Document Detail

Middle cerebral artery stenosis caused by relatively low-dose irradiation with stereotactic radiosurgery for cerebral arteriovenous malformations: case report.
MedLine Citation:
PMID:  9257317     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE AND IMPORTANCE: There have been occasional reports of stenosis or occlusion of major cerebral arteries occurring several years after stereotactic radiosurgery for cerebral arteriovenous malformations. Nevertheless, little information is available regarding the actual irradiation dose to which the affected artery had been exposed. CLINICAL PRESENTATION: We present a patient with arteriovenous malformations who, although asymptomatic, developed remarkable stenosis of the middle cerebral artery trunk (M1) 3 years after gamma knife radiosurgery. The nidus was covered with a 50% isodose volume. A central dose of 36 Gy was used. A gradual decrease in nidus volume had been suggested by 1- and 2-year postradiosurgical neuroimaging examinations. Three-year postradiosurgical angiography revealed severe segmental stenosis of the M1, as well as remarkable nidus shrinkage. INTERVENTION: The actual irradiation dose delivered to the affected portion of the artery, as retrospectively determined using a highly accurate three-dimensional analysis technique, was estimated to be 5.1 to 9.8 Gy. CONCLUSION: This case suggests that a normal major artery, if located close to the target volume, may be affected by low-dose irradiation (10 Gy or even slightly less) delivered with radiosurgery, although a decrease in blood flow through the M1 because of nidus shrinkage or associated stenosis of the distal middle cerebral artery, as well as other unknown factors, may also contribute to proximal M1 stenosis.
M Yamamoto; M Ide; M Jimbo; Y Ono
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  41     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1997 Aug 
Date Detail:
Created Date:  1997-09-30     Completed Date:  1997-09-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  474-7; discussion 477-8     Citation Subset:  IM    
Department of Neurosurgery, Tokyo Women's Medical College Dai-ni Hospital, Japan.
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MeSH Terms
Arterial Occlusive Diseases / etiology*,  radiography
Cerebral Angiography
Cerebral Arteries*
Constriction, Pathologic
Dose-Response Relationship, Radiation
Intracranial Arteriovenous Malformations / radiography,  surgery*
Middle Aged
Radiation Injuries / complications*
Radiosurgery / adverse effects*
Stereotaxic Techniques*

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