A Radiation-Induced Meningioma “Cures” A Complex Dural Arteriovenous Fistula

Abstract

Objective We report a case of spontaneous thrombosis of an extremely complex dural arteriovenous fistula (DAVF), believed to be previously incurable, after the development of a radiation-induced meningioma resulting from prior attempts to treat the fistula with radiosurgery.

Methods A very large DAVF was treated over the course of 3 decades with a combination of partial embolization and stereotactic radiosurgery with no angiographic or clinical treatment response at long-term follow-up. However, with the development of new neurologic symptoms 13 years after radiosurgery, a meningioma was found to have arisen in the previously irradiated field, and surprisingly, the fistula had spontaneously thrombosed. The meningioma was successfully removed.

Results We discuss the unique pathophysiology of the radiation-induced meningioma causing this previously incurable DAVF progressing to obliteration. We also review the natural history of DAVFs, including reported rates of spontaneous occlusion, as well as the success of radiosurgery in their treatment. Finally, the incidence of radiosurgery-induced tumors, particularly meningiomas, is reviewed.

Conclusion The relationship between the spontaneous thrombosis of a DAVF and the radiation-induced meningioma is unique and has not previously been reported.

Keywords

dural arteriovenous fistula - spontaneous thrombosis - radiation-induced meningioma - radiosurgery

