Postradiosurgery cystic degeneration in brain metastases causing delayed and potentially severe sequelae: Systematic review and illustrative cases Review
| Authors: | Giantini-Larsen, A.; Abou-Mrad, Z.; Goldberg, J. L.; El Ahmadieh, T. Y.; Beal, K.; Young, R. J.; Rosenblum, M.; Moss, N. S. |
| Review Title: | Postradiosurgery cystic degeneration in brain metastases causing delayed and potentially severe sequelae: Systematic review and illustrative cases |
| Abstract: | BACKGROUND Cystic postradiation degeneration has previously been described in the literature as a rare but potentially severe complication after central nervous system (CNS) irradiation for vascular malformations. Limited cases have been reported in the setting of brain metastases. OBSERVATIONS Thirty-six total cases, including three reported here, of cystic postradiation degeneration are identified. Of 35 cases with complete clinical information, 34 (97.25%) of 35 were symptomatic from cystic changes at diagnosis. The average time between initial radiation dose and cyst development was 7.61 years (range 2–31 years). Although most patients were initially treated conservatively with medication, including steroids, 32 (88.9%) of 36 ultimately required surgical intervention. The most common interventions were craniotomy for cyst fenestration or resection (25 of 36; 69.4%) and Ommaya placement (8 of 36). After intervention, clinical improvement was seen in 10 (67%) of 15 cases, with persistent or worsening deficit or death seen in 5 (33%) of 15. Cysts were decompressed or obliterated on postoperative imaging in 20 (83.3%) of 24 cases, and recurrence was seen in 4 (16.7%) of 24. LESSONS Cystic degeneration is a rare and delayed sequela after radiation for brain metastases. This entity has the potential to cause significant and permanent neurological deficit if not properly recognized and addressed. Durable control can be achieved with a variety of surgical treatments, including cyst fenestration and Ommaya placement © 2023, American Association of Neurological Surgeons. All rights reserved. |
| Keywords: | brain neoplasms; metastasis; radiosurgery; radiation injuries; cysts |
| Journal Title: | Journal of Neurosurgery: Case Lessons |
| Volume: | 5 |
| Issue: | 6 |
| ISSN: | 2694-1902 |
| Publisher: | American Association of Neurological Surgeons |
| Date Published: | 2023-02-06 |
| Start Page: | CASE22462 |
| Language: | English |
| DOI: | 10.3171/case22462 |
| PROVIDER: | scopus |
| PMCID: | PMC10550559 |
| PUBMED: | 36748750 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Nelson S. Moss -- Source: Scopus |
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