Intramedullary spinal cavernous malformation following spinal irradiation

Abstract

<jats:p content-type="fine-print">✓ There is a growing body of evidence in the literature suggesting that cavernous malformations of the central nervous system may develop after neuraxis irradiation. The authors discuss the case of a 17-year-old man who presented with progressive back pain and myelopathy 13 years after undergoing craniospinal irradiation for a posterior fossa medulloblastoma. Spinal magnetic resonance (MR) imaging, performed at the time of his initial presentation with a medulloblastoma, demonstrated no evidence of a malformation. Imaging studies and evaluation of cerebrospinal fluid revealed no evidence of recurrence or dissemination. Spinal MR imaging demonstrated an extensive lesion in the thoracic spine with an associated syrinx suggestive of a cavernous malformation. A thoracic laminectomy was performed and the malformation was successfully resected. Pathological examination confirmed the diagnosis. The patient did well after surgery and was ambulating without assistance 6 weeks later. To the best of the authors' knowledge, this is the second reported case in the literature and the first in the young adult age group suggesting the de novo development of cavernous malformations in the spinal cord after radiotherapy. An increased awareness of these lesions and close follow-up examination are recommended in this setting.</jats:p>

Postradiation lumbosacral radiculopathy with spinal root cavernomas mimicking carcinomatous meningitis

“…[9][10][11] They are also different from the features of solitary brain and spinal postirradiation cavernomas, which have the same radiologic features as spontaneous cavernomas. [12][13][14][15] Indeed, unlike these cavernomas, postirradiation spinal root cavernomas demonstrate gadolinium enhancement and are not hypointense on T2*-weighted MR images.…”

Coexistence of intracranial and spinal cavernous malformations: a study of prevalence and natural history

“…10,12,26 They may be asymptomatic, or they may cause pain, myelopathy, or sensorimotor deficits due to hemorrhage and mass effect. 21,27 Patients with spinal CMs may be at increased risk for multiple neuraxis CMs. 3,29 The coexistence of CMs in the brain and spinal cord typically occurs in patients with the familial form of CM.…”

Postirradiation Spinal Root Cavernoma

“…They were intramedullary, with an MR aspect similar to the one of spontaneous cavernomas, i.e. hypo-and hyperintense signal on MRI, with a surrounding rim of hypointense signal on T 2 sequences, without any gadolinium enhancement [4][5][6] . Postradiotherapy cavernomas were also observed in the roots, with a different MR pattern (isointense on T 1 sequences, absence of a hypointense rim on T 2 , pronounced gadolinium enhancement) [our case and 7 ].…”

“…Clinical and radiological evolution of these lesions are the same as spontaneous brain cavernomas. To our knowledge, 4 radiation-related spinal cord cavernomas have been reported in the literature [4][5][6][7] . They were intramedullary, with an MR aspect similar to the one of spontaneous cavernomas, i.e.…”