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Radiation-induced cerebral aneurysm successfully treated with endovascular coil embolization
N Murakami1, T Tsukahara, H Toda
1Department of Neurosurgery and Clinical Research Unit, Kyoto National Hospital, Kyoto, Japan.
Acta Neurochirurgica. Supplement
|October 16, 2002
Summary
Cerebral aneurysms developed 19 years post-radiation for craniopharyngioma. Successful treatment preserved blood flow, highlighting the need for prompt diagnosis and intervention for these rare, high-mortality vascular lesions.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Cranial irradiation, while effective for tumors like craniopharyngioma, can lead to delayed vascular complications.
- Radiation-induced intracranial vasculopathy is a recognized risk, often presenting as arterial stenosis or occlusion.
- Aneurysm formation is a less common but critical sequela of radiation-induced vasculopathy.
Observation:
- A 30-year-old male developed multiple cerebral aneurysms 19 years after receiving 60 Gy irradiation for craniopharyngioma.
- Angiography identified right internal carotid-posterior communicating (IC-PC) and upper basilar trunk aneurysms, alongside atherosclerotic changes.
- The patient presented with significant vascular abnormalities secondary to prior radiation therapy.
Findings:
- The right IC-PC aneurysm was surgically wrapped, and the basilar trunk aneurysm was treated with endovascular coil embolization.
- Initial treatment resulted in basilar artery stenosis, but complete packing was achieved.
- A 6-month follow-up angiogram confirmed aneurysm resolution and preserved patency of the basilar artery.
Implications:
- This case underscores that aneurysm formation, though less frequent than occlusive lesions, is a potential long-term complication of cranial radiation.
- The high mortality associated with ruptured intracranial aneurysms necessitates timely diagnosis and aggressive management.
- Multimodal treatment approaches, including surgical wrapping and endovascular embolization, can be effective in managing radiation-induced cerebral aneurysms.