Impact of cranial irradiation on the clinical presentation of cerebral cavernous malformations.

Overview

abstract

OBJECTIVE: To characterize the clinical behavior of radiation-induced CCMs (RICCMs). METHODS: We retrospectively reviewed 240 patients with radiographically confirmed CCMs diagnosed between 1991 and 2022 at a single tertiary care academic center in the United States, stratified by prior cranial irradiation (CI). Demographic, clinical, and radiographic variables were compared using chi-square, Mann-Whitney U, and Fisher's exact tests. RESULTS: Fifteen patients (6.3%) had a history of prior cranial irradiation. The mean age at diagnosis (RICCM: 49.4 ± 17.1 vs. non-RICCM 52.0 ± 19.9 years) and female sex distribution (60% vs. 55.6%) were similar between groups. Patients with RICCMs were more likely to have a brain tumor (86.7% vs. 13.3%, p < 0.001) and to be diagnosed incidentally (80% vs. 32.9%, p = 0.001), with 12 of 15 identified on follow-up for brain tumor. Median latency from radiation to CCM diagnosis was 13 years. No RICCM patients presented with a new neurologic deficit. Brainstem CCMs were rare in both groups (6.7% vs. 5.3%), and there was no difference in lesion location overall (60% vs. 71.1% supratentorial), median size (10 mm vs. 9 mm), multiplicity (26.7% vs. 16.9%), associated developmental venous anomaly (20% vs. 44.4%), or radiographic hemorrhage (53.3% vs. 35.6%). Resection rates were similar between cohorts (20% vs. 16%). CONCLUSIONS: CCMs in patients with a history of CI were radiographically indistinguishable from the non-CI cohort, and their overall clinical course may be similar. However, CI patients more often presented asymptomatically during follow-up for brain tumor despite a similar incidence of radiographic hemorrhage. Long-term imaging surveillance remains critical in patients with prior cranial irradiation to facilitate timely diagnosis and management.