Abstract
High-grade cerebral arteriovenous malformations (AVMs) are too complex to be treated only with surgery; hence, combined therapy is an alternative that has emerged recently. Our standard treatment for AVMs that are difficult to treat with surgery was CyberKnife hypo-fractionated stereotactic radiosurgery alone. However, this procedure also has delayed adverse effects, such as subtotal occlusion, cystic changes, hemangiomatous lesions, and radiation-induced tumors. We report a case with an AVM requiring surgical removal at the irradiated site 5 years after undergoing CyberKnife treatment. A 47-year-old female developed an epileptic episode 20 years ago and was diagnosed with AVM following various evaluations. At the age of 42, she underwent CyberKnife stereotactic radiation therapy in another hospital. She came to us complaining of headaches and vision disorders 5 years later. Diagnostic imaging showed tumorous lesions in the area where the AVM existed. Edema was also noted in the surrounding areas. Conservative treatment showed no improvement. Therefore, surgical resection was performed and symptoms improved soon after. Considering her history and symptoms, we made a diagnosis of radiation-induced cavernoma. From this case, we learned that stereotactic radiation shows potential as a preoperative treatment for AVMs and is useful for multi-stage extirpation, which is one of the options in combined therapy.
