Gamma Knife radiosurgery for pure arterial malformation associated with pseudoaneurysm

초록

Pure arterial malformations (PAMs) are rare intracranial vascular anomalies consisting of tightly coiled, dilated, and tortuous arteries without any venous components or arteriovenous shunting. Although PAMs are often considered benign and discovered incidentally, emerging evidence suggests that a subset may progress or rupture, particularly when associated with aneurysmal changes. We present a case of a 58-year-old man with a PAM originating from the anterior choroidal artery, detected incidentally on brain magnetic resonance imaging (MRI). Digital subtraction angiography confirmed the diagnosis, and the lesion was deemed unsuitable for surgical or endovascular intervention due to its deep location. The patient underwent Gamma Knife radiosurgery with a marginal dose of 18 Gy prescribed to the 50% isodose line. Follow-up MRI at 6 months demonstrated a marked reduction in lesion size, and complete obliteration was confirmed by cerebral angiography 3 years after treatment. No complications were observed during the follow-up period. This case illustrates that stereotactic radiosurgery may serve as a safe and effective treatment alternative for PAMs located in surgically challenging regions. Further studies are warranted to establish the long-term outcomes and optimal indications for radiosurgical treatment of PAMs.

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