Articles

Article

Case Report

Exp Neurobiol 2016; 25(4): 191-196

Published online August 31, 2016

https://doi.org/10.5607/en.2016.25.4.191

© The Korean Society for Brain and Neural Sciences

Brain Edema after Repeat Gamma Knife Radiosurgery for a Large Arteriovenous Malformation: A Case Report

Joo Whan Kim1, Hyun-Tai Chung1, Moon Hee Han2, Dong Gyu Kim1 and Sun Ha Paek1*

Departments of 1Neurosurgery, 2Radiology, Seoul National University Hospital, Seoul 03080, Korea

Correspondence to: *To whom correspondence should be addressed.
TEL: 82-2-2072-3993, FAX: 82-2-744-8459
e-mail: paeksh@snu.ac.kr

Received: April 25, 2016; Revised: June 8, 2016; Accepted: June 16, 2016

Abstract

Brain edema due to venous thrombosis following stereotactic radiosurgery for a cerebral arteriovenous malformation (AVM) has rarely been reported. We report a patient with a large AVM in the eloquent area, and brain edema developed in this area after repeat Gamma knife stereotactic radiosurgery (GKRS). An 18-year-old female presented with a 4-year-history of persistent headache. Magnetic resonance imaging and transfemoral carotid angiogram revealed a high-flow large AVM in the left parieto-occipital area. Brain edema developed and aggravated patient's symptoms after time-staged GKRS. The cause of edema was thought to be the failure of the surrounding venous channels to drain the venous flow from the normal brain and the drainage was hampered by the persistent shunt flow from the AVM, which was due to the thrombosis of one huge draining vein of the AVM. The microsurgical resection of the AVM nidus eliminated shunt flow and completely normalized the brain edema. Microsurgical resection of the AVM nidus completely normalized the brain edema due to thrombosis of a draining vein of an AVM develops after SRS.

Keywords: Intracranial Arteriovenous Malformations, Radiosurgery, Brain Edema