Cavernous malformations after cerebral irradiation during childhood: report of nine cases

Duhem, R.; Vinchon, Matthieu; Leblond, Pierre; Soto-Ares, Gustavo; Dhellemmes, P

doi:10.1007/s00381-004-1120-2

Cited by 53 publications

(56 citation statements)

References 9 publications

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“…The commonest primitive neoplasm in this work was medulloblastoma 13 . The incidence of radiation-induced cavernomas in our experience was of 3 out of 63 (4.76%) children irradiated for brain tumors, which is in agreement with the incidence reported by others 4,6 that ranged between 2.15% and 3.4%. A higher incidence (31%) of cavernomas after cranial irradiation has been reported in children treated of medulloblastoma 11 .…”

Section: Formation Of Cavernomas After Radiotherapysupporting

confidence: 92%

“…They attribute the development of hemorrhages to disruption and alteration of capillary integrity by irradiation and also to lesions remarkably similar to cavernous angiomas 8,14 . Additional reports support the role of radiation injury in the development of de novo cavernomas 2,[4][5][6][7][8][9][10][11]13 . On considering the risk factors involved in the development of radiation induced cavernomas and, in a similar way to those reported in the formation of second malignant neoplasms, two group of risk factors have to be taken into account: (a) therapy related factors, such as radiation therapy, dose, associated use of chemotherapy etc., and (b) factors inherent to the patients, such as age, immune status, genetic factors etc 1,16 .…”

Section: Formation Of Cavernomas After Radiotherapymentioning

confidence: 91%

“…The neuroimaging diagnosis of cavernoma is readily achieved with MRI or CT. MRI usually shows a nidus with no surrounding cerebral edema, the core of the lesion shows an heterogeneous signal intensity with a dark rim of hemosiderin ("pop-corn" appearance) 9 . Duhem et al suggest that MRI should include a gradient echo sequence especially for detecting the smallest lesions, with other MRI sequences some cavernomas may remain undetected 6 . Vazquez et al recommend performing MRI instead of CT scans in the follow-up of children with brain tumors to avoid the cumulative risks of irradiation and the possible induction of second neoplasms 16 .…”

Section: Diagnosismentioning

confidence: 99%

“…Since then, some reports have attributed the formation of cavernomas to the treatment with radiotherapy 1,2,4,[6][7][8][9][10][11]13,14 . In several instances, cavernomas manifested with spontaneous cerebral hemorrhage 2 while, in others, the lesions were discovered during the evaluation of new symptoms unrelated to the initial brain tumor 4,6,10,11,13 . There are two possibilities to explain the formation of such lesions: they may be pre-existent to the brain tumor and radiotherapy or they may be caused by irradiation.…”

Section: Introductionmentioning

confidence: 99%

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Cavernomas in children with brain tumors: a late complication of radiotherapy

et al. 2008

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Objectives. To report three children, two with medulloblastomas and one with a pineal germinoma, treated with radiotherapy that developed intracerebral cavernous hemangiomas some years after treatment. With this work, we aim to draw attention to this occurrence in the neurosurgical community.Results. The patients were two girls and one boy with ages comprised between 2.5 and 7 years (mean 5.2 years). The average interval from irradiation to the appearance of cavernoma was of 5.3 years (range 5-6 years). The lesions were found during the routine neuroimaging studies performed for the follow-up of their primary neoplasms. No patient showed signs or symptoms related to the cavernomas. However, the three children will need both clinical and neuroimaging surveillance to monitor the evolution of these incidentally discovered lesions.Conclusions. Intracranial cavernomas can occur years after cerebral radiation therapy. In spite of previous reports that show a high incidence of bleeding lesions, cavernomas may be found incidentally during the neuroimaging surveillance studies that are performed to children with brain tumors previously treated with radiotherapy. In these cases, a conservative attitude seems to be advisable, reserving surgery only for those lesions that grow or bleed.KEY WORDS: Cavernoma. Incidentaloma. Radiation induced cavernoma. Medulloblastoma. Pineal germinoma. Adverse effects of radiation therapy.Cavernomas en niños con tumores cerebrales: una complicación tardía de la radioterapia Resumen

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Section: Formation Of Cavernomas After Radiotherapysupporting

confidence: 92%

Section: Formation Of Cavernomas After Radiotherapymentioning

confidence: 91%

Section: Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cavernomas in children with brain tumors: a late complication of radiotherapy

et al. 2008

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“…37 The radiological and pathological appearances of individual RICMs are indistinguishable from sporadic or familial CMs (i.e., nonradiation CMs), but uncertainty exists as to whether these are clinically distinct entities. There are multiple reports that RICMs have a higher risk of hemorrhage than sporadic CMs, 9,13,22,28,33,38 but the definition of hemorrhage (clinically symptomatic vs radiological only) has varied among studies, and hemorrhage risk calculations for RICMs have all been retrospective. Patient age and radiation dose may also influence the natural history of RICMs.…”

mentioning

confidence: 99%

Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort

Cutsforth‐Gregory¹,

Lanzino

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et al. 2015

JNS

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abbreviatioNs CM = cavernous malformation; GRE = gradient echo; mRS = modified Rankin Scale; RICM = radiation-induced CM; RIT = radiation-induced telangiectasia; SWI = susceptibility-weighted imaging. results Thirty-two patients with RICMs were identified (56.2% men), with a median age of 31.1 years at RICM diagnosis. The median latency from radiation treatment to RICM diagnosis was 12.0 years (interquartile range 5.0-19.6 years). RICMs were always within the previous radiation port. RICMs were symptomatic at diagnosis in 46.9%, and were associated with symptomatic intracranial hemorrhage at any time in 43.8%. Older age at the time of radiation treatment and higher radiation dose were associated with shorter latency. RICMs tended to be diagnosed at a younger age than nonradiation CMs (median 31.1 vs 42.4 years, respectively; p = 0.054) but were significantly less likely to be symptomatic at the time of diagnosis (46.9% vs 65.8%, respectively; p = 0.036). RICMs were more likely to be multiple CMs than nonradiation CMs (p = 0.0002). Prospectively, the risk of symptomatic hemorrhage was 4.2% for RICMs and 2.3% for nonradiation CMs per person-year (p = 0.556). In the absence of symptoms at presentation, the risk of hemorrhage for RICMs was higher than for nonradiation CMs (4.2% vs 0.35%, respectively; p = 0.118). coNclusioNs In this patient population, RICMs occurred within the radiation port approximately 12 years after radiation treatment. Compared with nonradiation CMs, RICMs were more likely to occur as multiple CMs, to present at a younger age, and were at least as likely to cause symptomatic hemorrhage.

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