Article

Gamma knife surgery (GKS) is a proven modality for the treatment of arteriovenous
malformations (AVMs), but neural degeneration is a serious complication of GKS.
In this study, we report on a patient who displayed delayed neural degeneration
following GKR, using diffusion tensor imaging (DTI). A 43-year-old male patient
was diagnosed with an intraventricular hemorrhage (IVH) due to rupture of an AVM
in the right middle cerebellar peduncle, and exhibited cognitive impairment,
quadriparesis, and ataxia after IVH onset. He underwent GKS 5 weeks after onset.
Brain MRIs performed at 6 weeks, 7 months, and 21 months post-onset revealed
encephalomalactic lesions in the right pons, middle cerebellar peduncle, and
medulla oblongata. DTI at 6 weeks post-onset suggested neural injuries of the
right corticospinal tract (CST), right middle cerebellar peduncle (MCP), and
right inferior cerebellar peduncle (ICP). DTI at 7 months suggested that the
right CST and right ICP had recovered to some extent, which concurred with
improved clinical manifestations. However, at 21 months, four neural tracts
(right CST, right MCP, and both ICPs) appeared to have degenerated, which was
in-line with aggravation of corresponding clinical manifestations. Experiences of
this patient suggest DTI is a useful technique for the detection of neural
degeneration after GKS.

Langue : ANGLAIS