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A case of delayed cyst formation post brain AVM stereotactic radiosurgery for arteriovenous malformation: Case report

      Highlights

      • Cerebral cyst formation has been previously reported developing 3-10 years post radiotherapy for AVM.
      • We present a case of cyst formation developing and progressing 20 years after SRS for cerebral AVM.
      • We recommend consideration of delayed cerebral cyst formation in cases of new onset focal neurological syndromes, even decades after radiotherapy for AVM.

      Abstract

      Arteriovenous malformations (AVMs) are a rare cause of cerebrovascular abnormality with incidence of about 1 in 100,000 people per year and point prevalence of about 0.2%. AVMs are associated with serious complications such as intracranial haemorrhage (2–4% a year, 16% and 29% at 10 and 20 years after diagnosis), seizures (10–30%), focal neurologic deficits, and headaches. The management options are surveillance, endovascular embolization, microsurgical excision and stereotactic radiosurgery (SRS).
      In SRS Stereotactically focused high energy beams of photons induce progressive thrombosis by fibro-intimal hyperplasia and subsequent luminal obliteration. These changes usually take one to three years known as “latency period”. Complications are reported in 8% of patients undergoing SRS, including radiographic parenchymal lesions, cranial nerve deficits, seizures, headaches, and cyst formation.
      Cyst formation is reported in about 1.2 % of patients undergoing SRS. While the exact mechanism of post SRS cyst formation is unclear, it is hypothesized that it might be due to damage to the blood brain barrier and increased vessel wall permeability. Delayed cyst formation is reported with latency period between 3 and 10 years after radiotherapy for treatment of cerebrovascular AVMs. However, cystic formation with longer latency periods (in one case upto 17 years) after radiotherapy for other causes such as nasopharyngeal cancers have been reported.
      Here we report a case of delayed cyst formation after SRS for cerebrovascular AVM with latency period of 20 years.

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      References

        • Al-Shahi R.
        A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults.
        Brain. 2001; 124: 1900-1926
        • Schaller K.
        • Steiger H.-J.
        To treat, or not to treat, that is the question: critical review of brain AVM surgery, surgical results and natural history in 2017 by Michael Morgan et al..
        Acta Neurochir. 2017; 159: 1455-1456
        • Garcin B.
        • Houdart E.
        • Porcher R.
        • Manchon E.
        • Saint-Maurice J.P.
        • Bresson D.
        • Stapf C.
        Epileptic seizures at initial presentation in patients with brain arteriovenous malformation.
        Neurology. 2012; 78: 626-631
        • Ropper A.H.
        • Solomon R.A.
        • Connolly Jr., E.S.
        Arteriovenous malformations of the brain.
        N Engl J Med. 2017; 376: 1859-1866https://doi.org/10.1056/NEJMra1607407
        • Flemming K.D.
        • Lanzino G.
        Management of unruptured intracranial aneurysms and cerebrovascular malformations. CONTINUUM: lifelong learning.
        Neurology. 2017; 23: 181-210
        • Ishikawa E.
        • Yamamoto M.
        • Saito A.
        • et al.
        Delayed cyst formation after gamma knife radiosurgery for brain metastases.
        Neurosurgery. 2009; 65: 689-695
        • Fang W.
        • Gu B.
        • Jing X.
        • et al.
        Late-onset cystic brain necrosis after radiotherapy for nasopharyngeal carcinoma.
        Jpn J Clin Oncol. 2017; 47: 499-504