Glioblastoma development following stereotactic radiosurgery for an arteriovenous malformation: A case report

Stereotactic Radiosurgery (SRS) is a non-invasive treatment modality used for various intracranial pathologies including Arteriovenous Malformations (AVMs), high and low-grade gliomas, and brain metastases. This report presents a very rare case of a 29-year-old male who initially presented with headache and insomnia. Subsequent diagnostic investigations revealed a large right temporal lobe AVM that was 45.48 cc in volume, supplied by the superior and inferior truncus of the Middle Cerebral Artery (MCA), as well as anterior and posterior choroidal arteries. The patient underwent volume-staged SRS with a marginal dose of 15 Gy for each stage, conducted in two stages six months apart. The patient achieved near-complete obliteration initially. However, three years later from the last stage presented with a headache that was diagnosed as a subarachnoid hemorrhage, leading to surgical removal of the residual AVM. Subsequently patient presented with seizures and further imaging studies revealed a contrast-bearing mass at the site previously operated. A second operation revealed the mass to be a glioblastoma. Despite chemoradiotherapy patient succumbed to death. Malignant transformations following SRS, although rare, remain one of the most feared and devastating outcomes.