TY - JOUR
T1 - Radiation-induced anterior inferior cerebellar artery pseudoaneurysm after stereotactic radiosurgery for vestibular schwannoma
T2 - features observed by direct surgery
AU - Yamashiro, Kei
AU - Sadato, Akiyo
AU - Hasegawa, Mitsuhiro
AU - Wakako, Akira
AU - Omi, Tatsuo
AU - Nakagawa, Mitsuru
AU - Kuroda, Makoto
AU - Hirose, Yuichi
N1 - Publisher Copyright:
© 2021 The Neurosurgical Foundation.
PY - 2023
Y1 - 2023
N2 - Background: In vestibular schwannoma (VS) patients treated with stereotactic radiosurgery (SRS), radiation-induced pseudoaneurysm is a rare long-term complication. To the best of our knowledge, there has been only one report of direct surgery in ruptured cases, and the optimal strategy for direct surgery is yet to be clarified. This case report describes a case of ruptured VS-related SRS-induced pseudoaneurysm that was successfully treated by direct surgery. Case presentation: A 57-year -old man underwent SRS for VS, and the tumour was well controlled after the SRS. Nine years after the SRS, however, he developed subarachnoid haemorrhage, and a SRS-induced distal anterior inferior cerebellar artery aneurysm was detected on the surface of the tumour. During the trapping surgery, the aneurysm was embedded in the tumour, and it was difficult to separate the aneurysm and tumour. Besides, the facial nerve and tumour restricted exposure of the parent artery. The parent artery proximal to the aneurysm could only be exposed by resecting caudal part of the tumour. The aneurysm was trapped with permanent clips and it was pathologically diagnosed as pseudoaneurysm. Conclusion: It was suggested that the VS-related SRS-induced pseudoaneurysm is tightly adhered with surrounding structures and exposure of the parent artery could be limited due to the tumour and facial nerve. In this case report, we describe detailed intraoperative findings that will be useful for developing strategies for trapping surgery in future.
AB - Background: In vestibular schwannoma (VS) patients treated with stereotactic radiosurgery (SRS), radiation-induced pseudoaneurysm is a rare long-term complication. To the best of our knowledge, there has been only one report of direct surgery in ruptured cases, and the optimal strategy for direct surgery is yet to be clarified. This case report describes a case of ruptured VS-related SRS-induced pseudoaneurysm that was successfully treated by direct surgery. Case presentation: A 57-year -old man underwent SRS for VS, and the tumour was well controlled after the SRS. Nine years after the SRS, however, he developed subarachnoid haemorrhage, and a SRS-induced distal anterior inferior cerebellar artery aneurysm was detected on the surface of the tumour. During the trapping surgery, the aneurysm was embedded in the tumour, and it was difficult to separate the aneurysm and tumour. Besides, the facial nerve and tumour restricted exposure of the parent artery. The parent artery proximal to the aneurysm could only be exposed by resecting caudal part of the tumour. The aneurysm was trapped with permanent clips and it was pathologically diagnosed as pseudoaneurysm. Conclusion: It was suggested that the VS-related SRS-induced pseudoaneurysm is tightly adhered with surrounding structures and exposure of the parent artery could be limited due to the tumour and facial nerve. In this case report, we describe detailed intraoperative findings that will be useful for developing strategies for trapping surgery in future.
KW - Vestibular schwannoma
KW - pseudoaneurysm
KW - stereotactic radiosurgery
KW - trapping surgery
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U2 - 10.1080/02688697.2021.1940856
DO - 10.1080/02688697.2021.1940856
M3 - Article
C2 - 34148476
AN - SCOPUS:85108281086
SN - 0268-8697
VL - 37
SP - 1675
EP - 1679
JO - British Journal of Neurosurgery
JF - British Journal of Neurosurgery
IS - 6
ER -