Radiation-induced
aneurysms have been previously reported; however, multiple and repeated de novo
aneurysm formation chronologically and anatomically during long-term follow-up have not yet been observed. The pathogenesis of persistent radiation-induced vasculopathy is not fully understood.
CASE DESCRIPTION: A 31-year-old woman presented with intraventricular
hemorrhage due to
rupture of a right internal carotid artery (ICA)
aneurysm that developed 17 years after surgical resection of a low-grade
glioma in the right frontal lobe and postoperative
radiotherapy (focal, 50 Gy/25 fractions). During
glioma follow-up, salvage surgery with adjuvant gamma knife
therapy and
chemotherapy (
ranimustine,
vincristine,
temozolomide) were performed for recurrence of the
glioma. The
aneurysm was treated with endovascular coil embolization. However, she experienced repeated intraventricular
hemorrhages, and angiography revealed a de novo ICA
aneurysm. The de novo
aneurysms were treated with endovascular surgery using coil embolization and stenting. At 2 years after the third
hemorrhage, the
surgical wound became dehiscent, probably due to
wound infection, thus epicranial soft tissue reconstruction using vascularized skin flap was performed. Despite multistaged endovascular surgery for the ICA
aneurysm, she experienced repeated subarachnoid and intraventricular
hemorrhages. Angiography revealed a de novo
aneurysm of the right posterior cerebral artery and basilar trunk. She underwent coil embolization and stenting. Despite active management with endovascular surgery and close follow-up, she died after an eighth consecutive intraventricular and
intracerebral hemorrhage caused by a de novo large
aneurysm of the posterior cerebral artery.
CONCLUSIONS: To the best of our knowledge, the present study is the first to report on of refractory and recurring de novo
aneurysms treated by multistaged endovascular surgery during a long-term follow-up after
radiotherapy and multistaged
craniotomy for
glioma.