Department of Neurosurgery, National Defense Medical College, Saitama, Japan.
Neurol India. 2011 Jul-Aug;59(4):624-6. doi: 10.4103/0028-3886.84352.
We report a rare case of chronic encapsulated intracerebral hematoma (CEIH) after radiosurgery for a cerebral arteriovenous malformation (AVM). A 49-year-old male underwent transarterial embolization and surgical excision of a cerebral AVM presenting with cerebral hemorrhage in the left temporal lobe. Stereotactic radiosurgery (SRS) was done after 12 months. Magnetic resonance imaging (MRI) 14 months after SRS showed a small-enhancing lesion close to the left lateral ventricle and marked white matter edema. At that time a diagnosis of radiation-induced necrosis was made and steroids administered. At 43 months after SRS, MRI showed a small-enhancing mass close to the lateral ventricle with a hematoma cavity. Surgical excision was performed and histological examination revealed that the capsule consisted of an outer collagenous layer and an inner granulated layer with deposits of hemosiderin, which was compatible with CEIH. CEIH should be considered after SRS for AVM.
我们报告了一例脑动静脉畸形（AVM）放射外科治疗后罕见的慢性包膜脑内血肿（CEIH）病例。一名 49 岁男性因左颞叶脑出血接受了脑 AVM 的动脉内栓塞和手术切除。12 个月后进行立体定向放射外科手术（SRS）。SRS 后 14 个月的磁共振成像（MRI）显示靠近左侧脑室的小增强病变和明显的白质水肿。当时诊断为放射性坏死，并给予类固醇治疗。SRS 后 43 个月，MRI 显示靠近侧脑室的小增强肿块，伴血肿腔。进行了手术切除，组织学检查显示囊壁由外胶原层和内颗粒层组成，有含铁血黄素沉积，符合 CEIH。AVM 患者 SRS 后应考虑 CEIH。
