Keezer Mark Robert, Del Maestro Rolando
Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.
Can J Neurol Sci. 2009 May;36(3):303-10. doi: 10.1017/s0317167100007022.
The case of a 51-year-old man diagnosed with two acquired cavernous hemangiomas 17 years after cranial irradiation for a cerebellar astrocytoma is reported. A review of 84 cases of radiation-induced cavernous hemangiomas found in the literature is presented. In this series the mean age at the time of irradiation (+/- SD) was 10.4 +/- 2.0 years (median = 8 years), while the mean time to cavernous hemangioma diagnosis (+/- SD) was 10.3 +/- 1.9 years (median = 8 years). Time to cavernous hemangioma diagnosis was found to be inversely related to radiation dose. Hemorrhage from radiation-induced cavernous hemangiomas was found in 40.0% of patients, with an incidence of 3.9% per patient year. An inverse trend was identified between radiation dose and symptomatic presentation, cavernous hemangioma hemorrhage or surgical resection. This review of radiation-induced cavernous hemangiomas confirms that both younger patients and those who received a larger dose of radiation are at increased risk of radiation-induced cavernous hemangiomas. Our results suggest that, based on an assessment of CT or MR images, there may be an increased risk of hemorrhage when comparing radiation-induced to congenital cavernous hemangiomas. Increasing radiation doses appear to stabilize these lesions, decreasing the risk of a symptomatic presentation, cavernous hemangioma hemorrhage and surgical intervention.
报告了一例51岁男性患者，其在因小脑星形细胞瘤接受颅脑放疗17年后被诊断出患有两处后天性海绵状血管瘤。本文还对文献中发现的84例放射性海绵状血管瘤病例进行了综述。在该系列中，放疗时的平均年龄（±标准差）为10.4±2.0岁（中位数=8岁），而诊断出海绵状血管瘤的平均时间（±标准差）为10.3±1.9岁（中位数=8岁）。发现诊断出海绵状血管瘤的时间与辐射剂量呈负相关。40.0%的患者出现放射性海绵状血管瘤出血，每位患者每年的出血发生率为3.9%。在辐射剂量与症状表现、海绵状血管瘤出血或手术切除之间发现了相反的趋势。对放射性海绵状血管瘤的这一综述证实，年轻患者和接受较大辐射剂量的患者发生放射性海绵状血管瘤的风险增加。我们的结果表明，基于CT或MR图像评估，与先天性海绵状血管瘤相比，放射性海绵状血管瘤出血的风险可能更高。增加辐射剂量似乎能使这些病变稳定，降低出现症状、海绵状血管瘤出血和进行手术干预的风险。
