Abstract
Chronic encapsulated intracerebral hematoma is a unique type of intracerebral hematoma accompanied by a capsule that is abundant in fragile microvasculature occasionally causing delayed regrowth. A 37-year-old man who had undergone radiosurgery for an arteriovenous malformation (AVM) causing intracerebral hematoma in the left parietal lobe presented with headache, vomiting, and progressive truncal ataxia due to a cystic lesion that had been noted in the left thalamus, leading to progressive obstructive hydrocephalus. He underwent left frontal craniotomy via a transsylvian fissure approach, and the serous hematoma was aspirated. The hematoma capsule was easy to drain and was partially removed. Pathological findings demonstrated angiomatous fibroblastic granulation tissue with extensive macrophage invasion. The concentration of vascular endothelial growth factor (VEGF) was high in the hematoma (12012 pg/mL). The etiology and pathogenesis of encapsulated hematoma are unclear, but the gross appearance and pathological findings are similar to those of chronic subdural hematoma. Based on the high concentration of VEGF in the hematoma, expansion of the encapsulated hematoma might have been caused by the promotion of vascular permeability of newly formed microvasculature in the capsule.
Highlights
Stereotactic radiosurgery (SRS) has become a therapeutic alternative for the treatment of cerebral arteriovenous malformations (AVMs)
Chronic encapsulated intracerebral hematoma is a unique type of intracerebral hematoma first described by Hirch et al and characterized by the presence of a fibrotic capsule [13]
Chronic encapsulated hematoma has been found to be associated with stereotactic radiosurgery for AVMs
Summary
Stereotactic radiosurgery (SRS) has become a therapeutic alternative for the treatment of cerebral arteriovenous malformations (AVMs). Chronic encapsulated intracerebral hematoma is a rare cerebrovascular disease [1,2,3,4,5,6,7,8]. This type of hematoma expands slowly and behaves as a space-occupying lesion, sometimes resulting in obstructive hydrocephalus, uniquely located in the thalamus. Case Reports in Neurological Medicine cavity is located near the ventricles causing obstructive hydrocephalus, endoscopic aspiration of the hematoma with fenestration
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