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DOI: 10.1055/s-0034-1383859
Ruptured Internal Carotid Artery Aneurysm Presenting with Catastrophic Epistaxis after Repeated Stereotactic Radiotherapies for Anterior Skull Base Tumor: Case Reports and Review of the Literature
Publication History
10 July 2014
07 May 2014
Publication Date:
05 August 2014 (online)
![](https://www.thieme-connect.de/media/jnlsr/201402/lookinside/thumbnails/10.1055-s-0034-1383859-1.jpg)
Abstract
Objectives Radiation-induced aneurysm is a rare complication for head and neck tumors. Only seven cases of an aneurysm after stereotactic radiosurgery and/or stereotactic radiotherapy (SRT) have been described. We report two patients with a ruptured internal carotid artery (ICA) aneurysm presenting with catastrophic epistaxis after repeated SRT for an anterior skull base tumor.
Results Two male patients received repeated SRT in various combinations following surgery for an anterior skull base tumor. They presented with significant epistaxis due to rupture of the aneurysm of the ICA 6 and 77 months after the final SRT, respectively. The aneurysms were located within the radiation field. Preoperative angiography had revealed no aneurysms. Thus the aneurysms in these cases were most likely induced by the repeated SRT.
Conclusions This is a proven report of aneurysm formation following repeated SRT without conventional radiotherapy. SRT may be very effective to control malignant skull base tumors. However, the possible development of radiation-induced aneurysm of the ICA should be considered in the case of repeated SRT. The surviving patients who have received SRT should undergo sequential follow-up for possible vascular involvement.
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References
- 1 Azzarelli B, Moore J, Gilmor R, Muller J, Edwards M, Mealey J. Multiple fusiform intracranial aneurysms following curative radiation therapy for suprasellar germinoma. Case report. J Neurosurg 1984; 61 (6) 1141-1145
- 2 Casey AT, Marsh HT, Uttley D. Intracranial aneurysm formation following radiotherapy. Br J Neurosurg 1993; 7 (5) 575-579
- 3 Jensen FK, Wagner A. Intracranial aneurysm following radiation therapy for medulloblastoma. A case report and review of the literature. Acta Radiol 1997; 38 (1) 37-42
- 4 Lee JK, Chelvarajah R, King A, David KM. Rare presentations of delayed radiation injury: a lobar hematoma and a cystic space-occupying lesion appearing more than 15 years after cranial radiotherapy: report of two cases. Neurosurgery 2004; 54 (4) 1010-1013; discussion 1013–1014
- 5 Maruyama K, Mishima K, Saito N, Fujimaki T, Sasaki T, Kirino T. Radiation-induced aneurysm and moyamoya vessels presenting with subarachnoid haemorrhage. Acta Neurochir (Wien) 2000; 142 (2) 139-143
- 6 Murros KE, Toole JF. The effect of radiation on carotid arteries. A review article. Arch Neurol 1989; 46 (4) 449-455
- 7 O'Connor MM, Mayberg MR. Effects of radiation on cerebral vasculature: a review. Neurosurgery 2000; 46 (1) 138-149; discussion 150–151
- 8 Pereira P, Cerejo A, Cruz J, Vaz R. Intracranial aneurysm and vasculopathy after surgery and radiation therapy for craniopharyngioma: case report. Neurosurgery 2002; 50 (4) 885-887 ; discussion 887–888
- 9 Kiyosue H, Okahara M, Tanoue S , et al. Dispersion of coils after parent-artery occlusion of radiation-induced internal carotid artery pseudoaneurysm. AJNR Am J Neuroradiol 2004; 25 (6) 1080-1082
- 10 Okamura HO, Kamiyama R, Takiguchi Y, Kimizuka K, Ishikawa N, Kishimoto S. Histopathological examination of ruptured carotid artery after irradiation. ORL J Otorhinolaryngol Relat Spec 2002; 64 (3) 226-228
- 11 Sciubba DM, Gallia GL, Recinos P, Garonzik IM, Clatterbuck RE. Intracranial aneurysm following radiation therapy during childhood for a brain tumor. Case report and review of the literature. J Neurosurg 2006; 105 (2, Suppl): 134-139
- 12 Silverberg GD, Britt RH, Goffinet DR. Radiation-induced carotid artery disease. Cancer 1978; 41 (1) 130-137
- 13 Benson PJ, Sung JH. Cerebral aneurysms following radiotherapy for medulloblastoma. J Neurosurg 1989; 70 (4) 545-550
