1/5. radiation-induced cavernous angioma mimicking metastatic disease.patients with carcinoma of the lung typically have a limited life expectancy especially after developing metastatic disease in the brain. New enhancing lesions in the brain are usually felt to represent new areas of metastasis. Recently, there have been several case reports of cavernous angiomas appearing years after radiation to the brain, typically in children. We present a case of a 41-year-old gentleman with carcinoma of the lung with metastasis to the brain who received postoperative radiation. Five-and-a-half years later he presented with a new enhancing lesion of the brain with surrounding vasogenic oedema, thought to represent a metastatic tumour. It proved is the a radiation-induced cavernous angioma.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
2/5. Controversies in the management of brainstem cavernous angioma: report of two cases.Two cases of cavernous angioma involving the medulla oblongata are presented. Both cases underwent surgical excision with excellent outcome. The use of surgery via craniectomy is contrasted with stereotactic radiosurgery in light of the known natural history of the lesions. As a result, it is suggested that surgical excision provides immediate protection from the risks of recurrent haemorrhage, establishes a tissue diagnosis, allows complete removal at the primary intervention, avoids complications of radiation-induced damage and is performed more easily in these vascular anomalies due to the presence of a capsule with surrounding gliotic tissue. Additionally, it is implied that the natural history of lesions in this region is still unclear. For these reasons, it is suggested that surgical excision should be the primary therapeutic intervention for cavernous angiomata that involve the brainstem.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
3/5. Cavernous malformations after cerebral irradiation during childhood: report of nine cases.INTRODUCTION: Cavernous hemangioma is increasingly recognized as a late complication of cerebral irradiation (CI); however, the significance of the problem, especially the risk of hemorrhage, is not documented in the literature. In order to discover this, we reviewed our experience of radiation-induced cavernous hemangiomas (RICH) in patients who had received CI during childhood. methods: We reviewed retrospectively our pediatric database of 965 brain tumors, 419 of which were irradiated between 1964 and 2003. We collected nine cases of RICH diagnosed in patients who had received CI during childhood. RESULTS: The CI dosage ranged between 25 and 55 Gy. The interval between CI and the diagnosis of RICH ranged from 4 to 22 years. The RICH was the cause of brain hemorrhage in five cases, three of which required surgical evacuation. DISCUSSION: radiation-induced cavernous hemangiomas are an underestimated problem, and systematic screening of irradiated patients with gradient-echo MRI will probably yield more asymptomatic cases. We think that not all RICH require surgery, but only those responsible for intracerebral hemorrhage or that show radiological progression. CONCLUSION: With respect for the long interval between CI and diagnosis of RICH, we advise control with MRI, including gradient-echo sequence, as late as 15 years after CI, and closer monitoring of asymptomatic RICH.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
4/5. Treatment of symptomatic AOVMs with radiosurgery.In spite of great success in the treatment cerebral AVMs with stereotactic radiosurgery, the role of this treatment modality in angiographically occult vascular malformations (AOVMs) is not recognized. Since the installation of the Gamma-knife, we have treated 20 cases of AOVMs by radiosurgery. There were 13 males and 7 females, the age ranged from 3 to 58 years with an average age of 34.0 years. Their clinical presentations at the onset were haemorrhage in 11, convulsive seizure in 7 and progressive neurological deficits in 2. Two cases had multiple lesions. Among 20 symptomatic lesions, 14 were located supratentorially, 4 in the brain stem and 2 in the cerebellar hemispheres. Following localization with MRI and dose planning, the lesions were treated by radiosurgery and the doses ranged from 15 to 20 Gy at the margins. follow-up studies indicate a significant control of rebleeding as well as of the convulsive seizure. Imaging studies demonstrated the shrinkage of the lesion in 3 and reduced enhancement with gadolinium-DTPA in some others. Adverse effects, chiefly related to radiation-induced oedema, occurred in 5. But they were generally mild and well controlled by medication. Thus the preliminary results indicate a certain usefulness of radiosurgery in the treatment of symptomatic AOVMs.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
5/5. Multiple radiation-induced intracranial lesions after treatment for pituitary adenoma. Case report.This 53-year-old man presented with a syncopal episode 31 years after undergoing craniotomy and external-beam radiation for a pituitary macroadenoma. A gadolinium-enhanced magnetic resonance (MR) image of the brain demonstrated a 2.5-cm enhancing mass in the right caudate region that had not been seen on previous studies. A stereotactically guided biopsy procedure was performed to obtain specimens from the mass, which were consistent with ependymoma. The MR image also revealed two additional lesions that appeared to be within the radiation fields: a right temporal meningioma and a left frontal cavernous malformation. A review of the literature found three previous reports in which ependymomas presented after radiation therapy.- - - - - - - - - - ranking = 4keywords = radiation-induced (Clic here for more details about this article) |