title: Late Cerebrovascular Complications After Radiotherapy for Childhood Primary Central Nervous System Tumors.
abstract: BACKGROUND
  Brain radiotherapy plays a central role in the treatment of certain types of childhood primary central nervous system tumors. However, damage to surrounding normal brain tissue causes different acute and chronic medical and neurological complications. Despite the expected increase in number of childhood primary central nervous system tumor survivors, studies assessing the occurrence of late cerebrovascular complications, such as cavernoma, moyamoya, microbleeds, superficial siderosis, and stroke are sparse.
  
  
  METHODS
  We undertook a retrospective consecutive case series review describing the occurrence and characteristics of late cerebrovascular complications in 100 survivors of childhood primary central nervous system tumors treated with radiotherapy. Demographic, clinical, and radiological findings including gradient echo brain magnetic resonance data were retrieved.
  
  
  RESULTS
  Late cerebrovascular complications were found in 36 (36%) of the patients included in the study. Mean age at radiotherapy was 8.6 years (3-17) and at diagnosis was 23.9 years (3-38). The majority were males (21; 58%). The most common complications were microbleeds (29/36; 80.6%) and cavernomas 19 (52.8%). In seven (19.4%), late cerebrovascular complications were symptomatic: epilepsy (two), motor and language deficit (two), and sensorineural hearing loss and progressive ataxia (three) associated with cavernomas, stroke, and superficial siderosis, respectively. Follow-up length was associated with an increased diagnosis of late cerebrovascular complications (P < 0.0001). Late cerebrovascular complications occurred more commonly in children treated with whole-brain radiation therapy (P = 0.046). Factors such as sex, chemotherapy, and histological type of tumor were not correlated with the occurrence of late cerebrovascular complications.
  
  
  CONCLUSIONS
  Although not usually symptomatic, late cerebrovascular complications occur frequently in survivors of childhood primary central nervous system tumors treated with radiotherapy. Prolonged follow-up increases the probability of diagnosis. The impact and prognostic value of these late cerebrovascular complications is yet to be clarified.
authors: Department of Neurology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
authors: João
authors: J
authors: Passos
authors: Neurology Department, Centro Hospitalar do Algarve, Algarve, Portugal. Electronic address: nzwalo@gmail.com.
authors: Hipólito
authors: H
authors: Nzwalo
authors: Department of Neurology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
authors: Joana
authors: J
authors: Marques
authors: Department of Neurology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
authors: Ana
authors: A
authors: Azevedo
authors: Radiotherapy Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
authors: Eduardo
authors: E
authors: Netto
authors: Department of Pediatric Neuro-Oncology, Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
authors: Sofia
authors: S
authors: Nunes
authors: Departments of Neurology and Pediatric Neuro-Oncology, Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
authors: Duarte
authors: D
authors: Salgado
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
keywords: cavernoma; late complications; microbleeds; radiotherapy; stroke; superficial siderosis