Skip to main content

Advertisement

SpringerLink
Log in

Vascular complications of cranial radiation

  • Invited Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objectives

Cerebral vascular disease has been reported as a long-term complication of cranial radiotherapy. The purpose of this study was to examine the frequency and risk factors associated with development of cerebral vascular disease in children after cranial radiation.

Materials and methods

A retrospective chart review of all cancer patients treated between 1985 and 2003 who were under the age of 18 years at the time of initial radiotherapy was performed. Variables examined include diagnosis and site of malignancy, age at the time of radiotherapy, sex, total radiation dosage, number of fractions, duration, and whether the patient had proven cerebral vascular event.

Results

Two hundred and forty-four patients met the study criteria. One hundred and 13 cases involved tumors of the central nervous system. The remaining patients had systemic neoplastic disease. Post radiation cerebral vascular disease occurred in 11 (5%) patients, and all but one patient had a tumor involving the central nervous system (mainly in the posterior fossa and supratentorial midline).

Conclusion

There is an increased risk of cerebral vascular disease after radiation therapy in childhood, especially in children who received high dose radiation at the posterior fossa and supratentorial axial region.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johannesen T, Langmark F, Lote K (2000) Cause of death and long-term survival in patients with neuro-epithelial brain tumors: a population-based study. Eur J Cancer 39:2355–2363

    Article  Google Scholar 

  2. Bowers D, Mulne A, Reisch J, Elterman R et al (2002) Nonperioperative strokes in children with central nervous system tumors. Cancer 94:1094–1101

    Article  PubMed  Google Scholar 

  3. Beyer R, Padon P, Sabel D et al (1986) Moyamoya pattern of vascular occlusion after radiotherapy for glioma of the optic chiasm. Neurology 36:1173–1178

    PubMed  CAS  Google Scholar 

  4. Bitzer M, Topken H (1995) Progressive cerebral vascular occlusive disease after radiation therapy. Stroke 26:131–136

    PubMed  CAS  Google Scholar 

  5. Debrun G, Sauvegrain J, Aicardi J et al (1975) Moyamoya nonspecific radiological syndrome. Neuroradiology 8:241–244

    Article  Google Scholar 

  6. Hirata Y, Matsukudo Y, Mihara Y et al (1985) Occlusion of the internal carotid artery after radiation therapy for the chiasmal lesion. Acta Neurochir 74:141–147

    Article  CAS  Google Scholar 

  7. Klatte E, Ranken E, Smith E et al (1976) The radiologic spectrum in neurofibromatosis. Semin Roentgenol 11:17–33

    Article  PubMed  CAS  Google Scholar 

  8. Mori K, Takeuchi J, Ishikawa M et al (1978) Occlusion arteriopathy and brain tumor. J Neurosurg 49:22–35

    PubMed  CAS  Google Scholar 

  9. Nishizawa S, Ayu H, Yokoyama T et al (1991) Post-irradiation vasculopathy of intracranial major arteries in children. Neurol Med Chir (Tokyo) 31:336–341

    Article  CAS  Google Scholar 

  10. Omura M, Aida N, Sekido K, Kakehi M Matsubara S (1997) Large intracranial vessel occlusive vasculopathy after radiation therapy in children: clinical features and usefulness of magnetic resonance imaging. Int J Radiat Oncol Biol Phys 32:24–29

    Google Scholar 

  11. Rajakulasingam K, Cerullo L, Raimondi A (1979) Childhood moya moya syndrome, postradiation pathogenesis. Child’s Brain 5:467–475

    Article  PubMed  CAS  Google Scholar 

  12. Serdarolu A, Simsek F, Gucugener K et al (2000) Moyamoya syndrome after radiation therapy for optic pathway glioma: case report. J Child Neurol 15:765–767

    Article  PubMed  Google Scholar 

  13. Servo A, Puramen M (1978) Moyamoya syndrome as a complication of radiation therapy case report. J Neurosurg 48:1026–1029

    PubMed  CAS  Google Scholar 

  14. Wright T, Besnan M (1976) Radiation-induced cerebrovascular disease in children. Neurology 74:141–147

    Google Scholar 

  15. Cantini R, Giorgiette W, Valleriari A et al (1989) Radiation-induced cerebral lesions in childhood. Childs Nerv Syst 5:135–139

    Article  PubMed  Google Scholar 

  16. Grenier Y, Tomita T, Marymont M et al (1998) Late postirradiation occlusive vasculopathy in childhood medulloblastoma. J Neurosurg 89:460–464

    Article  PubMed  CAS  Google Scholar 

  17. Hasegawa S, Hamada J, Morioke M et al (2000) Radiation-induced cerebrovasculopathy of the distal middle cerebral artery and distal posterior cerebral artery. Neurol Med Chir (Tokyo) 40:220–223

