Pathological Changes in Surgically Resected Cystic Cerebral Cavernous Malformation 13 Years After Radiosurgery: Case Report and Review of the Literature.

Abstract

Stereotactic radiosurgery (SRS) as a treatment for cerebral cavernous malformation (CCM) has been controversial, but there are few pathological reports showing its long-term therapeutic effect, and literature reporting the CCM cyst formation after SRS is also rare. We present a 30-year-old woman with a ruptured right parietal CCM treated with SRS 13 years ago. The post-SRS imaging follow-up revealed CCM rehemorrhage and cyst formation. Surgical resection was performed, and a subsequent pathological examination revealed that the CCM still had some incomplete occluded vessels and a large number of newly formed capillaries, and hemorrhagic band and hemosiderin were seen around the nodule. Recurrent hemorrhage after SRS for CCM could be related to incomplete occluded vessels and newly formed capillaries. Repeated hemorrhage from CCM newly formed capillaries into the small cavity increased the osmotic pressure, resulting in fluid entering the cavity and cyst enlargement.