Operative management of pediatric radiation-induced cavernous malformations: insights from a single-center cohort

Cerebral cavernous malformation (CCM) can develop following radiation therapy. Although data on the natural history of this subgroup remain limited, guidelines support resection of growing or symptomatic lesions. Given the paucity of literature on surgically treated pediatric radiation-induced cavernous malformation (RICM), we present a series of pediatric patients with RICM treated with surgical resection.

IRB-approved single-center retrospective study (2002-2025) including patients with radiographic de novo CCM development following intracranial radiation therapy for oncologic disease who subsequently underwent surgical resection.

Seven patients met inclusion criteria (4 male, 3 female; mean age at oncologic treatment 5.4 years). Oncologic diagnoses included desmoplastic medulloblastoma, classic medulloblastoma, acute lymphoblastic leukemia, ependymoma, non-germinomatous germ cell tumor, malignant mixed germ cell tumor, and high-grade glioma/glioneuronal tumor with anaplasia. Mean radiation dose was 4791 cGy (range 1800-5940). Mean time from radiation treatment to CCM detection was 5.8 years (IQR: 4.1-9.3). Surgical indications included symptomatic lesions in 71% (headache or deficit) and asymptomatic growth/hemorrhage in 29%. All seven patients underwent gross total resection with no subsequent hemorrhagic events. All symptomatic patients with available follow-up had resolution of presenting symptoms (mean follow-up 6.7 years).

Surgically treated pediatric RICM may represent a more aggressive subgroup, with shorter latency to CCM detection (5.8 vs. ~ 10 years) and higher symptomatic presentation (71% vs. 16%) than reported overall RICM cohorts. Nevertheless, surgical resection was effective in alleviating symptoms and preventing subsequent hemorrhage, helping inform treatment decisions in this specific patient population.