Formation of intracerebral cavernous malformations after brain radiation treatment for central nervous system neoplasia in children

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  • 1 Departments of Neurosurgery, Radiology, and Pathology, University of Cincinnati College of Medicine, Cincinnati, Ohio; and Mayfield Clinic, Cincinnati, Ohio
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Object. Radiation is a common treatment modality for pediatric brain tumors. The authors present a retrospective review of six children who developed cerebral cavernous malformations after they underwent radiation treatment for central nervous system (CNS) neoplasia and propose two possible models to explain the formation of cavernous malformations.

Methods. Three boys, aged 13, 9, and 17 years, suffered intracerebral hemorrhages from cerebral cavernous malformations 87, 94, and 120 months, respectively, after they received whole-brain radiation therapy (WBRT) for acute lymphocytic leukemia. A 10-year-old girl and a 19-year-old man developed temporal lobe cavernous malformations 46 and 48 months, respectively, after they received radiation therapy for posterior fossa astrocytomas. A 12-year-old girl developed a temporal lobe cavernous malformation 45 months after WBRT was administered for a medulloblastoma. In all of these cases the cavernous malformation appeared in the irradiated field, was not known to be present prior to radiation therapy, and developed after a latency period following treatment. The incidence of cavernous malformations in these patients suggests that children who undergo radiation therapy of the brain may have an increased risk of hemorrhage.

Conclusions. Two possible models may explain the formation of cavernous malformations following brain radiation in these patients. First, the cavernous malformations may form de novo in response to the radiation. Second, the cavernous malformations may have been present, but radiographically occult, at the time of radiation therapy and may have hemorrhaged in response to the radiation. The authors conclude that cavernous malformations may develop after brain radiation and propose a possible mechanism for this formation.

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Contributor Notes

Address reprint requests to: Jeffrey J. Larson, M.D., Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Bethesda Avenue, P.O. Box 670515, Cincinnati, Ohio 45267–0515.
  • 1.

    Allen JC, , Miller DC, & Budzilovich GN, et al: Brain and spinal cord hemorrhage in long-term survivors of malignant pediatric brain tumors: a possible late effect of therapy. Neurology 41:148150, 1991 Allen JC, Miller DC, Budzilovich GN, et al: Brain and spinal cord hemorrhage in long-term survivors of malignant pediatric brain tumors: a possible late effect of therapy. Neurology 41:148–150, 1991

    • Search Google Scholar
    • Export Citation
  • 2.

    Ball WS Jr, , Prenger EC, & Ballard ET: Neurotoxicity of radio/chemotherapy in children: pathologic and MR evaluation. AJNR 13:761776, 1992 Ball WS Jr Prenger EC, Ballard ET: Neurotoxicity of radio/chemotherapy in children: pathologic and MR evaluation. AJNR 13:761–776, 1992

    • Search Google Scholar
    • Export Citation
  • 3.

    Buckingham MJ, , Crone KR, & Ball WS, et al: Management of cerebral cavernous angiomas in children presenting with seizures. Childs Nerv Syst 5:347349, 1989 Buckingham MJ, Crone KR, Ball WS, et al: Management of cerebral cavernous angiomas in children presenting with seizures. Childs Nerv Syst 5:347–349, 1989

    • Search Google Scholar
    • Export Citation
  • 4.

    Chung E, , Bodensteiner J, & Hogg JP: Spontaneous intracerebral hemorrhage: a very late delayed effect of radiation therapy. J Child Neurol 7:259263, 1992 Chung E, Bodensteiner J, Hogg JP: Spontaneous intracerebral hemorrhage: a very late delayed effect of radiation therapy. J Child Neurol 7:259–263, 1992

    • Search Google Scholar
    • Export Citation
  • 5.

    Curling OD Jr, , Kelly DL Jr, & Elster AD, et al: An analysis of the natural history of cavernous angiomas. J Neurosurg 75:702708, 1991 Curling OD Jr, Kelly DL Jr, Elster AD, et al: An analysis of the natural history of cavernous angiomas. J Neurosurg 75:702–708, 1991

    • Search Google Scholar
    • Export Citation
  • 6.

