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The prognosis and treatment effectiveness of de novo aneurysm formation after radiation therapy for brain tumor

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Abstract

Radiation therapy is a well-established, minimally invasive method of treating brain tumors. In recent years, the number of post-radiotherapy patients has increased, and delayed side effects are evident. De novo aneurysm formation after radiation often manifests as fatal subarachnoid hemorrhage (SAH), resulting in severe clinical outcomes. Nevertheless, the prognosis and therapeutic efficacy of radiation-induced aneurysms (RIAs) remain unclear. Using the PubMed database from 1980 to 2021, we screened 45 articles (53 individual cases) on RIAs; approximately 70% of RIAs were diagnosed after rupture. Of 38 ruptured RIAs, 12 (31.6%) had modified Rankin scale (mRS) 5–6. On the other hand, all unruptured RIAs (15 cases) recovered without neurological deficits (p = 0.012). Ten of the 39 ruptured RIAs were treated surgically, and 22 were treated endovascularly. There was no significant difference in mRS between treatment modalities (p = 0.393), but conservative therapy was significantly related to unfavorable outcomes (p = 0.025). To improve clinical outcomes, RIAs need to be diagnosed before rupture. Surgeons should be aware of de novo aneurysm formation in patients long after radiation therapy.

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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Author notes

  1. Satoshi Shinoda and Shinsuke Muraoka contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan

    Satoshi Shinoda, Shinsuke Muraoka, Hiroyuki Shimizu & Naoki Koketsu

  2. Department of Neurosurgery, Kariya Toyota General Hospital, Sumiyoshi Cho 5-15, Kariya, Aichi, Japan

    Shinsuke Muraoka

  3. Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    Yoshio Araki & Ryuta Saito

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  1. Satoshi Shinoda
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  2. Shinsuke Muraoka
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  3. Hiroyuki Shimizu
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Contributions

- Substantial contributions to conception and design: SS, SM, HS, NK.

- Acquisition and analysis and interpretation of data: SS, SM, HS, YA.

- Drafting a significant portion of the manuscript or figures: SS, SM.

- Supervisor: RS.

Corresponding author

Correspondence to Shinsuke Muraoka.

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All procedures performed were in accordance with the ethical standards of the Declaration of Helsinki. This study was approved by the institutional review board of Tosei General Hospital.

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Shinoda, S., Muraoka, S., Shimizu, H. et al. The prognosis and treatment effectiveness of de novo aneurysm formation after radiation therapy for brain tumor. Neurosurg Rev 45, 2995–3002 (2022). https://doi.org/10.1007/s10143-022-01820-5

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