Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Rue Gabriel-Perret-Gentil 5, 1205, Genève, Suisse, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Neurosurg Rev. 2022 Feb;45(1):243-251. doi: 10.1007/s10143-021-01598-y. Epub 2021 Jul 4.
Radiation-induced cavernous malformations (RICMs) are delayed complications of brain irradiation during childhood. Its natural history is largely unknown and its incidence may be underestimated as RCIMS tend to develop several years following radiation. No clear consensus exists regarding the long-term follow-up or treatment. A systematic review of Embase, Cochrane Library, PubMed, Google Scholar, and Web of Science databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Based on our inclusion/exclusion criteria, 12 articles were included, totaling 113 children with RICMs, 86 were treated conservatively, and 27 with microsurgery. We were unable to precisely define the incidence and natural history from this data. The mean age at radiation treatment was 7.3 years, with a slight male predominance (54%) and an average dose of 50.0 Gy. The mean time to detection of RICM was 9.2 years after radiation. RICM often developed at distance from the primary lesion, more specifically frontal (35%) and temporal lobe (34%). On average, 2.6 RICMs were discovered per child. Sixty-seven percent were asymptomatic. Twenty-one percent presented signs of hemorrhage. Clinical outcome was favorable in all children except in 2. Follow-up data were lacking in most of the studies. RICM is most often asymptomatic but probably an underestimated complication of cerebral irradiation in the pediatric population. Based on the radiological development of RICMs, many authors suggest a follow-up of at least 15 years. Studies suggest observation for asymptomatic lesions, while surgery is reserved for symptomatic growth, hemorrhage, or focal neurological deficits.
放射性空洞性血管畸形（RICMs）是儿童期脑部放疗后的迟发性并发症。其自然病史在很大程度上尚不清楚，而且由于 RICMs 往往在放疗后数年才会发展，其发病率可能被低估。对于长期随访或治疗，目前尚无明确共识。我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 Embase、Cochrane 图书馆、PubMed、Google Scholar 和 Web of Science 数据库进行了系统评价。根据我们的纳入/排除标准，共纳入 12 篇文章，总计 113 例 RICMs 患儿，86 例接受保守治疗，27 例接受显微手术治疗。我们无法从这些数据中准确确定发病率和自然病史。放疗的平均年龄为 7.3 岁，男性略占优势（54%），平均剂量为 50.0 Gy。RICM 的平均检出时间为放疗后 9.2 年。RICM 常发生在远离原发性病变的部位，更具体地说是额叶（35%）和颞叶（34%）。平均每个孩子发现 2.6 个 RICMs。67%的患儿无症状。21%的患儿出现出血迹象。除 2 例外，所有患儿的临床结局均良好。大多数研究均缺乏随访数据。RICM 通常无症状，但可能是儿童期脑部照射的被低估的并发症。基于 RICMs 的影像学发展，许多作者建议至少进行 15 年的随访。研究表明，无症状病变可观察，而对于有症状生长、出血或局灶性神经功能缺损的病变则行手术治疗。
