Radiotherapy-related intracranial aneurysm: case presentation of a 17-year male and a meta-analysis based on individual patient data.
OBJECTIVE
The aim of this study was to investigate the incidence, clinical profiles, latency, and outcomes of radiotherapy (RT)-related intracranial aneurysms, rare but often fatal complications of cranial irradiation.


METHODS
We reviewed all published individual patient data regardless of language, using survival analysis to make statistical inferences.


RESULTS
We examined a total of 58 patients with RT-related intracranial aneurysms, including one unpublished case presented here, of whom 74.1 % presented with rupture. In the study, 29.3 % were younger than 18 years. The mean age at which patients received the first course of RT was 34.8 ± 22.8 years old. The mean latency between initiating RT and presenting with aneurysm was 10.4 ± 8.5 years. Rapid death ensured in 24 % shortly after presentation. The only significant predictor of death was rupture. In those with a single aneurysm, 43.1 % were located at the internal carotid artery, while 15.5 % of patients had multiple aneurysms. A male-to-female ratio of 1.87, 0.5, and 1.32 was found in patients younger than age 52, 52 years of age or older, and all 58 patients, respectively. Older age when receiving RT and presentation with ruptured aneurysm were significantly associated with shorter latency.


CONCLUSIONS
RT-related intracranial aneurysms presented differently from classical ones based on age, sex, site, multiplicity, and type. Sex ratios differed with age. The younger age group showed a longer latency of occurrence of an aneurysm. Older patients and those who develop ruptured aneurysms presented earlier. Since rupture may affect outcome, early detection of aneurysms before rupture may save lives.
Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Yuan-Hung
YH
Wu
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Sheng-Shuan
SS
Lin
Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Hsin-Hung
HH
Chen
School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Feng-Chi
FC
Chang
Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Muh-Lii
ML
Liang
Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
Tai-Tong
TT
Wong
Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
Sang-Hue
SH
Yen
Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan. chenyw@vghtpe.gov.tw.|School of Medicine, National Yang-Ming University, Taipei, Taiwan. chenyw@vghtpe.gov.tw.
Yi-Wei
http://orcid.org/0000-0003-3946-7540
YW
Chen
D000293:Adolescent; D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000209:etiology; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D013223:Statistics as Topic / Q000379:methods; D055815:Young Adult
Aneurysm; Radiation toxicity; Radiotherapy; Vasculopathy