Department of Neurosurgery, University Hospital of Wales Cardiff, Heath Park, Cardiff, UK.
Acta Neurochir (Wien). 2010 May;152(5):803-15. doi: 10.1007/s00701-009-0581-1. Epub 2010 Jan 8.
We report two cases of operative intervention that was beneficial in the treatment of delayed symptomatic radionecrotic masses that had developed following stereotactic radiosurgery (SRS) using the gamma knife (GK) for the treatment of cerebral arteriovenous malformations (AVM).
Case 1 involved a small craniotomy for decompression of a large cerebral multiloculated cyst, which had become symptomatic 84 months following gamma knife treatment for a left frontal lobe AVM. Case 2 involved surgical excision of an occipital radionecrotic mass 72 months following GK treatment for an occipital AVM. This patient had suffered from longstanding symptomatic cerebral oedema, which on occasions had become life threatening. Case 2 is also the first report of a radionecrotic mass occurring post-SRS for an AVM, which conversely appeared to demonstrate increased uptake on single photon emission computed tomography (SPECT) scan. The first literature review of such delayed symptomatic radionecrotic lesions is presented. There appears to be a late onset of symptoms (average 55 months, range 12-111 months) associated with such radionecrosis. Drainage of such cysts or excision of the mass lesion appears to be consistently beneficial to the patients and appears to be uncomplicated.
We recommend early surgical intervention for such delayed symptomatic radionecrotic masses that do not resolve following non-operative management. We also recommend caution in interpretation of SPECT scan results when attempting to differentiate radionecrosis from neoplasia.
我们报告了两例手术干预的病例,这些病例对治疗因伽玛刀(GK)立体定向放射外科治疗脑动静脉畸形(AVM)后出现的迟发性症状性放射性坏死肿块具有益处。
病例 1 行小骨窗开颅术以减压大脑多发性囊肿,该囊肿在接受左额叶 AVM 的 GK 治疗后 84 个月出现症状。病例 2 行枕叶放射性坏死肿块切除术,该病例在接受 GK 治疗枕叶 AVM 后 72 个月出现症状。该患者长期患有症状性脑水肿,有时危及生命。病例 2 也是首例报告的 SRS 治疗 AVM 后出现放射性坏死肿块的病例,该病例的单光子发射计算机断层扫描(SPECT)扫描反而显示摄取增加。这是对这种迟发性症状性放射性坏死病变的首次文献回顾。这种放射性坏死似乎存在症状迟发(平均 55 个月,范围 12-111 个月)。对于这种迟发性症状性放射性坏死肿块,在非手术治疗后未缓解的情况下,我们建议进行早期手术干预。当试图区分放射性坏死与肿瘤时,我们还建议对 SPECT 扫描结果的解释持谨慎态度。
我们建议对未通过非手术治疗缓解的这种迟发性症状性放射性坏死肿块进行早期手术干预。当试图区分放射性坏死与肿瘤时,我们还建议对 SPECT 扫描结果的解释持谨慎态度。