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Radiotherapy-related intracranial aneurysm: case presentation of a 17-year male and a meta-analysis based on individual patient data

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Abstract

Purpose

The aim of this study was to investigate the incidence, clinical profiles, latency, and outcomes of radiotherapy (RT)-related intracranial aneurysms, rare but often fatal complications of cranial irradiation.

Methods

We reviewed all published individual patient data regardless of language, using survival analysis to make statistical inferences.

Results

We examined a total of 58 patients with RT-related intracranial aneurysms, including one unpublished case presented here, of whom 74.1 % presented with rupture. In the study, 29.3 % were younger than 18 years. The mean age at which patients received the first course of RT was 34.8 ± 22.8 years old. The mean latency between initiating RT and presenting with aneurysm was 10.4 ± 8.5 years. Rapid death ensured in 24 % shortly after presentation. The only significant predictor of death was rupture. In those with a single aneurysm, 43.1 % were located at the internal carotid artery, while 15.5 % of patients had multiple aneurysms. A male-to-female ratio of 1.87, 0.5, and 1.32 was found in patients younger than age 52, 52 years of age or older, and all 58 patients, respectively. Older age when receiving RT and presentation with ruptured aneurysm were significantly associated with shorter latency.

Conclusions

RT-related intracranial aneurysms presented differently from classical ones based on age, sex, site, multiplicity, and type. Sex ratios differed with age. The younger age group showed a longer latency of occurrence of an aneurysm. Older patients and those who develop ruptured aneurysms presented earlier. Since rupture may affect outcome, early detection of aneurysms before rupture may save lives.

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References

  1. Campen CJ, Kranick SM, Kasner SE, Kessler SK, Zimmerman RA, Lustig R, et al. (2012) Cranial irradiation increases risk of stroke in pediatric brain tumor survivors. Stroke 43(11):3035–3040

    Article  PubMed  PubMed Central  Google Scholar 

  2. Murphy ES, Xie H, Merchant TE, Jennifer SY, Chao ST, Suh JH (2015) Review of cranial radiotherapy-induced vasculopathy. J Neuro-Oncol 122(3):421–429

    Article  CAS  Google Scholar 

  3. Keene DL, Johnston DL, Grimard L, Michaud J, Vassilyadi M, Ventureyra E (2006) Vascular complications of cranial radiation. Child Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 22(6):547–555

    Article  Google Scholar 

  4. Azzarelli B, Moore J, Gilmor R, Muller J, Edwards M, Mealey J (1984) Multiple fusiform intracranial aneurysms following curative radiation therapy for suprasellar germinoma. Case report. J Neurosurg 61(6):1141–1145

    Article  CAS  PubMed  Google Scholar 

  5. Gomori JM, Levy P, Weshler Z (1987) Radiation-induced aneurysm of the basilar artery—a case report. Angiology 38(2):147–150

    Article  CAS  PubMed  Google Scholar 

  6. Nishi T, Matsukado Y, Kodama T, Hiraki T (1987) Multiple intracranial aneurysms following radiation therapy for pituitary adenoma. Case report. Neurol Med Chir 27(3):224–228

    Article  CAS  Google Scholar 

  7. Benson PJ, Sung JH (1989) Cerebral aneurysms following radiotherapy for medulloblastoma. J Neurosurg 70(4):545–550

    Article  CAS  PubMed  Google Scholar 

  8. Scodary DJ, Tew JM Jr, Thomas GM, Tomsick T, Liwnicz BH (1990) Radiation-induced cerebral aneurysms. Acta Neurochir 102(3–4):141–144

    Article  CAS  PubMed  Google Scholar 

  9. Thun F, Lanfermann H (1991) Intracranial giant aneurysm due to the effects of radiation. Radiologe 31(5):244–246

    CAS  PubMed  Google Scholar 

  10. Moriyama T, Shigemori M, Hirohata Y, Konishi J, Tokunaga T, Kuramoto S (1992) Multiple intracranial aneurysms following radiation therapy for pituitary adenoma; a case report. No Shinkei Geka 20(4):487–492

