Acta Neurochirurgica

, Volume 161, Issue 1, pp 43–48 | Cite as

Cavernous malformations are rare sequelae of stereotactic radiosurgery for brain metastases

  • Kira Seiger
  • Arjun V. Pendharkar
  • Peyman Samghabadi
  • Steven D. Chang
  • Nam Cho
  • Clara Y. H. Choi
  • Candace Wang
  • Melanie Hayden Gephart
  • Scott G. SoltysEmail author
Case Report - Brain Tumors
Part of the following topical collections:
  1. Brain tumors


The development of cavernous malformations many years following conventionally fractionated brain irradiation is well recognized and commonly reported. However, cavernous malformation induction following stereotactic radiosurgery (SRS) is largely unreported. Herein, we describe two cases of cavernous malformation formation years following SRS for brain metastases. A 20-year-old woman with breast cancer brain metastases received treatment with whole brain radiotherapy (WBRT), then salvage SRS 1.4 years later for progression of a previously treated metastasis. This lesion treated with SRS had hemorrhagic enlargement 3.0 years after SRS. Resection revealed a cavernous malformation. A 25-year-old woman had SRS for a brain metastasis from papillary thyroid carcinoma. Resection of a progressive, hemorrhagic lesion within the SRS field 2 years later revealed both recurrent carcinoma as well as cavernous malformation. As patients with brain metastases live longer following SRS, our cases highlight that the differential diagnosis of an enlarging enhancing lesion within a previous SRS field includes not only cerebral necrosis and tumor progression but also cavernous malformation induction.


Stereotactic radiosurgery Cavernous malformation Brain metastases Late effects 


Compliance with ethical standards

The patients have consented to this IRB-approved review and submission of this case report to the journal.

Conflict of interest

Scott G Soltys – Consultant – Inovio Pharmaceuticals, Inc.

The remaining authors declare no other conflicts of interest.


