Management and prognosis of cysts developed on long-term follow-up after Gamma Knife radiosurgery for intracranial arteriovenous malformations

Masahiro Izawa, Mikhail Chernov, Motohiro Hayashi, Kotaro Nakaya, Shuji Kamikawa, Koichi Kato, Takashi Higa, Hiroshi Ujiie, Hidetoshi Kasuya, Takakazu Kawamata, Yoshikazu Okada, Osami Kubo, Hiroshi Iseki, Tomokatsu Hori, Kintomo Takakura

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    Abstract

    Background: Delayed cyst formation is a well-recognized complication after radiosurgery for intracranial AVM. The objective of the present study was the evaluation of the different management options for these lesions and the corresponding prognosis of patients. Methods: Between 2000 and 2005, 12 patients with intracranial AVM initially treated by GKR were reevaluated at Tokyo Women's Medical University because of delayed cyst formation in the vicinity of the target area. There were 7 men and 5 women. The mean age of the patients was 31.8 years at the time of GKR and 41.1 years at the time of complication. The average period between treatment and diagnosis of the complication constituted 6.7 years. All AVMs had lobar location and showed complete angiographic obliteration after GKR. Results: The most common neurological signs and symptoms at the time of cyst presentation were headache (10 cases) and seizures (4 cases). Two patients were asymptomatic. Three patients underwent surgery soon after the diagnosis of the cyst, whereas initial observation was done in another 9. Among the latter, 5 patients had to be treated surgically thereafter because of persistent or aggravated neurological symptoms associated with radiological cyst expansion. Four other patients, including both asymptomatic ones, are in stable condition without surgery. Follow-up after treatment of the cyst varied from 7 to 60 months (average, 34.3 months). All patients are in good condition. Conclusions: Although delayed formation of cysts after GKR for intracranial AVM should be considered as a complication of the radiosurgical treatment, it has a relatively good prognosis. Observation can be recommended as initial option for compensated and asymptomatic patients.

    Original languageEnglish
    Pages (from-to)400-406
    Number of pages7
    JournalSurgical Neurology
    Volume68
    Issue number4
    DOIs
    Publication statusPublished - 2007 Oct 1

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    Keywords

    • Arteriovenous malformation
    • Complication
    • Cyst
    • Gamma Knife radiosurgery
    • Management
    • Prognosis

    ASJC Scopus subject areas

    • Surgery
    • Clinical Neurology

    Cite this

    Izawa, M., Chernov, M., Hayashi, M., Nakaya, K., Kamikawa, S., Kato, K., Higa, T., Ujiie, H., Kasuya, H., Kawamata, T., Okada, Y., Kubo, O., Iseki, H., Hori, T., & Takakura, K. (2007). Management and prognosis of cysts developed on long-term follow-up after Gamma Knife radiosurgery for intracranial arteriovenous malformations. Surgical Neurology, 68(4), 400-406. https://doi.org/10.1016/j.surneu.2006.11.051