Radiation-induced cavernous malformations after single-fraction meningioma radiosurgery

Gábor Nagy, Brandon A. McCutcheon, Caterina Giannini, Michael J. Link, Bruce E. Pollock

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Stereotactic radiosurgery (SRS) is a commonly performed procedure for patients with intracranial meningiomas. OBJECTIVE: To describe the clinical features of patients with radiation-induced cavernous malformations (RICM) after single-fraction meningioma SRS. METHODS: Retrospective study of patients having single-fraction SRS for intracranial meningioma at our center from 1990 through 2009, and 1 patient who had single-fraction SRS elsewhere. Patients were excluded if they refused research authorization (n = 7), had a World Health Organization Grade II or III meningioma (n = 65), had a genetic predisposition for tumor development (n = 52), had prior or concurrent radiation therapy (n = 49), or had less than 2 yr of magnetic resonance imaging follow-up after SRS (n = 77). The median follow-up of the remaining 426 patients was 7.9 yr (range, 2-24.9). RESULTS: Three RICM (0.7%) were identified at 2, 10, and 21 yr after SRS. Two patients were asymptomatic, whereas 1 patient had a brainstem hemorrhage causing facial weakness and numbness. The risk of developing an RICM after SRS was 0.2% at 5 yr and 0.9% at 15 yr. All patients were observed and remained stable without additional bleeding in follow-up of 7, 12.8, and 2 yr, respectively. A fourth patient developed progressive neurological dysfunction starting 7 yr after SRS at another center and was treated for several years with bevacizumab without improvement. Surgical resection was performed 11.5 yr after SRS and histologic examination was consistent with an RICM. CONCLUSION: The risk of RICM after single-fraction SRS for intracranial meningiomas is very low, but the latency period noted until their detection emphasizes the need for extended imaging follow-up after SRS of benign lesions.

Original languageEnglish (US)
Pages (from-to)207-212
Number of pages6
JournalOperative Neurosurgery
Volume15
Issue number2
DOIs
StatePublished - Jan 1 2018

Fingerprint

Radiosurgery
Meningioma
Radiation
Hemorrhage
Hypesthesia
Genetic Predisposition to Disease
Brain Stem
Radiotherapy
Retrospective Studies
Magnetic Resonance Imaging

Keywords

  • Cavernous malformation
  • Complication
  • Meningioma
  • Radiation
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Radiation-induced cavernous malformations after single-fraction meningioma radiosurgery. / Nagy, Gábor; McCutcheon, Brandon A.; Giannini, Caterina; Link, Michael J.; Pollock, Bruce E.

In: Operative Neurosurgery, Vol. 15, No. 2, 01.01.2018, p. 207-212.

Research output: Contribution to journalArticle

Nagy, Gábor ; McCutcheon, Brandon A. ; Giannini, Caterina ; Link, Michael J. ; Pollock, Bruce E. / Radiation-induced cavernous malformations after single-fraction meningioma radiosurgery. In: Operative Neurosurgery. 2018 ; Vol. 15, No. 2. pp. 207-212.
@article{9241b464b2284c25a2d0ad35ec386c04,
title = "Radiation-induced cavernous malformations after single-fraction meningioma radiosurgery",
abstract = "BACKGROUND: Stereotactic radiosurgery (SRS) is a commonly performed procedure for patients with intracranial meningiomas. OBJECTIVE: To describe the clinical features of patients with radiation-induced cavernous malformations (RICM) after single-fraction meningioma SRS. METHODS: Retrospective study of patients having single-fraction SRS for intracranial meningioma at our center from 1990 through 2009, and 1 patient who had single-fraction SRS elsewhere. Patients were excluded if they refused research authorization (n = 7), had a World Health Organization Grade II or III meningioma (n = 65), had a genetic predisposition for tumor development (n = 52), had prior or concurrent radiation therapy (n = 49), or had less than 2 yr of magnetic resonance imaging follow-up after SRS (n = 77). The median follow-up of the remaining 426 patients was 7.9 yr (range, 2-24.9). RESULTS: Three RICM (0.7{\%}) were identified at 2, 10, and 21 yr after SRS. Two patients were asymptomatic, whereas 1 patient had a brainstem hemorrhage causing facial weakness and numbness. The risk of developing an RICM after SRS was 0.2{\%} at 5 yr and 0.9{\%} at 15 yr. All patients were observed and remained stable without additional bleeding in follow-up of 7, 12.8, and 2 yr, respectively. A fourth patient developed progressive neurological dysfunction starting 7 yr after SRS at another center and was treated for several years with bevacizumab without improvement. Surgical resection was performed 11.5 yr after SRS and histologic examination was consistent with an RICM. CONCLUSION: The risk of RICM after single-fraction SRS for intracranial meningiomas is very low, but the latency period noted until their detection emphasizes the need for extended imaging follow-up after SRS of benign lesions.",
keywords = "Cavernous malformation, Complication, Meningioma, Radiation, Stereotactic radiosurgery",
author = "G{\'a}bor Nagy and McCutcheon, {Brandon A.} and Caterina Giannini and Link, {Michael J.} and Pollock, {Bruce E.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1093/ons/opx254",
language = "English (US)",
volume = "15",
pages = "207--212",
journal = "Operative Neurosurgery",
issn = "2332-4252",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Radiation-induced cavernous malformations after single-fraction meningioma radiosurgery

