In the present study, we compared the histological and MRI findings of RICHs following SRS to those of de novo CHs. So far, there has been no thorough histologic review of RICHs following SRS in comparison to de novo CHs. 16, 17 Similar to de novo CHs, RICHs present as enhancing lesions on MRI and are found to be composed of vasculature and hemorrhage upon histological examination. 13 Together with hemorrhage after brain irradiation, these lesions described as a 'radiation-induced cavernous hemangioma' (RICH), 14, 15 although some authors refer to such lesions as 'radiation-induced telangiectasia'. 11, 12 Some patients who receive SRS develop a localized vascular, tumor-like lesion at the treatment site, months or even years after treatment. 4, 5 Stereotactic radiosurgery (SRS), initially introduced by Leksell, 6 is now widely applied to patients with various brain lesions, including primary brain tumors, 7, 8 metastatic lesions, 9, 10 and vascular malformations. Some sporadic cases of CH have been described as late complications of cerebral radiation. Briefly, these gene are thought to be involved in generation of abnormal vessels and affect brain parenchyma surrounding the endothelial cells.

So far, these mutations have been most frequently observed in Hispanic-Americans of Mexican descent. Most de novo CHs occur sporadically, although some patients have a family history of CH related to mutations in the cerebral cavernous malformation ( CCM) genes, CCM1, CCM2, and CCM3. Old hemorrhage and reactive gliosis are frequently found at the periphery of the lesion. 2 Histologically, de novo CH is composed of proliferating ectatic, single-endothelial lined abnormal vessels that lack smooth muscle, and absence of intervening brain parenchyma within the lesion is also characteristic. Currently, magnetic resonance imaging (MRI) is the most sensitive and accurate diagnostic tool for de novo CH, and typically reveals an enhancing multiloculated cystic lesion with popcorn- or mulberry-like features on both T1- and T2-weighted images, due to clustered capillaries and venules that bleed periodically. 1 Patients present with headache, neurologic deficits, or seizures. De novo cavernous hemangioma (CH) is the second most common vascular malformation of the central nervous system, with an incidence of approximately 0.5%.

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