    CAS  PubMed  Google Scholar 

  11. Casey AT, Marsh HT, Uttley D (1993) Intracranial aneurysm formation following radiotherapy. Br J Neurosurg 7(5):575–579

    Article  CAS  PubMed  Google Scholar 

  12. John DG, Porter MJ, van Hasselt CA (1993) Beware bleeding from the ear. J Laryngol Otol 107(2):137–139

    Article  CAS  PubMed  Google Scholar 

  13. McConachie NS, Jacobson I (1994) Bilateral aneurysms of the cavernous internal carotid arteries following yttrium-90 implantation. Neuroradiology 36(8):611–613

    Article  CAS  PubMed  Google Scholar 

  14. Holodny AI, Deck M, Petito CK (1996) Induction and subsequent rupture of aneurysms of the circle of Willis after radiation therapy in Ehlers-Danlos syndrome: a plausible hypothesis. AJNR Am J Neuroradiol 17(2):226–232

    CAS  PubMed  Google Scholar 

  15. Jensen FK, Wagner A (1997) Intracranial aneurysm following radiation therapy for medulloblastoma. A case report and review of the literature. Acta Radiol 38(1):37–42

    CAS  PubMed  Google Scholar 

  16. Mak W, Chow T, Kwok S (2000) Radionecrosis of internal carotid artery in nasopharyngeal carcinoma presenting as epistasis. Aust N Z J Surg 70(3):237–238

    Article  CAS  PubMed  Google Scholar 

  17. Maruyama K, Mishima K, Saito N, Fujimaki T, Sasaki T, Kirino T (2000) Radiation-induced aneurysm and moyamoya vessels presenting with subarachnoid haemorrhage. Acta Neurochir 142(2):139–143

    Article  CAS  PubMed  Google Scholar 

  18. Aichholzer M, Gruber A, Haberler C, Bertalanffy A, Slavc I, Czech T (2001) Intracranial hemorrhage from an aneurysm encased in a pilocytic astrocytoma—case report and review of the literature. Child Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 17(3):173–178

    Article  CAS  Google Scholar 

  19. Cheng KM, Chan CM, Cheung YL, Chiu HM, Tang KW, Law CK (2001) Endovascular treatment of radiation-induced petrous internal carotid artery aneurysm presenting with acute haemorrhage. A report of two cases. Acta Neurochir 143(4):351–355 discussion 5-6

    Article  CAS  PubMed  Google Scholar 

  20. Huang PP, Kamiryo T, Nelson PK (2001) De novo aneurysm formation after stereotactic radiosurgery of a residual arteriovenous malformation: case report. AJNR Am J Neuroradiol 22(7):1346–1348

    CAS  PubMed  Google Scholar 

  21. Lam HCK, Abdullah VJ, Wormald PJ, Van Hasselt CA (2001) Internal carotid artery hemorrhage after irradiation and osteoradionecrosis of the skull base. Otolaryngol Head Neck Surg 125(5):522–527

    CAS  PubMed  Google Scholar 

  22. Aoki S, Hayashi N, Abe O, Shirouzu I, Ishigame K, Okubo T, et al. (2002) Radiation-induced arteritis: thickened wall with prominent enhancement on cranial MR images—report of five cases and comparison with 18 cases of moyamoya disease 1. Radiology 223(3):683–688

    Article  PubMed  Google Scholar 

  23. Murakami N, Tsukahara T, Toda H, Kawakami O, Hatano T (2002) Radiation-induced cerebral aneurysm successfully treated with endovascular coil embolization. Acta Neurochir Suppl 82:55–58

    CAS  PubMed  Google Scholar 

  24. Pereira P, Cerejo A, Cruz J, Vaz R (2002) Intracranial aneurysm and vasculopathy after surgery and radiation therapy for craniopharyngioma: case report. Neurosurgery 50(4):885–887 discussion 7-8