    Dubovsky J, , Zabramski JM, & Kurth J, et al: A gene responsible for cavernous malformations of the brain maps to chromosome 7q. Hum Mol Genet 4:453458, 1995 Dubovsky J, Zabramski JM, Kurth J, et al: A gene responsible for cavernous malformations of the brain maps to chromosome 7q. Hum Mol Genet 4:453–458, 1995

    • Search Google Scholar
    • Export Citation
  • 7.

    Fortuna A, , Ferrante L, & Mastronardi L, et al: Cerebral cavernous angioma in children. Childs Nerv Syst 5:201207, 1989 Fortuna A, Ferrante L, Mastronardi L, et al: Cerebral cavernous angioma in children. Childs Nerv Syst 5:201–207, 1989

    • Search Google Scholar
    • Export Citation
  • 8.

    Gaensler EHL, , Dillon WP, & Edwards MSB, et al: Radiation-induced telangiectasia in the brain simulates cryptic vascular malformations at MR imaging. Radiology 193:629636, 1994 Gaensler EHL, Dillon WP, Edwards MSB, et al: Radiation-induced telangiectasia in the brain simulates cryptic vascular malformations at MR imaging. Radiology 193:629–636, 1994

    • Search Google Scholar
    • Export Citation
  • 9.

    Garner TB, , Curling OD Jr, & Kelly DL Jr, et al: The natural history of intracranial venous angiomas. J Neurosurg 75:715722, 1991 Garner TB, Curling OD Jr, Kelly DL Jr, et al: The natural history of intracranial venous angiomas. J Neurosurg 75:715–722, 1991

    • Search Google Scholar
    • Export Citation
  • 10.

    Günel M, , Awad IA, & Anson J, et al: Mapping of a gene causing cerebral cavernous malformation to 7q11.2—q21. Proc Natl Acad Sci USA 92:66206624, 1995 Günel M, Awad IA, Anson J, et al: Mapping of a gene causing cerebral cavernous malformation to 7q11.2—q21. Proc Natl Acad Sci USA 92:6620–6624, 1995

    • Search Google Scholar
    • Export Citation
  • 11.

    Günel M, , Awad IA, & Finberg K, et al: Genetic heterogeneity of inherited cerebral cavernous malformation. Neurosurgery 38:12651271, 1996 Günel M, Awad IA, Finberg K, et al: Genetic heterogeneity of inherited cerebral cavernous malformation. Neurosurgery 38:1265–1271, 1996

    • Search Google Scholar
    • Export Citation
  • 12.

    Hassler O, & Movin A: Microangiographic studies on changes in the cerebral vessels after irradiation. I. Lesions in the rabbit produced by 60Co γ-rays, 195 kV and 34 MV roentgen rays. Acta Radiol Ther Phys Biol 4:279288, 1966 Hassler O, Movin A: Microangiographic studies on changes in the cerebral vessels after irradiation. I. Lesions in the rabbit produced by 60Co γ-rays, 195 kV and 34 MV roentgen rays. Acta Radiol Ther Phys Biol 4:279–288, 1966

    • Search Google Scholar
    • Export Citation
  • 13.

    Kondziolka D, , Lunsford LD, & Flickinger JC, et al: Reduction of hemorrhage after stereotactic radiosurgery for cavernous malformations. J Neurosurg 83:825831, 1995 Kondziolka D, Lunsford LD, Flickinger JC, et al: Reduction of hemorrhage after stereotactic radiosurgery for cavernous malformations. J Neurosurg 83:825–831, 1995

    • Search Google Scholar
    • Export Citation
  • 14.

    Martins ANJ, , Johnston JS, & Henry JM, et al: Delayed radiation necrosis of the brain. J Neurosurg 47:336345, 1977 Martins ANJ, Johnston JS, Henry JM, et al: Delayed radiation necrosis of the brain. J Neurosurg 47:336–345, 1977

    • Search Google Scholar
    • Export Citation
  • 15.

