Uozumi Yoichi, Sumitomo Masaki, Maruwaka Mikio, Araki Yoshio, Izumi Takashi, Miyachi Shigeru, Kato Takenori, Hasegawa Toshinori, Kida Yoshihisa, Okamoto Sho, Wakabayashi Toshihiko
Department of Neurosurgery, Kamiiida Daiichi General Hospital, Nagoya, Aichi, Japan.
Neurol Med Chir (Tokyo). 2012;52(5):343-5. doi: 10.2176/nmc.52.343.
A 30-year-old female developed moyamoya syndrome after gamma knife surgery (GKS) for cerebral arteriovenous malformation (AVM), and was treated with bypass surgery. She suffered from flittering scotoma, right transient hemianopsia, and headache for 1 year. Cerebral angiography revealed a Spetzler-Martin grade III AVM located in the left occipital lobe. After staged embolization, GKS was performed with a minimum dose of 20 Gy to the periphery of the nidus at the 50% isodose level of the maximum target dose. Gradual nidus regression was achieved, and the clinical symptoms disappeared completely. However, at 30 months after GKS, the patient suffered transient ischemic attack. Cerebral angiography showed left middle cerebral artery occlusion with moyamoya vessels. The patient underwent direct and indirect bypass surgery. After surgery, the patient was free from ischemic symptoms. Chronic inflammation and long-term changes in expression of cytokines and growth factors after GKS may have triggered this case.
一名30岁女性在接受脑动静脉畸形（AVM）的伽玛刀手术（GKS）后出现烟雾病综合征，并接受了搭桥手术。她出现闪烁暗点、右侧短暂性偏盲和头痛1年。脑血管造影显示Spetzler-Martin III级AVM位于左枕叶。在分期栓塞后，在最大靶剂量的50%等剂量水平对病灶周边给予最小剂量20 Gy进行GKS。病灶逐渐缩小，临床症状完全消失。然而，在GKS后30个月，患者发生短暂性脑缺血发作。脑血管造影显示左大脑中动脉闭塞伴烟雾状血管。患者接受了直接和间接搭桥手术。术后，患者无缺血症状。GKS后的慢性炎症以及细胞因子和生长因子表达的长期变化可能引发了该病例。