  1. 1.
    American Society for Radiation Oncology: Choosing Wisely 2014. Accessed 1 Nov 2017
  2. 2.
    Barnett GH, Linskey ME, Adler JR, Cozzens JW, Friedman WA, Heilbrun MP, Lunsford LD, Schulder M, Sloan AE, American Association of Neurological S, Congress of Neurological Surgeons Washington Committee Stereotactic Radiosurgery Task F (2007) Stereotactic radiosurgery--an organized neurosurgery-sanctioned definition. J Neurosurg 106:1–5. CrossRefGoogle Scholar
  3. 3.
    Cha YJ, Nahm JH, Ko JE, Shin HJ, Chang JH, Cho NH, Kim SH (2015) Pathological evaluation of radiation-induced vascular lesions of the brain: distinct from de novo cavernous hemangioma. Yonsei Med J 56:1714–1720. CrossRefGoogle Scholar
  4. 4.
    Ciricillo SF, Cogen PH, Edwards MS (1994) Pediatric cryptic vascular malformations: presentation, diagnosis and treatment. Pediatr Neurosurg 20:137–147CrossRefGoogle Scholar
  5. 5.
    Crocker M, deSouza R, Epaliyanage P, Bodi I, Deasy N, Selway R (2007) Masson’s tumour in the right parietal lobe after stereotactic radiosurgery for cerebellar AVM: case report and review. Clin Neurol Neurosurg 109:811–815. CrossRefGoogle Scholar
  6. 6.
    Di Giannatale A, Morana G, Rossi A, Cama A, Bertoluzzo L, Barra S, Nozza P, Milanaccio C, Consales A, Garre ML (2014) Natural history of cavernous malformations in children with brain tumors treated with radiotherapy and chemotherapy. J Neuro-Oncol 117:311–320. CrossRefGoogle Scholar
  7. 7.
    Fujimoto D, von Eyben R, Gibbs IC, Chang SD, Li G, Harsh GR, Hancock S, Fischbein N, Soltys SG (2018) Imaging changes over 18 months following stereotactic radiosurgery for brain metastases: both late radiation necrosis and tumor progression can occur. J Neuro-Oncol 136:207–212. CrossRefGoogle Scholar
  8. 8.
    Gaspar LE, Scott C, Murray K, Curran W (2000) Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47:1001–1006CrossRefGoogle Scholar
  9. 9.
    Gross BA, Batjer HH, Awad IA, Bendok BR (2009) Brainstem cavernous malformations. Neurosurgery 64:E805–E818; discussion E818. CrossRefGoogle Scholar
  10. 10.
    Heckl S, Aschoff A, Kunze S (2002) Radiation-induced cavernous hemangiomas of the brain: a late effect predominantly in children. Cancer 94:3285–3291. CrossRefGoogle Scholar
  11. 11.
    Iwai Y, Yamanaka K, Yoshimura M (2007) Intracerebral cavernous malformation induced by radiosurgery. Case report. Neurol Med Chir (Tokyo) 47:171–173CrossRefGoogle Scholar
  12. 12.
    Karamchandani J, Vogel H, Fischbein N, Gibbs I, Edwards MS, Griffith H (2012) Extravascular papillary endothelial hyperplasia mimicking neoplasm after radiosurgery: case report. Neurosurgery 70:E1043–E1048; discussion E1048. CrossRefGoogle Scholar
  13. 13.
    Keezer MR, Del Maestro R (2009) Radiation-induced cavernous hemangiomas: case report and literature review. Can J Neurol Sci 36:303–310CrossRefGoogle Scholar
  14. 14.
    Kleinschmidt-DeMasters BK, Lillehei KO (2016) Radiation-induced cerebral vascular “malformations” at biopsy. J Neuropathol Exp Neurol.
  15. 15.
    Koike T, Yanagimachi N, Ishiguro H, Yabe H, Yabe M, Morimoto T, Shimizu T, Takakura H, Kato S (2012) High incidence of radiation-induced cavernous hemangioma in long-term survivors who underwent hematopoietic stem cell transplantation with radiation therapy during childhood or adolescence. Biol Blood Marrow Transplant 18:1090–1098. CrossRefGoogle Scholar
  16. 16.
    Kurita H, Sasaki T, Kawamoto S, Taniguchi M, Kitanaka C, Nakaguchi H, Kirino T (1996) Chronic encapsulated expanding hematoma in association with gamma knife stereotactic radiosurgery for a cerebral arteriovenous malformation. Case report. J Neurosurg 84:874–878. CrossRefGoogle Scholar
  17. 17.
    Larson JJ, Ball WS, Bove KE, Crone KR, Tew JM Jr (1998) Formation of intracerebral cavernous malformations after radiation treatment for central nervous system neoplasia in children. J Neurosurg 88:51–56. CrossRefGoogle Scholar
  18. 18.
    Motegi H, Kuroda S, Ishii N, Aoyama H, Terae S, Shirato H, Iwasaki Y (2008) De novo formation of cavernoma after radiosurgery for adult cerebral arteriovenous malformation--case report. Neurol Med Chir (Tokyo) 48:397–400CrossRefGoogle Scholar
