ABSTRACT
Iatrogenic vertebral artery (VA) injury is a rare but significant complication of anterior cervical spine surgery. In the grossly degenerate cervical spine the VA may adopt a tortuous pathway thus predisposing to inadvertent injury during surgery. Here we illustrate such a case and discuss potential management strategies.
Subject(s)
Iatrogenic Disease , Vertebral Artery/injuries , Aneurysm, False/etiology , Aneurysm, False/surgery , Cervical Vertebrae/surgery , Endovascular Procedures , Female , Humans , Middle Aged , Vertebral Artery/abnormalities , Vertebral Artery/surgeryABSTRACT
CASE REPORT: We report two cases of operative intervention that was beneficial in the treatment of delayed symptomatic radionecrotic masses that had developed following stereotactic radiosurgery (SRS) using the gamma knife (GK) for the treatment of cerebral arteriovenous malformations (AVM). DISCUSSION: Case 1 involved a small craniotomy for decompression of a large cerebral multiloculated cyst, which had become symptomatic 84 months following gamma knife treatment for a left frontal lobe AVM. Case 2 involved surgical excision of an occipital radionecrotic mass 72 months following GK treatment for an occipital AVM. This patient had suffered from longstanding symptomatic cerebral oedema, which on occasions had become life threatening. Case 2 is also the first report of a radionecrotic mass occurring post-SRS for an AVM, which conversely appeared to demonstrate increased uptake on single photon emission computed tomography (SPECT) scan. The first literature review of such delayed symptomatic radionecrotic lesions is presented. There appears to be a late onset of symptoms (average 55 months, range 12-111 months) associated with such radionecrosis. Drainage of such cysts or excision of the mass lesion appears to be consistently beneficial to the patients and appears to be uncomplicated. CONCLUSION: We recommend early surgical intervention for such delayed symptomatic radionecrotic masses that do not resolve following non-operative management. We also recommend caution in interpretation of SPECT scan results when attempting to differentiate radionecrosis from neoplasia.