Choi Hyoung Soo, Kim Chae-Yong, Choi Byung Se, Jeon Seung Hyuck, Kim In Ah, Kim Joo-Young, Lee Kyu Sang, Choe Gheeyoung
Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Brain Tumor Res Treat. 2025 Apr;13(2):58-64. doi: 10.14791/btrt.2025.0003.
Radiation-induced cavernous malformations (RICMs) are rare but significant late complications of high-dose radiation therapy, particularly in young survivors of brain tumors. This report presents two cases of RICMs following aggressive multimodal treatment, including surgery, chemotherapy, and radiation therapy. Case 1 was a 22-year-old male patient with medulloblastoma treated with craniospinal irradiation, tumor bed boost, and tandem autologous peripheral blood stem cell transplantation. Approximately 8 years after treatment completion, routine follow-up imaging revealed a small focal hemorrhage in the right cerebellum, consistent with an RICM. The lesion was asymptomatic and managed conservatively with regular imaging, showing spontaneous resolution over time, with a significant size reduction noted 9 years post-treatment. Case 2 describes a 32-year-old male with an intracranial germinoma treated with whole-ventricular irradiation. Three years after treatment, the patient developed a symptomatic hemorrhagic RICM near a pre-existing developmental venous anomaly. Surgical resection and Gamma Knife Surgery stabilized the lesion; however, residual symptoms, including tremors and gait disturbances, persisted, affecting the patient's daily activities. These cases illustrate the diverse clinical courses of RICMs, ranging from spontaneous resolution to the necessity of surgical intervention, and emphasize the importance of long-term surveillance and tailored management strategies for late-onset complications.
放射性海绵状血管畸形（RICM）是高剂量放射治疗罕见但严重的晚期并发症，尤其是在脑肿瘤年轻幸存者中。本报告介绍了两例在积极的多模式治疗（包括手术、化疗和放射治疗）后发生的RICM病例。病例1是一名22岁的男性髓母细胞瘤患者，接受了全脑全脊髓照射、瘤床加量照射和串联自体外周血干细胞移植。治疗结束约8年后，常规随访影像学检查发现右小脑有一个小的局灶性出血，符合RICM表现。该病变无症状，通过定期影像学检查进行保守治疗，随着时间推移显示自发消退，治疗后9年时病变大小显著缩小。病例2描述了一名32岁男性颅内生殖细胞瘤患者，接受了全脑室照射。治疗三年后，患者在既往存在的发育性静脉异常附近出现了有症状的出血性RICM。手术切除和伽玛刀手术使病变稳定；然而，包括震颤和步态障碍在内的残留症状仍然存在，影响了患者的日常活动。这些病例说明了RICM的不同临床病程，从自发消退到需要手术干预，并强调了对迟发性并发症进行长期监测和制定个性化管理策略的重要性。
