Late neurological sequelae due to brainstem irradiation for an assumed glioma

There is ongoing discussion whether radiotherapy might be beneficial in the treatment of intracranial cavernomas, however long-term sequelae due to brainstem irradiation may exist.

The case of a 72-year-old female is reported who received radiotherapy in the pre-MRI era due to a suspected intra-axial pontine lesion. Later on she developed severe trigeminal neuropathy and an MRI was performed 27 years after irradiation of the brainstem. On these images a large cavernous malformation with signs of multiple haemorrhages instead of the pontine glioma was seen accompanied by a substantial atrophy of brainstem structures.

This case impressively demonstrates the long-term outcome of brainstem irradiation and reflects that cavernomas do not respond to radiotherapy.