    Article  CAS  Google Scholar 

  18. Kyoi K, Kirino Y, Saleaki T et al (1989) Therapeutic irradiation of brain tumor and cerebrovasculopathy. No Shinkei Geka 17:163–170

    PubMed  CAS  Google Scholar 

  19. Lee KF, Hodes PJ (1967) Intracranial ischemic lesions. Radiol Clin North Am 5:353–360

    Google Scholar 

  20. Maher C, Kaffel C (2000) Early vasculopathy following radiation in a child with medulloblastoma. Pediatr Neurosurg 32:256–258

    Article  Google Scholar 

  21. Minerra K, Sesajima R, Kowada M et al (1993) Case report: radiation induced vasculopathy implicated by depressed blood flow and metabolism in a pineal glioma. Br J Radiol 66:727–733

    PubMed  Google Scholar 

  22. Okuno T, Prensky A, Grado M (1985) Moyamoya syndrome associated with irradiation of an optic glioma in children: a report of two cases and review of literature. Pediatr Neurol 1:311–316

    Article  PubMed  CAS  Google Scholar 

  23. Ono J, Mimaki T, Tagawa T et al (1985) Two case reports of cerebrovascular disorder after radiation therapy. No To Hattatsu 17:64–70

    PubMed  CAS  Google Scholar 

  24. Painter M, Chutarian A, Hilal S (1975) Cerebrovasculopathy following irradiation in childhood. Neurology 25:189–194

    PubMed  CAS  Google Scholar 

  25. Rudoltz M, Regine W, Langston J et al (1998) Multiple causes of cerebrovascular events in children with tumors of the parasellar region. J Neuro-oncol 37:251–261

    Article  CAS  Google Scholar 

  26. Maruyama K, Mishimo K, Saito N et al (2000) Radiation induced aneurysm and moyamoya vessels presenting with subarachnoid haemorrhage. Acta Neurochir (Wien) 142:139–143

    Article  CAS  Google Scholar 

  27. Azzarelli B, Moore J, Gilmou R et al (1984) Multiple fusiform intracranial aneurysms following curative radiation therapy for suprasellar germinoma. J Neurosurg 61:1141–1145

    PubMed  CAS  Google Scholar 

  28. Benson P, Sony J (1989) Cerebral aneurysms following radiotherapy for medulloblastoma. J Neurosurg 70:545–550

    PubMed  CAS  Google Scholar 

  29. Jenson F, Wagner A (1997) Intracranial aneurysm following radiation therapy for medulloblastoma: a case report and review of the literature. Acta Radiol 38:37–42

    PubMed  Google Scholar 

  30. Pereira P, Cerjo A, Cruz J et al (2002) Intracranial aneurysm and vasculopathy after surgery and radiation therapy for craniopharyngioma: case report. Neurosurgery 50:885–888

    Article  PubMed  Google Scholar 

  31. Mitchell W, Fishman L, Miller J et al (1991) Stroke as a late sequela of cranial irradiation for childhood brain tumor. J Child Neurol 6:128–133

    Article  PubMed  CAS  Google Scholar 

  32. Shuyer A, Packer R, Vezina L et al (1995) “Complicateed migraine-like episodes” in children following cranial irradiation and chemotherapy. Neurology 45:1837–1840

    PubMed  Google Scholar 

  33. Bejjani G, Caputy A, Kurtzke R, Duong D, Sekhar L (1997) Remote hemorrhage of a pontine cavernous angioma fifty-two years after cerebral radiation. Acta Neurchir (Wien) 149:583–584

    Article  Google Scholar 

  34. Chang S, Vanefsky M, Havton L, Silverberg G (1998) Bilateral cavernous malformations resulting from irradiation of a choriod plexus papilloma. Neurol Res 20:529–532

    PubMed  CAS  Google Scholar 

  35. Ciricillo S, Cogen P, Edwards M (1994) Pediatric cryptic vascular malformations presentation, diagnosis, and treatment. Pediatr Neurosurg 20:137–147

    Article  PubMed  CAS  Google Scholar 

  36. Duhem R, Vinchon M, Leblond P, Soto-Ares G, Dhellemmes P (2005) Cavernous malformations after cerebral irradiation during childhood: report of nine cases. Childs Nerv Syst 21:922–925

    Article  PubMed  Google Scholar 

  37. Humpl F, Brühl K, Bold J, Schwartz M, Stoeter P, Gutjahr P (1997) Cerebral haemorrhage in long-term survivors of childhood acute lymphoblastic leukemia. Eur J Pediatr 156:370–376

