Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature

J Neurosurg. 2001 May;94(5):816-21. doi: 10.3171/jns.2001.94.5.0816.

Abstract

Stereotactic radiosurgery is being increasingly advocated as the primary modality for treatment of vestibular schwannomas (VS). This modality has been shown to arrest tumor growth, with few associated short-term morbidities, and with possibly better hearing and facial nerve preservation rates than microsurgery. Radiation-induced oncogenesis has long been recognized, although stereotactic radiosurgery de novo induction of a secondary tumor has never been clearly described. The authors report on a patient with a VS who did not have neurofibromatosis Type 2 and who underwent gamma knife surgery (GKS). This patient required microsurgical removal of the VS within 8 months because of development of a tumor cyst with associated brainstem compression and progressive hydrocephalus. The operation resulted in clinical stabilization and freedom from tumor recurrence. Seven and a half years after undergoing GKS, the patient presented with symptoms of raised intracranial pressure. Magnetic resonance imaging demonstrated a new ring-enhancing lesion in the inferior temporal lobe adjacent to the area of radiosurgery, which on craniotomy was confirmed to be a glioblastoma multiforme (GBM). Despite additional conventional external-beam radiation to the temporal lobe, the GBM has progressed. Whereas this first reported case of a GBM within the scatter field of GKS does not conclusively prove a direct causal link, it does fulfill all of Cahan's criteria for radiation-induced neoplasia, and demands increased vigilance for the potential long-term complications of stereotactic radiosurgery, and reporting of any similar cases.

Publication types

  • Case Reports

MeSH terms

  • Brain Neoplasms / etiology*
  • Brain Neoplasms / pathology
  • Brain Neoplasms / surgery
  • Female
  • Glioblastoma / etiology*
  • Glioblastoma / pathology
  • Glioblastoma / surgery
  • Humans
  • Middle Aged
  • Neoplasms, Radiation-Induced / surgery*
  • Neuroma, Acoustic / surgery*
  • Radiosurgery / adverse effects*
  • Tomography, X-Ray Computed