J Cerebrovasc Endovasc Neurosurg.  2012 Dec;14(4):300-304. 10.7461/jcen.2012.14.4.300.

Intracranial Aneurysm Following Cranial Radiation Therapy

• Huh W
• Bang JS
• Oh CW
• Kwon OK
• Hwang G

• KMID: 1431284
• DOI: http://doi.org/10.7461/jcen.2012.14.4.300

Abstract

We report herein a case of a radiation-induced aneurysm. A 69-year-old woman presented with subarachnoid hemorrhage. Eight years previously, she had undergone cranial radiation therapy (total dose of 59.4 Gy) as adjuvant therapy after surgical resection for a chondrosarcoma that was destroying her sphenoid sinus. The patient underwent catheter angiography, which revealed an aneurysm of the anterior communicating artery and luminal narrowing and irregularity in the petrous and lacerum segments of the right internal carotid artery. We attempted surgical clipping of the aneurysm, but there was repeated bleeding. Finally the aneurysm was treated with endovascular trapping. Potentially fatal bleeding also occurred from her internal carotid artery, which had also been irradiated during the previous cranial radiation therapy. We stopped the bleeding with endovascular coil embolization. Because of diffuse vascular changes of the cerebral vessels within irradiated fields, special attention must be paid to their treatment.

Keyword

Intracranial aneurysm; Subarachnoid hemorrhage; Radiotherapy

MeSH Terms

Aneurysm
Angiography
Arteries
Carotid Artery, Internal
Catheters
Chondrosarcoma
Female
Hemorrhage
Humans
Intracranial Aneurysm
Phenobarbital
Sphenoid Sinus
Subarachnoid Hemorrhage
Surgical Instruments
Phenobarbital

Figure

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  Fig. 1 A 69-year-old woman was found to have a large mass destroying her sphenoid sinus when she lost vision in her right eye eight years prior to current presentation (A). After treatment she was clinically monitored throughout the next eight years with serial Magnetic Resonance Imaging (MRI) and none of the MRI shows any sign of residual or recurrent tumor (B).

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  Fig. 2 Balloon occlusion test, which was performed before tumor removal, shows a good cross-filling via the anterior communicating and no vascular lesion.

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  Fig. 3 Brain computed tomography (CT) shows intracerebral and subarachnoid hemorrhage (A). Angiography reveals an aneurysm of the anterior communicating artery (B and C). A source image of CT angiography shows luminal narrowing and irregularity in the petrous and lacerum segments of the right internal carotid artery (D).

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  Fig. 4 CT angiography performed ten days after surgery reveals the small, residual neck of the aneurysm (A). Angiography which was performed ten days after clipping shows slippage of clips from the aneurysm (B). Postembolization angiograms (C and D) reveals successful obliteration of the aneurysm.

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  Fig. 5 Angiography shows contrast leakage from the lacerum segment of the right internal carotid artery into the nasal cavity, suggesting carotid blow out syndrome (A). After coil embolization in the ruptured point, no more leakage is noted on angiography (B).

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