Intracranial Masson Lesion Following Stereotactic Radiosurgery for Treatment of Intracranial Arteriovenous Malformations.

OBJECTIVES: Masson tumor or intravascular papillary endothelial cell proliferation was first described in 1923. Only a few cases of intracranial Masson tumor have been reported following stereotactic radiosurgery (SRS). We report a series of 6 cases, age range 28-56 years, with intracranial Masson tumor following SRS for treatment of an intracranial arteriovenous malformation (AVM). METHODS: We performed a retrospective case note review, reviewed the imaging, SRS records, and neuropathology specimens following surgical excision. RESULTS: In our series all patients received Leksell SRS with the periphery of the AVM receiving doses ranging from 22-25 Gy. The time lapse from SRS to a clear enhancing mass appearing on imaging ranged from 5-10 years. Four patients underwent craniotomy and excision of the enhancing lesion for persistent edema and an enlarging cyst resulting in a resolution of symptoms. CONCLUSIONS: SRS is an effective treatment for obliteration of intracranial AVMs.

Outcomes of Microsurgical Clipping of Recurrent Aneurysms After Endovascular Coiling.

BACKGROUND: The outcomes of microsurgery of previously coiled aneurysms have been poorly described, and little is known about the factors predictive of poor outcome. Here we aimed to identify predictors of poor outcome following microsurgery for previously coiled recurrent aneurysms. METHODS: In this retrospective cohort study of a prospectively maintained vascular database, we reviewed presentations, recurrent aneurysm measurements, surgery, and outcomes of microsurgical clipping of recurrent previously coiled intracranial aneurysms. RESULTS: Our series comprised 39 patients (mean age, 49 years; range, 22-70 years) who underwent microsurgical clipping of 40 previously coiled intracranial aneurysms. One patient suffered seizures, 1 patient experienced transient neurologic worsening, and 1 patient developed hyponatraemia, none of whom had long-term sequelae. Two patients sustained postoperative infarcts, for an overall incidence of permanent morbidity of 5.1%. There were no deaths or rebleeds on follow-up. In 3 patients, including the 2 patients with infarct and 1 patient with a transient deficit, an attempt was made to remove the coil ball. These patients had larger aneurysms (1106 mm3 vs. 135 mm3; P = 0.005), with larger coil balls (257 mm3 vs. 52 mm3; P = 0.01) and wider necks (7.09 mm vs. 2.69 mm; P = 0.02) but smaller remnant heights (1.59 mm vs. 1.99 mm; P = 0.04). They were also more likely to have prolapsing coil loops (3/3 vs. 3/27; P = 0.016). CONCLUSIONS: Our study demonstrates good clinical outcomes from microsurgical clipping of recurrent aneurysms. In the vast majority of cases, clips can be applied primarily. Coil ball removal is associated with increased morbidity, and thus should be considered only as a second-line option, with the likely need identified before the initiation of surgery.

Degree and Duration of Functional Improvement on Long-Term Follow-Up of Spinal Dural Arteriovenous Fistulae Occluded by Endovascular and Surgical Treatment.

BACKGROUND: Long-term outcomes following occlusion of spinal dural arteriovenous fistula (SDAVF) are poorly understood and are based on small series reporting predominantly short-term outcomes. The degree and duration of improvement remain unclear. In this study, we analyzed long-term outcomes following occlusion in a cohort of patients with SDAVF. METHODS: This was a single-center cohort study of patients with SDAVF identified from a prospective database. Outcomes were assessed using a modified Aminoff and Logue Disability (ALD) Scale, the modified Rankin Scale (mRS), and patient-reported outcomes at presentation and long-term follow-up. Both angiographic recanalization and idiopathic functional recurrence rates were calculated. RESULTS: Of the total of 67 patients with SAVDF identified, 59 were eligible for inclusion in this study. Fifty-seven of these 59 (97%) underwent occlusion. Twenty-two patients underwent initial embolization; 12 were occluded. Two patients recanalized. Eleven patients underwent surgery after attempted embolization; 10 were occluded. Thirty-seven patients treated by surgery only were occluded. The median duration of follow-up was 63 months (range, 12-240 months). After occlusion, the ALD gait and urinary scores improved by a median of 1 point. Although the median mRS score was unchanged, 49% of the patients experienced improvement, most by 1 point. There was no difference between the patients occluded by embolization or surgery, but those requiring both approaches had worse gait and urinary scores (P = 0.005 and 0.03, respectively). The duration of symptoms by itself had no effect on outcomes (P = 0.61). Following occlusion, 5 patients experienced an idiopathic late functional deterioration. Of 16 patients presenting with paraplegia, 13 (81%) improved, with a median mRS improvement of 1 point. CONCLUSIONS: Following occlusion, patients with SDAVF experienced a modest improvement in symptoms, most commonly by 1 point on the ALD scale. Idiopathic late deterioration was seen in 9.1% of patients.