| Management and Prognosis of the Delayed De-novo Cyst Formation after GKRS for Intracranial AVMs |
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Eun-Suk Park, Do-Hoon Kwon, Chang-Jin Kim, Sung-Chul Jin |
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Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Department of Neurosurgery, Seoul National University, Bundang Hospital, Seongnam, Korea |
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| Abstract |
Objective
Delayed de-novo cystic formation is a well-known but rare late complication after gamma knife radiosurgery
(GKRS) for intracranial arteriovenous malformations (AVMs). The proper management for this complication has not been established. The purpose of this study was to describe management and prognosis of this complication in our clinical experiences.
Material and Method: Between 1991 and 2007, 764 patients with intracranial AVMs underwent GKRS. Of these patients, 11
patients presented with delayed cystic formation after GKRS with age ranging from 19 to 52 years (mean；33.2 years). The
median prescription isodose volume was 11.03cm3
(range, 0.5-41.7cm3
). The median marginal dose was 23Gy. Follow-up
period after treatment of the cyst varied from 1 to 113 months (average, 41.7 months).
Results
The incidence of delayed de-novo cyst formation in our series was 1.4%. The mean time interval between the denovo cyst formation and GKRS was 74.7 months. De-novo cysts developed in six patients with complete nidus obliteration.
Six patients presented with the symptom related to de-novo cyst formation. Close follow-up with periodic repeated images
was generally performed in five asymptomatic patients resulted in no symptomatic change. According to degree of nidus obliteration, six patients with symptomatic cysts underwent microsurgical resection of nidus with cyst (n=3) and Stereotactic cyst
aspiration & Ommaya reservoir insertion (n=3). All patients with surgical treatment were good clinical condition without surgical
complications.
Conclusion
Continuous monitoring for delayed de-novo cystic formation should be necessary for patients treated with GKRS
for AVMs. Based on author’s experience, stereotactic cyst aspiration and placement of Ommaya reservoir can be useful methods for management of symptomatic de-novo cyst with complete nidus obliteration. |
| Key Words:
Arteriovenous malformation, Gamma knife radiosurgery, Complication, Delayed cyst formation. |
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