Awano Takayuki, Kano Toshikazu, Nagaoka Takafumi, Kimura Shigeyoshi, Kano Tsuneo, Kido Goro, Katayama Yoichi, Kotani Akio
Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan.
No Shinkei Geka. 2006 Sep;34(9):927-32.
We report a patient with cerebral arteriovenous malformation (AVM) revealing growing mass lesion after stereotactic radiosurgery. This 12-year-old female presented headache. CT scan showed hematoma at the head of the right caudate nucleus and angiography showed AVM at the site. LINAC-based stereotactic radiosurgery was performed with the patient. Twenty-three months after the radiosurgery the patient complained headache and CT scan showed hematoma again at the same site, although angiography did not show AVM. Thirty-five months after the radiosurgery mass lesion with enhancement effect was observed at the site and the mass lesion grew gradually thereafter. Thirty-nine months after the radiosurgery the mass lesion was evacuated. Histological examination revealed fibrotic core and surrounding neovascularized area with hemorrhage. The histology shows a new etiology of growing mass lesion after radiosurgery for AVM.
我们报告了一例患有脑动静脉畸形(AVM)的患者,该患者在立体定向放射治疗后出现了不断增大的肿块病变。这名12岁女性出现头痛症状。CT扫描显示右侧尾状核头部有血肿,血管造影显示该部位存在AVM。对该患者进行了基于直线加速器的立体定向放射治疗。放射治疗23个月后,患者再次抱怨头痛,CT扫描显示同一部位再次出现血肿,尽管血管造影未显示AVM。放射治疗35个月后,在该部位观察到有强化效应的肿块病变,此后肿块病变逐渐增大。放射治疗39个月后,对肿块病变进行了切除。组织学检查显示有纤维化核心以及周围伴有出血的新生血管化区域。组织学表现揭示了AVM立体定向放射治疗后肿块病变增大的一种新病因。