    Article  PubMed  Google Scholar 

  25. Auyeung KM, Lui WM, Chow LC, Chan FL (2003) Massive epistaxis related to petrous carotid artery pseudoaneurysm after radiation therapy: emergency treatment with covered stent in two cases. Am J Neuroradiol 24(7):1449–1452

    PubMed  Google Scholar 

  26. Louis E, Martin-Duverneuil N, Carpentier AF, Mayer JM, Delattre JY (2003) Radiation-induced aneurysm of the cavernous internal carotid artery. Rev Neurol 159(3):319–322 Anevrysme post-radique de la carotide intra-caverneuse

    CAS  PubMed  Google Scholar 

  27. Chen H-C, Lin C-J, Jen Y-M, Juan C-J, Hsueh C-J, Lee J-C, et al. (2004) Ruptured internal carotid pseudoaneurysm in a nasopharyngeal carcinoma patient with skull base osteoradionecrosis. Otolaryngol Head Neck Surg 130(3):388–390

    Article  PubMed  Google Scholar 

  28. Gabriel CM, Stevens JC, Bremner F, Brew S, Plant GT (2004) Optic chiasm enhancement associated with giant aneurysm and yttrium treated pituitary adenoma. J Neurol Neurosurg Psychiatry 75(9):1343–1345

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Yucesoy K, Feiz-Erfan I, Spetzler RF, Han PP, Coons S (2004) Anterior communicating artery aneurysm following radiation therapy for optic glioma: report of a case and review of the literature. Skull Base: Off J N Am Skull Base Soc [et al] 14(3):169–173

    Article  Google Scholar 

  30. Lau WY, Chow CK (2005) Radiation-induced petrous internal carotid artery aneurysm. Ann Otol Rhinol Laryngol 114(12):939–940

    Article  PubMed  Google Scholar 

  31. Ghoshhajra BB, McLean GK, Foundation SIR (2006) SIR 2006 Annual Meeting Film Panel Case: radiation-induced cerebral aneurysms. J Vasc Interv Radiol: JVIR 17(12):1891–1896

    Article  PubMed  Google Scholar 

  32. Gonzales-Portillo GA, Valdivia JM (2006) Uncommon presentation of pediatric ruptured intracranial aneurysm after radiotherapy for retinoblastoma. Case report. Surg Neurol 65(4):391–395 discussion 5-6

    Article  PubMed  Google Scholar 

  33. Sciubba DM, Gallia GL, Recinos P, Garonzik IM, Clatterbuck RE (2006) Intracranial aneurysm following radiation therapy during childhood for a brain tumor. Case report and review of the literature. J Neurosurg 105(2 Suppl):134–139

    PubMed  Google Scholar 

  34. Takao T, Fukuda M, Kawaguchi T, Nishino K, Ito Y, Tanaka R, et al. (2006) Ruptured intracranial aneurysm following gamma knife surgery for acoustic neuroma. Acta Neurochir 148(12):1317–1318 discussion 8

    Article  CAS  PubMed  Google Scholar 

  35. Cheng KY, Lee KW, Chiang FY, Ho KY, Kuo WR (2008) 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 30(8):1132–1135

    Article  PubMed  Google Scholar 

  36. Akamatsu Y, Sugawara T, Mikawa S, Saito A, Ono S, Takayama K, et al. (2009) Ruptured pseudoaneurysm following gamma knife surgery for a vestibular schwannoma: case report. J Neurosurg 110(3):543–546

    Article  PubMed  Google Scholar 

  37. Liu AK, Bagrosky B, Fenton LZ, Gaspar LE, Handler MH, McNatt SA, et al. (2009) Vascular abnormalities in pediatric craniopharyngioma patients treated with radiation therapy. Pediatr Blood Cancer 52(2):227–230

    Article  PubMed  Google Scholar 

  38. Park KY, Ahn JY, Lee JW, Chang JH, Huh SK (2009) De novo intracranial aneurysm formation after gamma knife radiosurgery for vestibular schwannoma. J Neurosurg 110(3):540–542

