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Cavernous malformations of the brain after treatment for acute lymphocytic leukemia: presentation and long-term
Amit Singla1, Jill E Brace O'Neill, Edward Smith
1Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA.
Insights
Pediatric patients treated for acute lymphocytic leukemia (ALL) can develop brain cavernous malformations years later. Surgical removal of these lesions offers long-term protection against neurological deficits.
Area of Science:
- Neurology
- Pediatric Oncology
- Neurosurgery
Background:
- Cranial radiation therapy for acute lymphocytic leukemia (ALL) is a known risk factor for secondary brain tumors.
- The development of cerebral cavernous malformations (CCMs) after ALL treatment is rare but clinically significant.
Purpose of the Study:
- To investigate the clinical course and long-term outcomes of pediatric patients who developed brain cavernous malformations post-ALL treatment.
- To assess the efficacy of surgical intervention for these post-radiation CCMs.
Main Methods:
- Retrospective review of a surgical database for patients with CCMs developing after cranial radiation for ALL.
- Analysis of clinical presentation, radiological findings, and long-term follow-up data.
Main Results:
- Five pediatric patients developed CCMs 2-8 years after cranial radiation for ALL.
- Four of five patients presented with neurological symptoms including seizures and focal deficits.
- Surgical excision provided long-term protection, with no recurrence or new lesions observed in follow-up ranging from 2 to 17 years.
Conclusions:
- Symptomatic brain cavernous malformations can manifest years after ALL treatment, potentially with an aggressive course.
- Long-term clinical and imaging surveillance is recommended for ALL survivors.
- Craniotomy for CCM excision appears to be an effective treatment, preventing recurrence and neurological decline.
Object:
The authors undertook this study to determine the clinical course and long-term outcomes in pediatric patients who developed cavernous malformations of the brain following treatment for acute lymphocytic leukemia (ALL).
Methods:
They reviewed the senior author's database of surgically treated cavernous malformations of the brain to identify those patients whose cavernous malformations developed after cranial radiation during treatment for ALL. The medical records of these patients were reviewed to determine their clinical presentation, radiological findings, and outcome at long-term follow-up.
Results:
Five patients fulfilled the specified criteria over a 23-year period. At the time of ALL diagnosis, they were all 4-5 years old. The cerebral cavernous malformations developed 2-8 years after cranial radiation, and 4 of the 5 patients presented with neurological symptoms, which ranged from focal deficits to seizures. Two patients required a second craniotomy, one from lesion recurrence possibly due to incomplete resection, and another for a second cavernous malformation, which developed at another site 6 years after the initial malformation was excised. Long-term follow-up of 2, 10, 11, 11, and 17 years has revealed no additional lesion development or recurrence.
Conclusions:
Symptomatic cavernous malformations of the brain may develop several years after chemotherapy and cranial radiation treatment for ALL, and the clinical course of these cavernous malformations may be more aggressive than that of the typical post-radiation lesions seen in other conditions. Long-term clinical and imaging monitoring is recommended for children who have undergone treatment for ALL. Craniotomy for excision of the malformations appears to convey long-term protection from repeat hemorrhage and accumulating neurological deficits.