Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Neurosurgery, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil.
World Neurosurg. 2024 Apr;184:42-43. doi: 10.1016/j.wneu.2024.01.026. Epub 2024 Jan 11.
Radioinduced cavernous malformations (RICMs) are low-flow, angiographically occult vascular lesions. Giant radioinduced cavernous malformations (GRICMs) are a subtype of RICMs that are characterized by their large size. GRICMs are defined as RICMs that are larger than 3 cm in diameter. They are uncommon conditions accounting for 0.1% to 0.5% among patients who have received radiation therapy for head and neck cancer or brain tumors. The risk of developing GRICMs increases with the dose of radiation received and the length of time since radiation exposure. Other factors that may increase the risk of developing GRICMs include age, genetic predisposition, and underlying medical conditions. Due to the relatively low incidence of GRICMs and the limited number of studies on this condition, there are limited data about the management of this condition. This case report describes a 12-year-old female who was previously treated for a pilocytic astrocytoma in 2012. After undergoing stereotactic biopsy and whole-brain radiotherapy (50 gray in 28 sections), she was diagnosed with a radioinduced cavernous malformation in 2016 during follow-up imaging. The RICM was managed conservatively with imaging follow-up, which showed no increase in size between 2016 and 2019. However, in 2020, the patient experienced a seizure episode associated with left-sided hemiplegia. Further investigation with cranial magnetic resonance imaging and digital subtraction angiography showed a mixed-intensity image and surrounded by a low signal intensity rim on T2-weighted images, representing hemosiderin in the right central lobe, with intense perilesional edema, with no enhancement. Given the size and location of the mass, the patient underwent microsurgical resection of the RICM (Video 1). The surgery was successful, and the lesion was successfully resected. This case highlights the importance of careful monitoring for RICMs in patients who have received radiation therapy, as well as the potential for these lesions to cause significant symptoms and disability. The case also demonstrates that surgical intervention may be necessary in some cases to manage RICMs and that microsurgical resection can be an effective treatment option. The patient gave informed consent for surgery and video recording.
放射性诱导的海绵状血管畸形（RICM）是一种低流量、血管造影隐匿性血管病变。巨大放射性诱导的海绵状血管畸形（GRICM）是 RICM 的一个亚型，其特征是体积较大。GRICM 被定义为直径大于 3 厘米的 RICM。它们是一种罕见的疾病，在接受头颈部癌症或脑肿瘤放射治疗的患者中占 0.1%至 0.5%。GRICM 的发病风险随着接受的辐射剂量和辐射暴露后的时间长度而增加。其他可能增加 GRICM 发病风险的因素包括年龄、遗传易感性和潜在的医疗状况。由于 GRICM 的相对发病率较低，并且对这种情况的研究数量有限，因此关于这种情况的管理的数据有限。本病例报告描述了一名 12 岁女性，她曾于 2012 年因毛细胞星形细胞瘤接受治疗。在接受立体定向活检和全脑放疗（50 格雷分 28 次）后，她在 2016 年随访影像学检查中被诊断为放射性诱导的海绵状血管畸形。RICM 通过影像学随访进行保守治疗，2016 年至 2019 年间，RICM 大小无增加。然而，在 2020 年，患者出现左侧偏瘫相关的癫痫发作。进一步的颅磁共振成像和数字减影血管造影检查显示右中央叶有混合强度图像，在 T2 加权图像上有低信号强度边缘环绕，代表含铁血黄素，伴有强烈的周围水肿，无强化。鉴于肿块的大小和位置，患者接受了 RICM 的显微镜下切除术（视频 1）。手术成功，病变成功切除。本病例强调了对接受放射治疗的患者进行 RICM 仔细监测的重要性，以及这些病变可能导致严重症状和残疾的可能性。该病例还表明，在某些情况下，手术干预可能是管理 RICM 的必要手段，而显微镜下切除术是一种有效的治疗选择。患者对手术和视频录制知情同意。
