Chronic encapsulated intracerebral haematoma following stereotactic radiosurgery for cerebral arteriovenous malformation

Chronic encapsulated intracerebral haematoma (CEIH) is a rare, delayed complication of stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations. There are no evidence-based guidelines for CEIH management. Current practice patterns range from conservative management with steroids to surgical excision. Here, we report a very delayed case of CEIH that ultimately required surgical resection 24 years following SRS. To our knowledge, this is one of the longest documented cases of recurrent haemorrhages secondary to CEIH, which failed extensive attempts at conservative treatments including steroids, hyperbaric oxygen, vitamin E and pentoxifylline. This case suggests early surgical intervention may be warranted to prevent persistent and recurrent haemorrhages.