AU - Nagy, Gábor

AU - McCutcheon, Brandon A.

AU - Giannini, Caterina

AU - Link, Michael J.

AU - Pollock, Bruce E.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Stereotactic radiosurgery (SRS) is a commonly performed procedure for patients with intracranial meningiomas. OBJECTIVE: To describe the clinical features of patients with radiation-induced cavernous malformations (RICM) after single-fraction meningioma SRS. METHODS: Retrospective study of patients having single-fraction SRS for intracranial meningioma at our center from 1990 through 2009, and 1 patient who had single-fraction SRS elsewhere. Patients were excluded if they refused research authorization (n = 7), had a World Health Organization Grade II or III meningioma (n = 65), had a genetic predisposition for tumor development (n = 52), had prior or concurrent radiation therapy (n = 49), or had less than 2 yr of magnetic resonance imaging follow-up after SRS (n = 77). The median follow-up of the remaining 426 patients was 7.9 yr (range, 2-24.9). RESULTS: Three RICM (0.7%) were identified at 2, 10, and 21 yr after SRS. Two patients were asymptomatic, whereas 1 patient had a brainstem hemorrhage causing facial weakness and numbness. The risk of developing an RICM after SRS was 0.2% at 5 yr and 0.9% at 15 yr. All patients were observed and remained stable without additional bleeding in follow-up of 7, 12.8, and 2 yr, respectively. A fourth patient developed progressive neurological dysfunction starting 7 yr after SRS at another center and was treated for several years with bevacizumab without improvement. Surgical resection was performed 11.5 yr after SRS and histologic examination was consistent with an RICM. CONCLUSION: The risk of RICM after single-fraction SRS for intracranial meningiomas is very low, but the latency period noted until their detection emphasizes the need for extended imaging follow-up after SRS of benign lesions.

AB - BACKGROUND: Stereotactic radiosurgery (SRS) is a commonly performed procedure for patients with intracranial meningiomas. OBJECTIVE: To describe the clinical features of patients with radiation-induced cavernous malformations (RICM) after single-fraction meningioma SRS. METHODS: Retrospective study of patients having single-fraction SRS for intracranial meningioma at our center from 1990 through 2009, and 1 patient who had single-fraction SRS elsewhere. Patients were excluded if they refused research authorization (n = 7), had a World Health Organization Grade II or III meningioma (n = 65), had a genetic predisposition for tumor development (n = 52), had prior or concurrent radiation therapy (n = 49), or had less than 2 yr of magnetic resonance imaging follow-up after SRS (n = 77). The median follow-up of the remaining 426 patients was 7.9 yr (range, 2-24.9). RESULTS: Three RICM (0.7%) were identified at 2, 10, and 21 yr after SRS. Two patients were asymptomatic, whereas 1 patient had a brainstem hemorrhage causing facial weakness and numbness. The risk of developing an RICM after SRS was 0.2% at 5 yr and 0.9% at 15 yr. All patients were observed and remained stable without additional bleeding in follow-up of 7, 12.8, and 2 yr, respectively. A fourth patient developed progressive neurological dysfunction starting 7 yr after SRS at another center and was treated for several years with bevacizumab without improvement. Surgical resection was performed 11.5 yr after SRS and histologic examination was consistent with an RICM. CONCLUSION: The risk of RICM after single-fraction SRS for intracranial meningiomas is very low, but the latency period noted until their detection emphasizes the need for extended imaging follow-up after SRS of benign lesions.

KW - Cavernous malformation

KW - Complication

KW - Meningioma

KW - Radiation

KW - Stereotactic radiosurgery

UR - http://www.scopus.com/inward/record.url?scp=85055484171&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055484171&partnerID=8YFLogxK

U2 - 10.1093/ons/opx254

DO - 10.1093/ons/opx254

M3 - Article

C2 - 29281070

AN - SCOPUS:85055484171

VL - 15

SP - 207

EP - 212

JO - Operative Neurosurgery

JF - Operative Neurosurgery

SN - 2332-4252

IS - 2

ER -