Surgery for childhood "radiation-induced cavernous hemangioma" (RICH): A case report and literature review

Radiation-Induced Cavernous Hemangioma (RICH) is a possible consequence of brain irradiation that rarely causes symptoms but can result in severe hemorrhage and neurological symptoms. To date, only small numbers of RICH cases have been reported in the literature. We report on a case of a 16-year old male who underwent surgery for RICH due to intralesional hemorrhage. Follow-up imaging showed increasing hemorrhage of one of the lesions over time since irradiation. Additionally, the patient experienced headache and seizure-like events. Therefore, microsurgical resection was performed to prevent further hemorrhage and the risk of a symptomatic bleeding event. Imaging carried out after surgery showed no sign of any new hemorrhage but still multiple other RICH lesions. Patients with RICH are often asymptomatic, but still it can lead to severe hemorrhage. Thus, follow-up imaging after brain irradiation is crucial to detect early signs of RICH and assess its evolution. To prevent symptomatic hemorrhage, surgery for RICH should be carefully considered on a case-by-case basis if the patient becomes symptomatic or if imaging shows increasing hemorrhage.