Radiation-induced meningiomas, cerebral aneurysm, and multiple cavernomas 2 decades after radiotherapy for...

Radiation therapy is a mainstay in the management of medulloblastoma. However, it carries long-term side effects including radiation-induced tumors and vasculopathies. The authors report the first case of the occurrence of radiation-induced meningiomas, an intracranial aneurysm, and multiple cavernomas in a patient with a remote history of medulloblastoma. In addition, this is only the seventh reported radiation-associated superior cerebellar artery (SCA) aneurysm, the first such aneurysm to be associated with external beam RT and the first such aneurysm to be treated with microsurgery.

The patient was diagnosed with medulloblastoma when he was 4 years old and underwent surgery, craniospinal irradiation, and chemotherapy. He was well until 25 years later, when he presented with headache and left-sided weakness. Cranial imaging revealed multiple meningiomas and cavernomas. He underwent surgery to excise the largest meningioma in the right frontotemporal area. Two years later, he underwent another operation for a left frontal meningioma that increased in size. Two months postexcision, he presented with a subarachnoid hemorrhage from a ruptured right SCA aneurysm and underwent clipping. He was discharged well.

This case highlights the importance of long-term surveillance for patients treated with radiotherapy. However, the ideal follow-up duration and frequency of screening tests have yet to be determined. https://thejns.org/doi/10.3171/CASE25898.