Abstract
Cavernous malformations are a rare complication of radiation therapy reported most commonly as a late complication after cranial irradiation for pediatric malignancies. However, cavernous malformations after stereotactic radiosurgery in adult patients are not well characterized. We present a case of a 67-year-old female with metastatic breast cancer who received Gamma Knife stereotactic radiosurgery for brain metastases and developed a cavernous malformation at the site of a treated metastasis 30 months after treatment. She underwent resection and did well until 55 months later, when she developed symptomatic recurrence of cavernous malformation without evidence of tumor recurrence, requiring repeat resection. This represents the first reported case of radiation-induced cavernous malformation treated with stereotactic radiosurgery for brain metastases, who later developed a recurrence of the cavernous malformation. As patients with brain metastases are living longer and are increasingly treated with stereotactic radiosurgery, awareness of cavernous malformation as a potential complication and the risk of recurrence is critical to ensure appropriate diagnosis and management.
Highlights
Cavernous malformations, known as cavernous hemangiomas, cavernous angiomas, or cavernomas, are benign vascular malformations consisting of abnormal dilated thin-walled vessels without smooth muscle and lacking intervening brain parenchyma
We report the case of a 67-year-old patient who underwent Gamma Knife stereotactic radiosurgery (GK SRS) for brain metastases from a breast primary, who subsequently developed a histologically confirmed cavernous malformation that was resected, only to later develop a cavernous malformation recurrence
Our patient presented here represents a unique case of radiation-induced cavernous malformation (RICM) in a patient treated for metastatic breast cancer with GK SRS with only a 30-month or 2.5-year latency to histology-confirmed RICM, who later developed a recurrence of RICM after a near-total resection of her first RICM 87 months or 7.25 years after GK SRS
Summary
Known as cavernous hemangiomas, cavernous angiomas, or cavernomas, are benign vascular malformations consisting of abnormal dilated thin-walled vessels without smooth muscle and lacking intervening brain parenchyma. Axial contrast-enhanced T1-weighted (A) and T2-weighted FLAIR brain MRI (B) obtained eight months after resection of cavernous malformation demonstrating stable postsurgical changes status post left frontal craniotomy with unchanged minimal enhancement at the resection cavity site and mild surrounding edema She subsequently continued serial surveillance imaging with stable findings and no evidence of new intracranial disease until 79 months after GK SRS (47 months after resection), when brain MRI demonstrated increased nodular enhancement within the left frontal resection cavity with increased surrounding vasogenic edema. This finding was initially observed, on repeat brain MRI 87 months after GK SRS (55 months after resection), was found to be rapidly enlarging with worsening vasogenic edema causing a 5 mm midline shift, concerning for recurrence of cavernous malformation (Figure 5).
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