Postobliteration Arteriovenous Malformation Mimicking Malignant Change 30 Years After X-Knife Treatment—Case Report and Review of Literature

Arteriovenous malformations (AVMs) are potentially dangerous vascular anomalies of the brain that can cause seizures or intracranial hemorrhage in patients if left untreated. Because full excision of these lesions is not always possible in deep or eloquent areas of the brain, radiosurgical advances...

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Bibliographic Details
Published in:World neurosurgery 2019-08, Vol.128, p.169-173
Main Authors: Lee, Yao-Lin, Kuo, Jinn-Rung
Format: Article
Language:English
Subjects:
Adult
Arteriovenous malformation
Brain Neoplasms - diagnosis
Diagnosis, Differential
Female
Humans
Intracranial Arteriovenous Malformations - diagnostic imaging
Intracranial Arteriovenous Malformations - pathology
Intracranial Arteriovenous Malformations - radiotherapy
Intracranial Hemorrhages - diagnostic imaging
Intracranial Hemorrhages - pathology
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Radiation-induced changes
Radiosurgery
Single Photon Emission Computed Tomography Computed Tomography
Stereotactic radiosurgery
X-knife
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Summary:Arteriovenous malformations (AVMs) are potentially dangerous vascular anomalies of the brain that can cause seizures or intracranial hemorrhage in patients if left untreated. Because full excision of these lesions is not always possible in deep or eloquent areas of the brain, radiosurgical advances have gone a long way in the control and treatment of AVMs. Postradiosurgery AVMs are followed closely via outpatient clinics with serial imaging every few months to assess AVM obliteration. Post X-knife treatment AVMs still carry with them some risk of rebleeding and even a chance of malignant transformation. In this article, we report a case of a post X-knife−treated arteriovenous malformation with the appearance of malignant change on magnetic resonance imaging and thallium-201 on follow-up 30 years after treatment. Imaging with magnetic resonance angiography showed obliteration of the lesion but progressive change in size with new soft tissue components, which suggests radiation-related secondary malignancy. Surgery was arranged, and pathology results indicate no malignant change.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2019.04.263