J Cerebrovasc Endovasc Neurosurg.  2019 Sep;21(3):152-157. 10.7461/jcen.2019.21.3.152.

Chronic encapsulated expanding hematoma after stereotactic radiosurgery of cerebral arteriovenous malformation

• Choi MS
• Joo M
• Choi CY

• KMID: 2465245
• DOI: http://doi.org/10.7461/jcen.2019.21.3.152

Abstract

Stereotactic radiosurgery has become excellent alternative treatment for cerebral arteriovenous malformations (AVM). This technique has expanded to treatment of larger AVM which is not amenable to surgical management. However, its variable adverse effects should be also taken into considerations sincerely because of radiobiological characteristics such as delayed onset and progressive neurological deteriorations. Herein, we report a case in which progressively expanding hemorrhagic cyst with repeated bleedings so called chronic encapsulated expanding hematoma was developed on several years after radiosurgery treatment. Neurological and radiological findings were improved by surgical removal.

Keyword

chronic encapsulated expanding hematoma; adverse radiation effect; radiosurgery; arteriovenous malformation

MeSH Terms

Arteriovenous Malformations
Hematoma*
Intracranial Arteriovenous Malformations*
Radiosurgery*

Figure

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  Fig. 1 Brain computed tomography shows a collection of curvilinear structures with high density in the right occipital lobe.

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  Fig. 2 Brain magnetic resonance imaging reveals multiple signal voids in the mass like lesion that have variable width, length, and size. These findings are suggesting vascular malformations.

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  Fig. 3 On the lateral cerebral angiograms (A, B), the arteriovenous malformation has several feeders supplied by distal branches of middle cerebral artery and posterior cerebral artery, and has veins draining into the cortical veins and straight sinus.

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  Fig. 4 At 7 years after stereotactic radiosurgery, magnetic resonance imaging shows multiple stages cerebral hemorrhages, including repeated bleedings and enhancing lesion adjacent to the falx in the left occipital lobe. The enhancing lesion with peripheral low signal rim has been grown while right enhancing lesion and cysts have been under the control by repeated aspiration through the omaya reservoir.

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  Fig. 5 Pathological findings present extensive hemorrhagic necrosis in the center and hemosiderin deposition in the peripheral fibrosis.

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