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Cerebral radiation necrosis complicating stereotactic radiosurgery for arteriovenous malformation.
  1. P Statham,
  2. P Macpherson,
  3. R Johnston,
  4. D M Forster,
  5. J H Adams,
  6. N V Todd
  1. Department of Neurosurgery, Southern General Hospital, Glasgow, United Kingdom.


    A patient presented with symptoms and signs of raised intracranial pressure and increasing focal deficit 13 months after stereotactic radiosurgical treatment of an arteriovenous malformation (AVM). Computed Tomography (CT) showed a mass lesion at the site of the previous abnormality typical of radiation necrosis, but with features identical to those of a malignant neoplasm. Biopsy confirmed cerebral radiation necrosis. The radiation dose was 25 Gray to the periphery of two overlapping 14 mm collimator fields, delivered in a single dose. Treatment with steroids led to improvement in the symptoms and signs of raised intracranial pressure, but not the focal deficit. Radiation necrosis is a consequence of the large doses required to obliterate AVMs and is a limiting factor in their treatment. It is important for clinicians referring patients for stereotactic radiosurgery to be aware of this complication, and to be able to recognise and treat it.

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