Abstract
Paediatric patients receiving cranial irradiation therapy for brain tumours are at increased risk of cerebrovascular complications. Radiation-induced moyamoya syndrome (MMS) is a well-recognised complication of this. We present a case of an 8-year-old boy with a history of medulloblastoma, who underwent surgical excision followed by post-operative adjuvant oncological treatment. Six years later, he developed cerebellar/intraventricular haemorrhage. He underwent an emergency external ventricular drain (EVD) insertion followed by posterior fossa suboccipital craniotomy. On dural opening, an abnormal vessel was visualised on the surface of the right cerebellar hemisphere, which was not disturbed. No obvious abnormalities were identified intra-operatively. Cerebral catheter angiography confirmed the presence of a right-sided occipital artery (OA) to posterior inferior cerebellar artery (PICA) extracranial to intracranial (EC-IC) bypass with a zone of the distal PICA territory supplied by this EC-IC bypass. A presumed flow aneurysm originated from the bypass in the distal PICA, identified as cause for the haemorrhage. We highlight a rare cause for intracranial haemorrhage in this cohort of patients. Children who have undergone radiotherapy may have exquisitely sensitive cerebral vasculature and need careful vigilance and evaluation for vasculopathic complications following spontaneous haemorrhage.
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Conception and design: Adikarige Haritha Dulanka Silva and Alexandra Valetopoulou. Manuscript writing and preparation of figures: Alexandra Valetopoulou, Adikarige Haritha Dulanka Silva, Greg James, Kristian Aquilina, Adam Rennie and Vijeya Ganesan. Revising the manuscript and table: Alexandra Valetopoulou, Adikarige Haritha Dulanka Silva, Greg James, Kristian Aquilina, Adam Rennie and Vijeya Ganesan. All authors reviewed the submitted version of the manuscript.
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Valetopoulou, A., Aquilina, K., Rennie, A. et al. Rupture of a flow aneurysm secondary to spontaneous extracranial to intracranial revascularisation in the posterior fossa following radiation-induced vasculopathy for cerebellar tumour. Childs Nerv Syst 40, 239–243 (2024). https://doi.org/10.1007/s00381-023-06126-5
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DOI: https://doi.org/10.1007/s00381-023-06126-5