Morihiro Yusuke, Kato Syoichi, Imoto Hirochika, Nomura Sadahiro, Harada Kei, Kajiwara Koji, Fujii Masami, Fujisawa Hirosuke, Saito Kenichi, Suzuki Michiyasu
Department of Neurosurgery,Yamaguchi University School of Medicine, Japan.
No Shinkei Geka. 2010 Aug;38(8):751-6.
Gamma knife and CyberKnife radiosurgery are well established and less invasive treatments for arteriovenous malformation. Delayed cyst formation is a rare but well-known complication of radiosurgery for arteriovenous malformations. The optimal treatment of cysts forming after radiosurgery remains debatable. We present a case of cyst formation after radiosurgery for brain arteriovenous malformation that was treated with a cystoperitoneal shunt (C-P shunt). A 36-year-old woman presented with left hemiparesis and numbness. Computed tomography (CT) revealed intracranial hemorrhage in the right basal ganglia. Digital subtraction angiography revealed arteriovenous malformation in the brain. Intravascular embolization was performed three times and radiosurgery was performed twice, whereby complete obliteration of the nidus was achieved. Six and a half years later, routine follow-up magnetic resonance imaging revealed cyst formation, and the patient gradually developed left hemiparesis. First, we performed stereotactic cyst aspiration. This initially resulted in a reduction in the size of the cyst and disappearance of left hemiparesis, but within a short time, the cyst increased in size again and there was recurrence of hemiparesis. Therefore, an Ommaya reservoir was established; aspiration of the cyst through this reservoir brought about an initial reduction in cyst size and alleviation of symptoms; however, no further reduction in cyst size or improvement in symptoms could be achieved. Twenty months after the placement of the Ommaya reservoir, we performed a C-P shunt operation. After the operation, further reduction in the cyst size and complete symptomatic recovery were observed.
伽玛刀和射波刀放射外科手术是治疗动静脉畸形的成熟且侵入性较小的方法。延迟性囊肿形成是动静脉畸形放射外科手术一种罕见但广为人知的并发症。放射外科手术后形成囊肿的最佳治疗方法仍存在争议。我们报告一例脑动静脉畸形放射外科手术后囊肿形成的病例，该病例采用了囊肿 - 腹腔分流术（C - P分流术）进行治疗。一名36岁女性出现左侧偏瘫和麻木症状。计算机断层扫描（CT）显示右侧基底节区颅内出血。数字减影血管造影显示脑部存在动静脉畸形。进行了三次血管内栓塞和两次放射外科手术，从而实现了畸形病灶的完全闭塞。六年半后，常规随访磁共振成像显示囊肿形成，患者逐渐出现左侧偏瘫。首先，我们进行了立体定向囊肿抽吸。这最初导致囊肿大小减小且左侧偏瘫消失，但在短时间内，囊肿再次增大且偏瘫复发。因此，建立了一个Ommaya储液囊；通过该储液囊抽吸囊肿最初使囊肿大小减小且症状缓解；然而，囊肿大小没有进一步减小，症状也没有进一步改善。在放置Ommaya储液囊20个月后，我们进行了C - P分流手术。手术后，观察到囊肿进一步缩小且症状完全恢复。