    Article  Google Scholar 

  38. Laitt R, Chambers J, Goddard P, Wakeley C, Dunca A, Foreman N (1995) Magnetic resonance imaging and magnetic resonance angiography in long term survivors of acute lymphoblastic leukemia treated with cranial irradiation. Cancer 76:1846–1852

    Article  PubMed  CAS  Google Scholar 

  39. Larson J, Ball W, Bove K, Crone K, Tew J (1998) Formation of intracranial cavernous malformations after radiation treatment of central nervous system neoplasia in children. J Neurosurg 88:51–56

    PubMed  CAS  Google Scholar 

  40. Maeder P, Gudinchet R, Meuli R, deTribolet N (1998) Development of cavernous malformation of the brain. AJNR Am J Neuroradiol 19:1141–1145

    PubMed  CAS  Google Scholar 

  41. Maraire J, Abulrauf S, Berger S, Knisely J, Award I (1999) De novo development of cavernous malformation of spinal cord following spinal axis radiation. J Neurosurg (Spine2) 90:234–238

    CAS  Google Scholar 

  42. Narayan P, Barrow D (2003) Intra medullary spinal cavernous malformation following spinal irradiation. Case report and review of the literature. J Neurosurg (Spine 1) 98:68–72

    Google Scholar 

  43. Novelli P, Reigel D, Gleason P, Yunis E (1997) Multiple cavernous angioma after high dose whole brain radiation therapy. Pediatr Neurosurg 26:322–325

    Article  PubMed  CAS  Google Scholar 

  44. Pozzati E, Giangaspero F, Marliani F, Acciarri F (1996) Occult cerebrovascular malformations after irradiation. Neurosurgery 39:677–684

    Article  PubMed  CAS  Google Scholar 

  45. Packer R, Rorke L, Lange B, Seigel K, Evans E (1985) Cerebrovascular accidents in children with cancer. Pediatrics 76:194–201

    PubMed  CAS  Google Scholar 

  46. Malone S, Szanto J, Alsbeith G, Szumacher E, Souhami L, Gray R, Girard A, Raaphorst P, Grimard L. (2003) Radiosensibilté et séquelles neurologiques tardives suite a la radiochirurgie de malformation artérioveineuse: la SP2 comme nouveau facteur prédictif. Cancer Radiother 4:225–230

    Google Scholar 

  47. Lawrence T, Blackstock A, McGinn C (2003) The mechanism of action of radiosensitization of conventional chemotherapeutic agents. Semin Radiat Oncol 13:13–21

    Article  PubMed  Google Scholar 

  48. O’Connor M, Mayberg M (2000) Effects of radiation on cerebral vasculature: a review. Neurosurgery 46:138–151

    Article  PubMed  CAS  Google Scholar 

  49. Keyeux A (1974) The influence of radiation on blood vessels and circulation: IX—blood flow and permeability in the central nervous system. Curr Top Radiat Res Q 10:135–140

    PubMed  CAS  Google Scholar 

  50. Reinhold HS, Keyeux A, Dunjic A, Janovic D, Maisin JF (1974). The influence of radiation on blood vessels and circulation XII—discussion and conclusion. Curr Top Radiat Res Q: 185–198

  51. Gaensler M, Dillon W, Edwards M, Larson D, Rosenau W, Wilson C (1994) Radiology 193:629–636

    PubMed  CAS  Google Scholar 

  52. Edwards M, Baungutter J, Wlson C (1993) Cavernous and other cryptic vascular lesions in pediatrics age group. In: Awad I, Barrow D (eds) Cavernous malformations. American Association of Neurosurgeons Park Ridge 1993, pp 163–183

  53. Gunel M, Awad I, Finberg K (1996) Genetic heterogeneity of inherited cerebral cavernous malformations. Neurosurgery 38:1265–1271

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

We thank Dr. Elizabeth Hsu for her suggestion and encouragement to write this paper.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Daniel L. Keene & Donna L. Johnston

  2. Department of Radiation Oncology, Ottawa Hospital, Ottawa, ON, Canada

    Laval Grimard

  3. Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Jean Michaud

  4. Department of Surgery, Division Neurosurgery, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Michael Vassilyadi & Enrique Ventureyra

Authors
  1. Daniel L. Keene
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donna L. Johnston
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laval Grimard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Michaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Vassilyadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Enrique Ventureyra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel L. Keene.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keene, D.L., Johnston, D.L., Grimard, L. et al. Vascular complications of cranial radiation. Childs Nerv Syst 22, 547–555 (2006). https://doi.org/10.1007/s00381-006-0097-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-006-0097-4

Keywords

Search

Navigation