    Article  PubMed  Google Scholar 

  39. Yamaguchi S, Kato T, Takeda M, Ikeda H, Kitamura K (2009) Ruptured distal anterior inferior cerebellar artery aneurysm following stereotactic irradiation for vestibular schwannoma: case report. Neurol Med Chir 49(5):202–205

    Article  Google Scholar 

  40. Pavlisa G, Rados M, Ozretic D, Pavlisa G (2010) Endovascular treatment of a ruptured radiation-induced aneurysm in a patient previously treated by Yttrium-90 brachytherapy. Acta Neurol Belg 110(3):276–278

    PubMed  Google Scholar 

  41. Endo H, Fujimura M, Inoue T, Matsumoto Y, Ogawa Y, Kawagishi J, et al. (2011) 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 51(3):226–229 English

    Article  Google Scholar 

  42. Vogel TD, Kulwin CG, DeNardo AJ, Payner TD, Boaz JC, Fulkerson DH (2011) Tumor bleeding from a de novo aneurysm associated with optic glioma. J Neurosurg Pediatr 7(6):633–636

    Article  PubMed  Google Scholar 

  43. Yoon WS, Lee KS, Jeun SS, Hong YK (2011) De novo aneurysm after treatment of glioblastoma. J Korean Neurosurg Soc 50(5):457–459

    Article  PubMed  PubMed Central  Google Scholar 

  44. Huh W, Bang JS, Oh CW, Kwon OK, Hwang G (2012) Intracranial aneurysm following cranial radiation therapy. J Cerebrovasc Endovasc Neurosurg 14(4):300–304

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gross BA, Ropper AE, Du R (2013) Vascular complications of stereotactic radiosurgery for arteriovenous malformations. Clin Neurol Neurosurg 115(6):713–717

    Article  PubMed  Google Scholar 

  46. Tamura M, Kogo K, Masuo O, Oura Y, Matsumoto H, Fujita K, et al. (2013) 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 74(2):111

    Article  PubMed  PubMed Central  Google Scholar 

  47. Fujita K, Tamura M, Masuo O, Sasaki T, Yamoto T, Fukai J, et al. (2014) 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. J Neurol Surg Rep 75(2):e200

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gulati P, Bhattacharyya B, Deb S, Ghosh S (2014) Multiple intracranial aneurysms following radiation therapy for nasopharyngeal carcinoma. Indian J Neurosurg 3(1):44

    Article  Google Scholar 

  49. Kellner CP, McDowell MM, Connolly ES, Sisti MB, Lavine SD (2014) Late onset aneurysm development following radiosurgical obliteration of a cerebellopontine angle meningioma. J Neurointerventional Surg. doi:10.1136/neurintsurg-2014-011206.rep

    Google Scholar 

  50. Nanney AD, El Tecle NE, El Ahmadieh TY, Daou MR, Ivan ENB, Marymont MH, et al. (2014) Intracranial aneurysms in previously irradiated fields: literature review and case report. World Neurosurg 81(3):511–519

    Article  PubMed  Google Scholar 

  51. Wu H, Guo L, Qiu Y, Yuan X (2014) Cavernous internal carotid artery aneurysm after radiotherapy presenting with external ophthalmoplegia. J Craniofac Surg 25(4):e380–e382

    Article  PubMed  Google Scholar 

  52. Yang K-L, Huang P-I, Wong T-T, Chang K-P, Wang L-W, Shiau C-Y, et al. (2010) Long-term outcomes of radiotherapy for primary pediatric brain tumors: statistics and strategies of a single institute in Taiwan. Ther Radiol Oncol 17(2):85–99

    Google Scholar 

  53. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269

    Article  PubMed  Google Scholar 

  54. Rinkel GJ, Djibuti M, Algra A, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke; J Cereb Circ 29(1):251–256

    Article  CAS  Google Scholar 

  55. Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, et al. (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366(26):2474–2482

    Article  PubMed  Google Scholar 

  56. Kato I, Toniolo P, Akhmedkhanov A, Koenig KL, Shore R, Zeleniuch-Jacquotte A (1998) Prospective study of factors influencing the onset of natural menopause. J Clin Epidemiol 51(12):1271–1276