- 14 Akamatsu Y, Sugawara T, Mikawa S , et al. Ruptured pseudoaneurysm following gamma knife surgery for a vestibular schwannoma. J Neurosurg 2009; 110 (3) 543-546
- 15 Auyeung KM, Lui WM, Chow LC, Chan FL. Massive epistaxis related to petrous carotid artery pseudoaneurysm after radiation therapy: emergency treatment with covered stent in two cases. AJNR Am J Neuroradiol 2003; 24 (7) 1449-1452
- 16 Cheng KY, Lee KW, Chiang FY, Ho KY, Kuo WR. Rupture of radiation-induced internal carotid artery pseudoaneurysm in a patient with nasopharyngeal carcinoma—spontaneous occlusion of carotid artery due to long-term embolizing performance. Head Neck 2008; 30 (8) 1132-1135
- 17 Endo H, Fujimura M, Inoue T , et al. Simultaneous occurrence of subarachnoid hemorrhage and epistaxis due to ruptured petrous internal carotid artery aneurysm: association with transsphenoidal surgery and radiation therapy: case report. Neurol Med Chir (Tokyo) 2011; 51 (3) 226-229
- 18 Park KY, Ahn JY, Lee JW, Chang JH, Huh SK. De novo intracranial aneurysm formation after gamma knife radiosurgery for vestibular schwannoma. J Neurosurg 2009; 110 (3) 540-542
- 19 Takao T, Fukuda M, Kawaguchi T , et al. Ruptured intracranial aneurysm following gamma knife surgery for acoustic neuroma. Acta Neurochir (Wien) 2006; 148 (12) 1317-1318 ; discussion 1318
- 20 Yamaguchi S, Kato T, Takeda M, Ikeda H, Kitamura K. Ruptured distal anterior inferior cerebellar artery aneurysm following stereotactic irradiation for vestibular schwannoma: case report. Neurol Med Chir (Tokyo) 2009; 49 (5) 202-205
- 21 Tamura M, Kogo K, Masuo O , et al. Formation and rupture of the internal carotid artery aneurysm after multiple courses of intensity-modulated radiation therapy for management of the skull base Ewing sarcoma/PNET: Case report. J Neurol Surg Rep 2013; 74 (2) 111-117
- 22 Chen HC, Lin CJ, Jen YM , et al. Ruptured internal carotid pseudoaneurysm in a nasopharyngeal carcinoma patient with skull base osteoradionecrosis. Otolaryngol Head Neck Surg 2004; 130 (3) 388-390
- 23 Mok JS, Marshall JN, Chan M, van Hasselt CA. Percutaneous embolization to control intractable epistaxis in nasopharyngeal carcinoma. Head Neck 1999; 21 (3) 211-216
- 24 Gonzales-Portillo GA, Valdivia JM. Uncommon presentation of pediatric ruptured intracranial aneurysm after radiotherapy for retinoblastoma. Case report. Surg Neurol 2006; 65 (4) 391-395 ; discussion 395–396
- 25 Aichholzer M, Gruber A, Haberler C, Bertalanffy A, Slavc I, Czech T. Intracranial hemorrhage from an aneurysm encased in a pilocytic astrocytoma—case report and review of the literature. Childs Nerv Syst 2001; 17 (3) 173-178
- 26 Yucesoy K, Feiz-Erfan I, Spetzler RF, Han PP, Coons S. Anterior communicating artery aneurysm following radiation therapy for optic glioma: report of a case and review of the literature. Skull Base 2004; 14 (3) 169-173
- 27 McConachie NS, Jacobson I. Bilateral aneurysms of the cavernous internal carotid arteries following yttrium-90 implantation. Neuroradiology 1994; 36 (8) 611-613
- 28 Murakami N, Tsukahara T, Toda H, Kawakami O, Hatano T. Radiation-induced cerebral aneurysm successfully treated with endovascular coil embolization. Acta Neurochir Suppl (Wien) 2002; 82: 55-58
- 29 Nishi T, Matsukado Y, Kodama T, Hiraki T. Multiple intracranial aneurysms following radiation therapy for pituitary adenoma. Case report. [in Japanese]. Neurol Med Chir (Tokyo) 1987; 27 (3) 224-228
- 30 Cheng KM, Chan CM, Cheung YL, Chiu HM, Tang KW, Law CK. Endovascular treatment of radiation-induced petrous internal carotid artery aneurysm presenting with acute haemorrhage. A report of two cases. Acta Neurochir (Wien) 2001; 143 (4) 351-355 ; discussion 355–356
- 31 Ciceri EFM, Regna-Gladin C, Erbetta A , et al. Iatrogenic intracranial pseudoaneurysms: neuroradiological and therapeutical considerations, including endovascular options. Neurol Sci 2006; 27 (5) 317-322
- 32 Mathews SS, Kumar RM, Rupa V. Iatrogenic pseudoaneurysm: a rare complication of sinonasal surgery. Am J Otolaryngol 2011; 32 (6) 607-610
- 33 Chen Z, Zhang J, Miao H, Niu Y, Feng H, Zhu G. Delayed rupture of iatrogenic cerebral pseudoaneurysms after neurosurgical procedures: report of two cases. Clin Neurol Neurosurg 2013; 115 (8) 1552-1554