Introduction: Cranial irradiation (CI) is a risk factor for the development of cerebral cavernous malformations (CCMs). However, little longitudinal cohort data on these patients exist. The purpose of this project is to characterize the clinical behavior of CCMs in patients with a history of CI.
Methods: Using radiology records, the authors identified and retrospectively reviewed 240 patients with CCMs between May 1991 and December 2022. Patient demographics, imaging, presentation, and medical history–including history of CI–were extracted. The Mann-Whitney test and chi-square were used to compare variables between patients with and without a history of CI.
Results: 15 patients with a CCM diagnosis (60% female) following CI were identified. The mean age at diagnosis did not differ between CI and non-CI cohorts (49.4 vs. 52.0 years). The CI cohort trended toward having a history of seizure (20% vs. 12%, p = 0.51) and mood disorder (33.3% vs. 16.4%, p=0.19). CI patients were more likely to have a brain tumor (86.7% vs. 13.3%, p< 0.001) and were more often diagnosed incidentally (80% vs. 32.9%, p< 0.01) with 12/15 identified on follow up for brain tumor. Only 1 patient with CI presented with a new neurologic deficit. There was no difference in CCM location (60% vs. 71.1% supratentorial), median size (10mm vs. 9mm), frequency of multiple lesions (26.7% vs. 16.9%), associated developmental anomaly (20% vs. 44.4%) or radiographic hemorrhage (53.3% vs. 35.6%) between CI and non-CI cohorts. There was no significant difference in the rate of surgical resection of CCMs for the CI cohort (20% vs. 16%).
Conclusion : CMs in patients with a history CI were radiographically indistinguishable from non-CI cohort. However, patients with CI presented asymptomatically during follow up for brain tumor despite a similar incidence of radiographic hemorrhage. Although CCMs in CI patients have distinctive presentation patterns, their overall clinical course may be similar to non-CI CCM patients.
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