues. Despite various therapies, the edema expanded to the ipsilateral hemisphere and induced neurological symptoms. The radiation-induced necrotic lesion was surgically removed 4 years after radiosurgery. While the preoperative FDG PET revealed severe hypometabolism in the left cerebrum, the necrotomy significantly ameliorated the brain edema, glucose metabolism (postoperative FDG PET), and symptoms. This case indicates that radiation necrosis-induced neurological deficits may be associated with brain edema and hypometabolism, which could be reversed by appropriate necrotomy.
Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Yae
Y
Harada
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Kenji
K
Hirata
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Naoki
N
Nakayama
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Shigeru
S
Yamaguchi
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Michiharu
M
Yoshida
Department of Radiation Oncology, Hokkaido Cancer Center, Sapporo, Japan.
Shunsuke
S
Onodera
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Osamu
O
Manabe
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Tohru
T
Shiga
Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan.
Satoshi
S
Terae
Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Hiroki
H
Shirato
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Nagara
N
Tamaki
F-18 fluorodeoxyglucose; Intracranial arteriovenous malformation; brain edema; positron emission tomography; radiation-induced necrosis; stereotactic radiosurgery