Acute intratumoral haemorrhage after gamma knife radiosurgery for malignant brain tumors : four cases report

Keywords: hemorrhage, brain tumor, complications, gamma knife, outcome

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     Acute intratumoral haemorrhage is a very rare event after gamma knife therapy. Only very few scattered cases have been reported in literature according to our knowledge.
     Our purpose was to define clinical factors and outcomes after post-gamma knife tumor hemorrhage.
     There were four cases (three females , one male) with acute intratumoral haemorrhage in our treatment centre from 1993 to 2011. The average age was 63.3, ranging from 44 to 77 years old.
     The diagnoses before treatments were metastases (three cases) and ependymocytoma ( one case). One case was pathologically conformed before the treatment. One case had a history of stage II hypertension . None had coagulation malfunction according to the blood biochemical examination. No complications were observed during frame fixation, treatment itself, or frame removal. The average volume of treatments was 12.3cm3 ranging from 9.5cm3 to 15.6cm3. The average maximum diameter was 35.3 mm ranging from 28.6mm to 38.4mm. The prescription marginal doses were separately set 14Gy and 18Gy at an average isodose line of 54% (48%-60%). The mean number of isocenters was 19.5 shots with a mean time on beam of 55.1mins. The average dose rate was 2.8 Gy/min (2.5Gy/min-3.1Gy/min).
     These four cases only represented 0.08% of all treated malignant tumor cases in our centre at the same period. After an average time of 3.2 hours (1hr – 5.5hr) , three cases presented progressive headache and developed coma within 2 hours, one case presented seizures 5.5 hours later. Three cases were performed an emergency open surgery to remove hematomas , one case was performed a ventricular drainage. Two cases suffered pulmonary complications within 2 weeks after surgery and the families gave up. The other two cases survived at least 1 year with mild complications.
     This was a retrospective study.
      GKR for malignant brain tumors may not be considered as a risk-free procedure and, while extremely rare, even fatal complications which are probably not the direct effects of GKS can occur after treatment.
     Performing surgery in time may be the only way to reverse progressive increased intracranial pressure.


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