Cavernous malformations of the brain after treatment for acute lymphocytic leukemia: presentation and long-term follow-up.

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.