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Vol. 33. Issue 1.
Pages 40-45 (January - February 2022)
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Vol. 33. Issue 1.
Pages 40-45 (January - February 2022)
Case Report
A chronic encapsulated expanding hematoma that developed 15 years after gamma knife surgery for a cerebral arteriovenous malformation: A case report and review of the literature
Un hematoma encapsulado crónico expansivo que se desarrolló 15 años después de la intervención quirúrgica con bisturí de rayos gamma para tratar una malformación arteriovenosa cerebral: informe de caso y revisión bibliográfica
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Akira Taguchia, Shinji Ohbab, Daiki Taniyamac, Kazuya Kuraokad, Fumiyuki Yamasakia,
Corresponding author
fyama@hiroshima-u.ac.jp

Corresponding author.
a Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minamiku, Hiroshima, Japan
b Department of Neurosurgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Aoyama-cho, Kureshi, Hiroshima, Japan
c Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minamiku, Hiroshima, Japan
d Department of Diagnostic Pathology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama-cho, Kureshi, Hiroshima 737-0023, Japan
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Table 1. Summary of patients with chronic encapsulated expanding hematomas after stereotactic radiosurgery for arteriovenous malformation.
Abstract

We report a case of gamma knife surgery (GKS)-induced chronic encapsulated expanding hematoma with extensive literature review. A 17-year-old young man underwent GKS after embolization for arteriovenous malformation (AVM) in the right frontal lobe and the AVM completely disappeared. He developed a generalized convulsion 15 years after GKS. MRI showed a small oedematous change at the AVM site. His epileptic seizure was controlled with anticonvulsant. His epilepsy recurred after three years, and MRI revealed an intracerebral hematoma with extensive surrounding edema at the same lesion. He underwent cerebral angiography and a recurrence of AVM was prevented. The hematoma was surgically removed, and intraoperative finding confirmed an old hematoma with a capsule and capillary hyperplasia, without developing cavernous angioma. The final diagnosis was a secondary chronic encapsulated expanding hematoma after GKS. This is the first report to show the early-stage imaging findings of this late effect after GKS.

Keywords:
Chronic encapsulated expanding hematoma
Arteriovenous malformation
Gamma knife surgery
Late effect
Resumen

Informamos de un caso de hematoma encapsulado crónico expansivo inducido por una intervención quirúrgica con bisturí de rayos gamma (GKS) con una amplia revisión bibliográfica. Un joven de 17 años se sometió a una GKS después de una embolización por malformación arteriovenosa (MAV) en el lóbulo frontal derecho, y la MAV desapareció por completo. Desarrolló una convulsión generalizada 15 años después de la GKS. La resonancia magnética (RM) mostró un pequeño cambio edematoso en la ubicación de la MAV. Su ataque epiléptico se controló con un anticonvulsivo. Su epilepsia se repitió 3 años después, y la RM reveló un hematoma intracerebral con un edema circundante extenso en la misma lesión. Se sometió a una angiografía cerebral y se evitó la recidiva de la MAV. El hematoma se extirpó quirúrgicamente, y el hallazgo intraoperatorio confirmó un antiguo hematoma con una hiperplasia capsular y capilar, sin desarrollo de angioma cavernoso. El diagnóstico final fue un hematoma encapsulado crónico expansivo secundario después de la GKS. Este es el primer informe que muestra los hallazgos del diagnóstico por imagen en la fase temprana de este efecto tardío después de la GKS.

Palabras clave:
Hematoma encapsulado crónico expansivo
Malformación arteriovenosa
Cirugía con bisturí de rayos gamma
Efecto tardío

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