Postirradiation Spinal Root Cavernoma

Labauge, Pierre; Lefloch, Anne; Chapon, Françoise; Castelnovo, Giovanni; Maubon, A.; Rigau, Valérie; Segnarbieux, F.

doi:10.1159/000096676

Cited by 13 publications

(20 citation statements)

References 7 publications

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“…6,7 In patient 1 from the present study, the biopsy was limited to the arachnoid and permitted only exclusion of a malignant infiltration. In the other three patients, including patient 2 from the present study, biopsy of the enhancing lesions demonstrated multiple spinal root cavernomas.…”

Section: Casementioning

confidence: 94%

“…These clinical and EMG findings are reminiscent of the "postirradiation lower motor neuron syndrome" reported by Bowen et al 1 On MRI, the lesions were suggestive of meningeal dissemination along the cauda equina with a T1 isointense signal and a diffuse, nodular gadolinium enhancement without hypointense rim on either T2-or T2* (T2 Star)-weighted MRI. [5][6][7] Unlike carcinomatous meningitis, however, postcontrast enhancement was faint, and all of the radiologic abnormalities were restricted to the radiation field, as demonstrated by the signal conversion of vertebral bone marrow on both T1-and T2-weighted images. 8 Furthermore, this ominous radiologic finding was discordant with the slowly progressive clinical course, the repeatedly negative cytologic CSF analyses (despite elevated protein concentration), and the stable MRI over time.…”

Section: Casementioning

confidence: 99%

“…In the other three patients, including patient 2 from the present study, biopsy of the enhancing lesions demonstrated multiple spinal root cavernomas. 6,7 Interestingly, in the autopsy study of one of their patients with "postirradiation lower motor neuron syndrome," Bowen et al 1 noticed a collection of abnormal dilated vessels, some of which had thin-walled, abnormally dilated vascular channels compressing adjacent nerve fibers in the cauda equina. The term "cavernoma" was not employed by these authors, but the resemblance with histologic features observed in our patient and in two prior case reports is striking.…”

Section: Casementioning

confidence: 99%

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Postradiation lumbosacral radiculopathy with spinal root cavernomas mimicking carcinomatous meningitis

Ducray

Guillevin²,

Psimaras³

et al. 2008

Neuro-Oncology

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Lumbosacral radiculopathy is a rare complication of radiotherapy and may be challenging to differentiate from diagnosis of a tumor recurrence. We reviewed the records of three patients with a past history of cancer and radiotherapy who were referred for suspicion of carcinomatous meningitis on lumbar MRI, but whose final diagnosis was radiation-induced lumbosacral radiculopathy. The three patients developed a progressive lumbosacral radiculopathy at 20, 13, and 47 years after lumbar radiotherapy delivered for renal cancer, Hodgkin's disease, and a seminoma, respectively. MRI showed a diffuse, nodular enhancement of the cauda equina nerve roots on T1 sequences, suggestive of leptomeningeal metastasis. A slowly progressive clinical course over several years and negative cerebrospinal fluid cytologic analysis ruled out the diagnosis of carcinomatous meningitis. Because of the radiologic findings, a biopsy was performed in two patients. In the first, a biopsy limited to the arachnoid excluded a malignant infiltration. In the second, a biopsy of the enhancing lesions demonstrated spinal root cavernomas. These observations, together with three recent case reports in the literature, delineate a syndrome of "radiationinduced lumbosacral radiculopathy with multiple spinal root cavernomas" that mimics carcinomatous meningitis on MRI. Its diagnosis is important in order to avoid inappropriate treatment and useless or dangerous spinal root biopsies.

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Section: Casementioning

confidence: 94%

Section: Casementioning

confidence: 99%

Section: Casementioning

confidence: 99%

See 1 more Smart Citation

Postradiation lumbosacral radiculopathy with spinal root cavernomas mimicking carcinomatous meningitis

Ducray

Guillevin²,

Psimaras³

et al. 2008

Neuro-Oncology

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“…The majority of reported cases have involved radiation treatment in childhood, with CMs discovered years or decades later. Only 8,18,21 in patients who received radiation therapy as adults have been previously reported, and these adult RICMs have never been compared directly with pediatric RICMs. Likewise, there has been no large-scale direct comparison of RICMs and nonradiation CMs.…”

mentioning

confidence: 99%

Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort

Cutsforth‐Gregory¹,

Lanzino

Link

et al. 2015

JNS

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abbreviatioNs CM = cavernous malformation; GRE = gradient echo; mRS = modified Rankin Scale; RICM = radiation-induced CM; RIT = radiation-induced telangiectasia; SWI = susceptibility-weighted imaging. results Thirty-two patients with RICMs were identified (56.2% men), with a median age of 31.1 years at RICM diagnosis. The median latency from radiation treatment to RICM diagnosis was 12.0 years (interquartile range 5.0-19.6 years). RICMs were always within the previous radiation port. RICMs were symptomatic at diagnosis in 46.9%, and were associated with symptomatic intracranial hemorrhage at any time in 43.8%. Older age at the time of radiation treatment and higher radiation dose were associated with shorter latency. RICMs tended to be diagnosed at a younger age than nonradiation CMs (median 31.1 vs 42.4 years, respectively; p = 0.054) but were significantly less likely to be symptomatic at the time of diagnosis (46.9% vs 65.8%, respectively; p = 0.036). RICMs were more likely to be multiple CMs than nonradiation CMs (p = 0.0002). Prospectively, the risk of symptomatic hemorrhage was 4.2% for RICMs and 2.3% for nonradiation CMs per person-year (p = 0.556). In the absence of symptoms at presentation, the risk of hemorrhage for RICMs was higher than for nonradiation CMs (4.2% vs 0.35%, respectively; p = 0.118). coNclusioNs In this patient population, RICMs occurred within the radiation port approximately 12 years after radiation treatment. Compared with nonradiation CMs, RICMs were more likely to occur as multiple CMs, to present at a younger age, and were at least as likely to cause symptomatic hemorrhage.

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“…Cauda cavernomas may be solitary or multiple. Solitary lesions are most common, but multiple lesions have been reported in two cases 3,14 . Although rare, de novo development of the cauda cavernoma has been described after radiation 14 .…”

Section: Resultsmentioning

confidence: 99%

Cauda Equina Cavernous Angioma Presenting as Acute Low Back Pain and Sciatica

Khalatbari¹,

Hamidi²,

Moharamzad³

et al. 2011

Neuroradiol J

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Spinal cavernous angiomas are rare vascular lesions occurring mainly in the vertebral bodies extending secondary into the extradural space. Only 3% of these lesions are intradural, usually localized within the spinal cord. Rarely, cavernous angioma has been reported to occur in the cauda equina. We describe clinical, diagnostic imaging, and surgical procedures of two cases of cavernous angioma of the cauda equina who presented with acute back pain and sciatica. The relevant literature is also reviewed.

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Postirradiation Spinal Root Cavernoma

Cited by 13 publications

References 7 publications

Postradiation lumbosacral radiculopathy with spinal root cavernomas mimicking carcinomatous meningitis

Postradiation lumbosacral radiculopathy with spinal root cavernomas mimicking carcinomatous meningitis

Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort

Cauda Equina Cavernous Angioma Presenting as Acute Low Back Pain and Sciatica

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