    Ogilvy CS, , Heros RC, & Ojemann RG, et al: Angiographically occult arteriovenous malformations. J Neurosurg 69:350355, 1988 Ogilvy CS, Heros RC, Ojemann RG, et al: Angiographically occult arteriovenous malformations. J Neurosurg 69:350–355, 1988

    • Search Google Scholar
    • Export Citation
  • 16.

    Okeda R, & Shibata T: Radiation encephalopathy—an autopsy case and some comments on the pathogenesis of delayed radionecrosis of the central nervous system. Acta Pathol Jpn 23:867883, 1973 Okeda R, Shibata T: Radiation encephalopathy—an autopsy case and some comments on the pathogenesis of delayed radionecrosis of the central nervous system. Acta Pathol Jpn 23:867–883, 1973

    • Search Google Scholar
    • Export Citation
  • 17.

    Poussaint TY, , Siffert J, & Barnes PD, et al: Hemorrhagic vasculopathy after treatment of central nervous system neoplasia in childhood: diagnosis and follow-up. AJNR 16:693699, 1995 Poussaint TY, Siffert J, Barnes PD, et al: Hemorrhagic vasculopathy after treatment of central nervous system neoplasia in childhood: diagnosis and follow-up. AJNR 16:693–699, 1995

    • Search Google Scholar
    • Export Citation
  • 18.

    Reinhold HS, & Hopewell JW: Late changes in the architecture of blood vessels of the rat brain after irradiation. Br J Radiol 53:693696, 1980 Reinhold HS, Hopewell JW: Late changes in the architecture of blood vessels of the rat brain after irradiation. Br J Radiol 53:693–696, 1980

    • Search Google Scholar
    • Export Citation
  • 19.

    Rigamonti D, , Drayer BP, & Johnson PC, et al: The MRI appearance of cavernous malformations (angiomas). J Neurosurg 67:518524, 1987 Rigamonti D, Drayer BP, Johnson PC, et al: The MRI appearance of cavernous malformations (angiomas). J Neurosurg 67:518–524, 1987

    • Search Google Scholar
    • Export Citation
  • 20.

    Rigamonti D, , Johnson PC, & Spetzler RF, et al: Cavernous malformations and capillary telangiectasia: a spectrum within a single pathological entity. Neurosurgery 28:6064, 1991 Rigamonti D, Johnson PC, Spetzler RF, et al: Cavernous malformations and capillary telangiectasia: a spectrum within a single pathological entity. Neurosurgery 28:60–64, 1991

    • Search Google Scholar
    • Export Citation
  • 21.

    Robinson JR, , Awad IA, & Little JR: Natural history of the cavernous angioma. J Neurosurg 75:709714, 1991 Robinson JR, Awad IA, Little JR: Natural history of the cavernous angioma. J Neurosurg 75:709–714, 1991

    • Search Google Scholar
    • Export Citation
  • 22.

    Russell DS, & Rubinstein LJ: Pathology of Tumours of the Nervous System, ed 4. Baltimore: Williams & Wilkins, 1989, pp 873875 Russell DS, Rubinstein LJ: Pathology of Tumours of the Nervous System, ed 4. Baltimore: Williams & Wilkins, 1989, pp 873–875

    • Search Google Scholar
    • Export Citation
  • 23.

    Sze G, , Krol G, & Olsen WL, et al: Hemorrhagic neoplasms: MR mimics of occult vascular malformations. AJR 149:12231230, 1987 Sze G, Krol G, Olsen WL, et al: Hemorrhagic neoplasms: MR mimics of occult vascular malformations. AJR 149:1223–1230, 1987

    • Search Google Scholar
    • Export Citation
  • 24.

    Valk PE, & Dillon WP: Radiation injury of the brain. AJNR 12:4562, 1991 Valk PE, Dillon WP: Radiation injury of the brain. AJNR 12:45–62, 1991

    • Search Google Scholar
    • Export Citation
  • 25.

    Wilson CB: Cryptic vascular malformations. Clin Neurosurg 38:4984, 1992 Wilson CB: Cryptic vascular malformations. Clin Neurosurg 38:49–84, 1992

    • Search Google Scholar
    • Export Citation

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