  19. 19.
    Murakami K, Jokura H, Kawagishi J, Watanabe M, Tominaga T (2011) Development of intratumoral cyst or extratumoral arachnoid cyst in intracranial schwannomas following gamma knife radiosurgery. Acta Neurochir 153:1201–1209. CrossRefGoogle Scholar
  20. 20.
    Nimjee SM, Powers CJ, Bulsara KR (2006) Review of the literature on de novo formation of cavernous malformations of the central nervous system after radiation therapy. Neurosurg Focus 21:e4Google Scholar
  21. 21.
    Pozzati E, Giuliani G, Gaist G, Piazza G, Vergoni G (1986) Chronic expanding intracerebral hematoma. J Neurosurg 65:611–614. CrossRefGoogle Scholar
  22. 22.
    Pozzati E, Acciarri N, Tognetti F, Marliani F, Giangaspero F (1996) Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery 38:662–669 discussion 669-670CrossRefGoogle Scholar
  23. 23.
    Rigamonti D, Hadley MN, Drayer BP, Johnson PC, Hoenig-Rigamonti K, Knight JT, Spetzler RF (1988) Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319:343–347. CrossRefGoogle Scholar
  24. 24.
    Sasagawa Y, Akai T, Itou S, Iizuka H (2009) Gamma knife radiosurgery-induced cavernous hemangioma: case report. Neurosurgery 64:E1006–E1007; discussion E1007. CrossRefGoogle Scholar
  25. 25.
    Shultz DB, Modlin LA, Jayachandran P, Von Eyben R, Gibbs IC, Choi CY, Chang SD, GRt H, Li G, Adler JR, Hancock SL, Soltys SG (2015) Repeat courses of stereotactic radiosurgery (SRS), deferring whole-brain irradiation, for new brain metastases after initial SRS. Int J Radiat Oncol Biol Phys 92:993–999. CrossRefGoogle Scholar
  26. 26.
    Smith ER, Scott RM (2010) Cavernous malformations. Neurosurg Clin N Am 21:483–490. CrossRefGoogle Scholar
  27. 27.
    Sneed PK, Mendez J, Vemer-van den Hoek JG, Seymour ZA, Ma L, Molinaro AM, Fogh SE, Nakamura JL, McDermott MW (2015) Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg 123:373–386. CrossRefGoogle Scholar
  28. 28.
    Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, Sneed PK, Chao ST, Weil RJ, Suh J, Bhatt A, Jensen AW, Brown PD, Shih HA, Kirkpatrick J, Gaspar LE, Fiveash JB, Chiang V, Knisely JP, Sperduto CM, Lin N, Mehta M (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425. CrossRefGoogle Scholar
  29. 29.
    Takei J, Tanaka T, Yamamoto Y, Teshigawara A, Tochigi S, Hasegawa Y, Murayama Y (2016) Chronic encapsulated expanding thalamic hematoma associated with obstructive hydrocephalus following radiosurgery for a cerebral arteriovenous malformation: a case report and literature review. Case Rep Neurol Med 2016:5130820. Google Scholar
  30. 30.
    Wang X, Hui XH, Liu JP, Mao Q (2012) Radiation-induced cavernous malformation at the site of arteriovenous malformation following gamma knife radiosurgery: case report. Clin Neurol Neurosurg 114:1287–1289. CrossRefGoogle Scholar
  31. 31.
    Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, Yamanaka K, Sato Y, Jokura H, Yomo S, Nagano O, Kenai H, Moriki A, Suzuki S, Kida Y, Iwai Y, Hayashi M, Onishi H, Gondo M, Sato M, Akimitsu T, Kubo K, Kikuchi Y, Shibasaki T, Goto T, Takanashi M, Mori Y, Takakura K, Saeki N, Kunieda E, Aoyama H, Momoshima S, Tsuchiya K (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15:387–395. CrossRefGoogle Scholar
  32. 32.
    Yeon JY, Suh YL, Kim JH, Lee JI (2010) Development of de novo cavernous hemangioma after radiosurgery for cavernous hemangioma. J Korean Neurosurg Soc 48:532–533. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Kira Seiger
    • 1
    • 2
  • Arjun V. Pendharkar
    • 3
  • Peyman Samghabadi
    • 4
  • Steven D. Chang
    • 3
  • Nam Cho
    • 5
  • Clara Y. H. Choi
    • 5
  • Candace Wang
    • 3
  • Melanie Hayden Gephart
    • 3
  • Scott G. Soltys
    • 1
    Email author
  1. 1.Department of Radiation OncologyStanford UniversityStanfordUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Department of NeurosurgeryStanford UniversityStanfordUSA
  4. 4.Department of PathologyStanford UniversityStanfordUSA
  5. 5.Department of Radiation OncologySanta Clara Valley Medical CenterSan JoseUSA

Personalised recommendations