    Article  CAS  PubMed  Google Scholar 

  57. Schievink WI (1997) Intracranial aneurysms. N Engl J Med 336(1):28–40

    Article  CAS  PubMed  Google Scholar 

  58. Group A (2000) Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke; J Cereb Circ 31(8):1843–1850

    Article  Google Scholar 

  59. Brisman JL, Song JK, Newell DW (2006) Cerebral aneurysms. N Engl J Med 355(9):928–939

    Article  CAS  PubMed  Google Scholar 

  60. Partap S ed (2012) Stroke and cerebrovascular complications in childhood cancer survivors. Semin Pediatr Neurol 19:18–24. Elsevier

  61. Green DM, Cox CL, Zhu L, Krull KR, Srivastava DK, Stovall M, et al. (2011) Risk factors for obesity in adult survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 30(3):246–255. doi:10.1200/JCO.2010.34.4267

  62. De Haas EC, Oosting SF, Lefrandt JD, Wolffenbuttel BH, Sleijfer DT, Gietema JA (2010) The metabolic syndrome in cancer survivors. Lancet Oncol 11(2):193–203

    Article  PubMed  Google Scholar 

  63. Wong ND, Nelson JC, Granston T, Bertoni AG, Blumenthal RS, Carr JJ, et al. (2012) Metabolic syndrome, diabetes, and incidence and progression of coronary calcium: the multiethnic study of atherosclerosis study. J Am Coll Cardiol Img 5(4):358–366

    Article  Google Scholar 

  64. McGill HC, McMahan CA, Herderick EE, Zieske AW, Malcom GT, Tracy RE, et al. (2002) Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation 105(23):2712–2718

    Article  PubMed  Google Scholar 

  65. Constine LS, Woolf PD, Cann D, Mick G, McCormick K, Raubertas RF, et al. (1993) Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 328(2):87–94

    Article  CAS  PubMed  Google Scholar 

  66. Schievink WI (1997) Genetics of intracranial aneurysms. Neurosurgery 40(4):651–663

    Article  CAS  PubMed  Google Scholar 

  67. Pence DM, Kim TH, Levitt SH (1990) Aneurysm, arachnoiditis and intrathecal Au (gold). Int J Radiat Oncol Biol Phys 18(5):1001–1004

    Article  CAS  PubMed  Google Scholar 

  68. Abla AA, Lawton MT, McDermott MW (2014) Intracranial aneurysm formation following radiation. World Neurosurg 3(81):492–493

    Article  Google Scholar 

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Acknowledgments

The authors are grateful for the financial support from grants of Taipei Veterans General Hospital (No: V103C-092, V104C-166 and V105C-152), Ministry of Science and Technology (MOST), R.O.C. (103-2314-B-075-MY3), Department of Health, R.O.C. (DOH102-TD-C-111-007), and partial research grant support from the charity Foundation of Mr. Chung-Yi Lee.

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Authors and Affiliations

  1. Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan

    Yuan-Hung Wu, Sang-Hue Yen & Yi-Wei Chen

  2. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan

    Yuan-Hung Wu

  3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Sheng-Shuan Lin

  4. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Sheng-Shuan Lin

  5. Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Hsin-Hung Chen, Muh-Lii Liang & Tai-Tong Wong

  6. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Hsin-Hung Chen, Feng-Chi Chang, Tai-Tong Wong & Yi-Wei Chen

  7. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Feng-Chi Chang

  8. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Muh-Lii Liang

  9. Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan

    Tai-Tong Wong

  10. Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan

    Sang-Hue Yen

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  1. Yuan-Hung Wu
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Correspondence to Yi-Wei Chen.

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Wu, YH., Lin, SS., Chen, HH. et al. Radiotherapy-related intracranial aneurysm: case presentation of a 17-year male and a meta-analysis based on individual patient data. Childs Nerv Syst 32, 1641–1652 (2016). https://doi.org/10.1007/s00381-016-3144-9

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