Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Growing Organized Hematomas Following Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformation : Five Cases of Surgical Excision

  • Park, Jung Cheol (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ahn, Jae Sung (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kwon, Do Hoon (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kwun, Byung Duk (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2014.03.20
  • Accepted : 2014.06.29
  • Published : 2015.07.28
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Abstract

Organized hematoma is a rare complication that can develop following gamma knife radiosurgery (GKS) for cerebral arteriovenous malformation (AVM). Here, we describe 5 patients with growing organized hematomas that developed from completely obliterated AVMs several years after GKS. The patients were 15, 16, 30, 36, and 38 years old at the time of GKS, respectively, and 3 patients were female. Four AVMs were located in the lobe of the brain, and the remaining AVM were in the thalamus. Between 2-12 years after GKS, patients developed progressive symptoms such intractable headache or hemiparesis and enhancing mass lesions were identified. Follow-up visits revealed the slow expansion of the hematomas and surrounding edema. Steroids were ineffective, and thus surgery was performed. Histology revealed organized hematomas with a capsule, but there was no evidence of residual AVMs or vascular malformation. After surgery, the neurological symptoms of all patients improved and the surrounding edema resolved. However, the hematoma continued to expand and intraventricular hemorrhage developed in 1 patient whose hematoma was only partially removed. GKS for cerebral AVM can be complicated by growing, organized hematomas that develop after complete obliteration. Growing hematomas should be surgically evacuated if they are symptomatic. Radical resection of the hematoma capsule is also strongly recommended.

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References

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