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Pathological changes in surgically resected angiographically occult vascular malformations after radiation
R J Gewirtz1, G K Steinberg, R Crowley
1Department of Neurosurgery, Stanford Stroke Center, Stanford University School of Medicine, California, USA.
Neurosurgery
|May 9, 1998
Summary
Radiation therapy, including stereotactic radiosurgery, did not obliterate intracranial vascular malformations. Pathological analysis revealed fibrosis and fibrinoid necrosis, but not vascular closure, in these treated lesions. Some patients may have a poor radiation response.
Area of Science:
- Neurology
- Radiation Oncology
- Pathology
Background:
- Angiographically occult vascular malformations (AOVMs) are challenging to treat.
- Radiation therapy is sometimes used when surgery poses high risks.
- Understanding the pathological effects of radiation on AOVMs is crucial.
Purpose of the Study:
- To evaluate the pathological changes in intracranial AOVMs after radiation treatment (stereotactic radiosurgery or conventional irradiation).
- To compare irradiated AOVMs with non-irradiated cavernous malformations.
Main Methods:
- Surgical resection of 11 previously irradiated AOVMs.
- Histopathological examination of resected lesions.
- Comparison with 10 non-irradiated cavernous malformations.
- Review of radiation doses and intervals from treatment to surgery.
Main Results:
- Irradiated AOVMs showed fibrosis, fibrinoid necrosis, and ferrugination, but not complete vascular obliteration.
- Fibrinoid necrosis was the only finding unique to irradiated lesions.
- Radiation necrosis of surrounding brain tissue was observed in one case.
- All irradiated lesions maintained patent vascular channels.
Conclusions:
- Stereotactic radiosurgery and conventional radiation therapy do not achieve histologic vascular obliteration in intracranial AOVMs.
- Recurrent bleeding in some AOVM patients may be linked to a poor response to radiation.
- These findings highlight the limitations of radiation as a sole treatment for AOVMs.