• References

• 1 Awad IA, Little JR, Akarawi WP, Ahl J. Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 1990; 72 (6) 839-850
• 2 Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995; 82 (2) 166-179
• 3 Cognard C, Gobin YP, Pierot L , et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995; 194 (3) 671-680
• 4 Hurst RW, Bagley LJ, Galetta S , et al. Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy. AJNR Am J Neuroradiol 1998; 19 (7) 1267-1273
• 5 Morimoto M, Mori K. How to treat dural arteriovenous malformations or fistulas. Crit Rev Neurosurg 1998; 8 (4) 248-255
• 6 Sarma D, ter Brugge K. Management of intracranial dural arteriovenous shunts in adults. Eur J Radiol 2003; 46 (3) 206-220
• 7 Spiotta AM, Sivapatham T, Hussain MS, Hui FK, Moskowitz SI, Gupta R. Combined surgical and endovascular approach to a complex dural arteriovenous fistula involving the superior sagittal sinus and torcula. J Stroke Cerebrovasc Dis 2012; 21 (4) 283-288
• 8 Bitoh S, Sakaki S. Spontaneous cure of dural arteriovenous malformation in the posterior fossa. Surg Neurol 1979; 12 (2) 111-114
• 9 Endo S, Koshu K, Suzuki J. Spontaneous regression of posterior fossa dural arteriovenous malformation. J Neurosurg 1979; 51 (5) 715-717
• 10 Hansen JH, Sogaard I. Spontaneous regression of an extra- and intracranial arteriovenous malformation. Case report. J Neurosurg 1976; 45 (3) 338-341
• 11 Kataoka K, Taneda M. Angiographic disappearance of multiple dural arteriovenous malformations. Case report. J Neurosurg 1984; 60 (6) 1275-1278
• 12 Kutluk K, Schumacher M, Mironov A. The role of sinus thrombosis in occipital dural arteriovenous malformations—development and spontaneous closure. Neurochirurgia (Stuttg) 1991; 34 (5) 144-147
• 13 Landman JA, Braun IF. Spontaneous closure of a dural arteriovenous fistula associated with acute hearing loss. AJNR Am J Neuroradiol 1985; 6 (3) 448-449
• 14 Luciani A, Houdart E, Mounayer C, Saint Maurice JP, Merland JJ. Spontaneous closure of dural arteriovenous fistulas: report of three cases and review of the literature. AJNR Am J Neuroradiol 2001; 22 (5) 992-996
• 15 Olutola PS, Eliam M, Molot M, Talalla A. Spontaneous regression of a dural arteriovenous malformation. Neurosurgery 1983; 12 (6) 687-690
• 16 Abdulrauf SI, Malik GM, Awad IA. Spontaneous angiographic obliteration of cerebral arteriovenous malformations. Neurosurgery 1999; Feb; 44 (2) 280-287
• 17 Pritz MB, Pribram HFW. Spontaneous closure of a high-risk dural arteriovenous malformation of the transverse sinus. Surg Neurol 1991; 36 (3) 226-228
• 18 Saito A, Furuno Y, Nishimura S, Kamiyama H, Nishijima M. Spontaneous closure of transverse sinus dural arteriovenous fistula: case report. Neurol Med Chir (Tokyo) 2008; 48 (12) 564-568
• 19 Voigt K, Sauer M, Dichgans J. Spontaneous occlusion of a bilateral caroticocavernous fistula studied by serial angiography. Neuroradiology 1971; 2 (4) 207-211
• 20 Cifarelli CP, Kaptain G, Yen CP, Schlesinger D, Sheehan JP. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery 2010; 67 (5) 1230-1235 , discussion 1235
• 21 Friedman JA, Pollock BE, Nichols DA, Gorman DA, Foote RL, Stafford SL. Results of combined stereotactic radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses. J Neurosurg 2001; 94 (6) 886-891
• 22 Guo WY, Pan DH, Wu HM , et al. Radiosurgery as a treatment alternative for dural arteriovenous fistulas of the cavernous sinus. AJNR Am J Neuroradiol 1998; 19 (6) 1081-1087
• 23 Koebbe CJ, Singhal D, Sheehan J , et al. Radiosurgery for dural arteriovenous fistulas. Surg Neurol 2005; 64 (5) 392-398 , discussion 398–399
• 24 Lewis AI, Tomsick TA, Tew Jr JM. Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 1994; 81 (6) 851-859
• 25 Link MJ, Coffey RJ, Nichols DA, Gorman DA. The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 1996; 84 (5) 804-809
• 26 Pan DH, Chung WY, Guo WY , et al. Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse-sigmoid sinus. J Neurosurg 2002; 96 (5) 823-829
• 27 Pollock BE, Nichols DA, Garrity JA, Gorman DA, Stafford SL. Stereotactic radiosurgery and particulate embolization for cavernous sinus dural arteriovenous fistulae. Neurosurgery 1999; 45 (3) 459-466 , discussion 466–467
• 28 Söderman M, Pavic L, Edner G, Holmin S, Andersson T. Natural history of dural arteriovenous shunts. Stroke 2008; 39 (6) 1735-1739
• 29 Wu HM, Pan DH, Chung WY , et al. Gamma Knife surgery for the management of intracranial dural arteriovenous fistulas. J Neurosurg 2006; 105 (Suppl): 43-51
• 30 Yang HC, Kano H, Kondziolka D , et al. Stereotactic radiosurgery with or without embolization for intracranial dural arteriovenous fistulas. Neurosurgery 2010; 67 (5) 1276-1283 , discussion 1284–1285
• 31 Loumiotis I, Lanzino G, Daniels D, Sheehan J, Link M. Radiosurgery for intracranial dural arteriovenous fistulas (DAVFs): a review. Neurosurg Rev 2011; 34 (3) 305-315 , discussion 315
• 32 Loeffler JS, Niemierko A, Chapman PH. Second tumors after radiosurgery: tip of the iceberg or a bump in the road?. Neurosurgery 2003; 52 (6) 1436-1440 , discussion 1440–1442
• 33 Niranjan A, Kondziolka D, Lunsford LD. Neoplastic transformation after radiosurgery or radiotherapy: risk and realities. Otolaryngol Clin North Am 2009; 42 (4) 717-729
• 34 Rowe J, Grainger A, Walton L, Silcocks P, Radatz M, Kemeny A. Risk of malignancy after gamma knife stereotactic radiosurgery. Neurosurgery 2007; 60 (1) 60-65 , discussion 65–66
• 35 Sheehan J, Yen CP, Steiner L. Gamma knife surgery-induced meningioma. Report of two cases and review of the literature. J Neurosurg 2006; 105 (2) 325-329
• 36 Duffau H, Lopes M, Janosevic V , et al. Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg 1999; 90 (1) 78-84
• 37 van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 2002; 33 (5) 1233-1236
• 38 Strom RG, Botros JA, Refai D , et al. Cranial dural arteriovenous fistulae: asymptomatic cortical venous drainage portends less aggressive clinical course. Neurosurgery 2009; 64 (2) 241-247 , discussion 247–248
• 39 Kim DJ, terBrugge K, Krings T, Willinsky R, Wallace C. Spontaneous angiographic conversion of intracranial dural arteriovenous shunt: long-term follow-up in nontreated patients. Stroke 2010; 41 (7) 1489-1494
• 40 Levi AD, Wallace MC, Bernstein M, Walters BC. Venous thromboembolism after brain tumor surgery: a retrospective review. Neurosurgery 1991; 28 (6) 859-863
• 41 Sawaya R, Zuccarello M, Elkalliny M, Nishiyama H ; Clinical profile. Postoperative venous thromboembolism and brain tumors: part I. Clinical profile. J Neurooncol 1992; 14 (2) 119-125
• 42 Valladares JB, Hankinson J. Incidence of lower extremity deep vein thrombosis in neurosurgical patients. Neurosurgery 1980; 6 (2) 138-141
• 43 Gerber DE, Segal JB, Salhotra A, Olivi A, Grossman SA, Streiff MB. Venous thromboembolism occurs infrequently in meningioma patients receiving combined modality prophylaxis. Cancer 2007; 109 (2) 300-305
• 44 Cahan WG, Woodard HQ, Higinbotham NL, Stewart FW, Coley BL. Sarcoma arising in irradiated bone: report of eleven cases. 1948. Cancer 1998; 82 (1) 8-34
• 45 Al-Mefty O, Topsakal C, Pravdenkova S, Sawyer JR, Harrison MJ. Radiation-induced meningiomas: clinical, pathological, cytokinetic, and cytogenetic characteristics. J Neurosurg 2004; 100 (6) 1002-1013
• 46 Banerjee J, Pääkkö E, Harila M , et al. Radiation-induced meningiomas: a shadow in the success story of childhood leukemia. Neuro-oncol 2009; 11 (5) 543-549
• 47 Lillehei KO, Donson AM, Kleinschmidt-DeMasters BK. Radiation-induced meningiomas: clinical, cytogenetic, and microarray features. Acta Neuropathol 2008; 116 (3) 289-301
• 48 Sadetzki S, Flint-Richter P, Ben-Tal T, Nass D. Radiation-induced meningioma: a descriptive study of 253 cases. J Neurosurg 2002; 97 (5) 1078-1082
• 49 Umansky F, Shoshan Y, Rosenthal G, Fraifeld S, Spektor S. Radiation-induced meningioma. Neurosurg Focus 2008; 24 (5) E7
• 50 Ganz JC. Gamma knife radiosurgery and its possible relationship to malignancy: a review. J Neurosurg 2002; 97 (5, Suppl): 644-652