De novo development of a cavernous malformation of the spinal cord following spinal axis radiation

Abstract

<jats:p content-type="fine-print">✓ Analysis of recent reports has suggested that cavernous malformations (CMs) of the brain may have an acquired pathogenesis and a dynamic pathophysiological composition, with documented appearance of new lesions in familial cases and following radiotherapy. The authors report the first case of demonstrated de novo formation of an intramedullary CM following spinal radiation therapy.</jats:p> <jats:p content-type="fine-print">A 17 year-old boy presented with diabetes insipidus and delayed puberty. Evaluation of endocrine levels revealed hypopituitarism, and magnetic resonance (MR) imaging demonstrated an infundibular mass. The patient underwent a pterional craniotomy and removal of an infundibular germinoma. The MR image of the spine demonstrated normal results. The patient received craniospinal radiation therapy and did well. He presented 5 years later with acute onset of back pain, lower-extremity weakness and numbness, and difficulty with urination. An MR image obtained of the spine revealed an intramedullary T-7 lesion; its signal characteristics were consistent with a CM.</jats:p> <jats:p content-type="fine-print">The patient was initially managed conservatively but developed progressive myelopathy and partial Brown—Séquard syndrome. Although he received high-dose steroids and bed rest, his symptoms worsened. He underwent a costotransversectomy and excision of a hemorrhagic vascular lesion via an anterolateral myelotomy. Pathological examination confirmed features of a CM. The patient has done well and was walking without assistance within 4 weeks of surgery.</jats:p> <jats:p content-type="fine-print">De novo genesis of CMs may be associated with prior radiation therapy to the spinal cord.</jats:p>

Brown-Séquard Syndrome Secondary to Spontaneous Bleed from Postradiation Cavernous Angiomas: Fig 1.

“…7 Although its exact pathogenesis remains obscure, several mechanisms have been postulated including children with acute lymphocytic leukemia (a frequent reason for craniospinal irradiation) being inherently prone to the development of cavernomas, radiation-induced growth of pre-existing tiny cavernomas, and radiation-induced fibrosis and venous outflow occlusion as well as release of hypoxia inducible factors and vasculo-endothelial growth factor. 6 Bleeds from cavernous angiomas are often mild.…”

Recurrent Subependymoma Treated with Radiosurgery

“…There are now numerous reported cases of de novo CMs after radiation therapy to the brain and spine [9,11,13,19]. Surgical resection of symptomatic cavernomas remains the treatment of choice [12,26,31].…”

Cavernomas da medula torácica: Considerações e relato de um caso-exemplo

“…Podem estar associados a angiomas de pele ou órgãos internos ou ocorrer após a radioterapia. 10,11,13 Ocorrem como lesões semelhantes a framboesas circundadas de gliose e um anel de hemossiderina. O plano gliótico é frequentemente infiltrado por prolongamentos dos cavernomas.…”