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Minim Invasive Neurosurg 2006; 49(04): 251-254
DOI: 10.1055/s-2006-950381
Case Report

Fatal Intratumoral Hemorrhage Immediately after Gamma Knife Radiosurgery for Brain Metastases: Case Report

M. Izawa
A1   Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
,
M. Chernov
A1   Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
,
M. Hayashi
A1   Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
,
Y. Kubota
A1   Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
,
H. Kasuya
A1   Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
,
T. Hori
A1   Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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Abstract

Radiosurgical treatment of brain tumors is sometimes considered to be free from significant acute complications or adverse effects. A rare case of fatal intratumoral hemorrhage immediately after gamma knife radiosurgery (GKR) for brain metastasis is reported. A 46-year-old woman with lung cancer complicated by systemic dissemination experienced an acute episode of headache, speech disturbances, and right-side hemiparesis. She had no history of arterial hypertension or coagulation disorders. CT and MRI disclosed multiple brain metastases. The largest tumor, which was located in the left frontal lobe and caused a significant mass effect, was removed microsurgically without any complications. GKR for nine residual metastases was done on the fourth postoperative day. The marginal dose, which corresponded to the 50% prescription isodose line, constituted 20 Gy. No complications were noticed during frame fixation, treatment itself, or frame removal. Fifteen minutes after the end of the GKR session the patient acutely fell into a deep coma. Urgent CT disclosed a massive hemorrhage in the left cerebellar hemisphere in the vicinity of the radiosurgically treated lesion. The patient died 4 days later and autopsy confirmed the presence of intratumoral hemorrhage. In conclusion, GKR for metastatic brain tumors should not be considered as a risk-free procedure and, while extremely rare, even fatal complications can occur after treatment.

Key words

Gamma knife radiosurgery - brain metastases - complication - intratumoral hemorrhage


Publication History

Publication Date:
13 October 2006 (online)

© 2006. Georg Thieme Verlag KG · Stuttgart · New York

Thieme Medical Publishers

 

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