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

Introduction: Cavernous hemangioma is increasingly recognized as a late complication of cerebral irradiation (CI); however, the significance of the problem, especially the risk of hemorrhage, is not documented in the literature. In order to discover this, we reviewed our experience of radiation-induced cavernous hemangiomas (RICH) in patients who had received CI during childhood. Methods: We reviewed retrospectively our pediatric database of 965 brain tumors, 419 of which were irradiated between 1964 and 2003. We collected nine cases of RICH diagnosed in patients who had received CI during childhood. Results: The CI dosage ranged between 25 and 55 Gy. The interval between CI and the diagnosis of RICH ranged from 4 to 22 years. The RICH was the cause of brain hemorrhage in five cases, three of which required surgical evacuation. Discussion: Radiation-induced cavernous hemangiomas are an underestimated problem, and systematic screening of irradiated patients with gradient-echo MRI will probably yield more asymptomatic cases. We think that not all RICH require surgery, but only those responsible for intracerebral hemorrhage or that show radiological progression. Conclusion: With respect for the long interval between CI and diagnosis of RICH, we advise control with MRI, including gradient-echo sequence, as late as 15 years after CI, and closer monitoring of asymptomatic RICH.