Silent lacunar lesions detected by magnetic resonance imaging of children with brain tumors: A late sequela of therapy

Background: Cerebral lacunes, which generally appear on magnetic resonance imaging as foci of white matter loss, usually occur in adults after ischemi c infarcts. We report the development of lacunes in children after therapy for brain tumors. Patients and Methods: We reviewed the clinical characteristics and radiolog ic studies of 524 consecutive children with brain tumors treated over a 10- year period. We documented the neuropsychologic findings associated with la cunes and the factors predictive of lacunar development. Results: lacunes developed in none of the 103 patients observed or treated with surgery alone. Twenty-five of the 421 patients treated with chemothera py or radiation therapy or both had lacunes. Patients were a median of 4.5 years old at the time of both diagnosis (range, 0.3 to 19.8 years) and radi otherapy (range, 1.5 to 20 years). Fourteen patients were treated with cran iospinal irradiation, and 11 were treated with local radiotherapy. The medi an time from radiotherapy to the appearance of lacunas was 2.01 years (rang e, 0.26 to 5.7 years). For all patients, lacunes were an incidental finding with no corresponding clinical deficits. The factor most predictive of lac unar development was age less than 5 years at the time of radiotherapy(P = .010). There was no significant difference in estimated decline in intellig ence quotient scores between patients with lacunes and age and diagnosis-ma tched controls. Conclusion: Lacunes may be caused by therapy-induced vasculopathy in childr en with brain tumors, with the most significant predictor being age less th an 5 years at the time of radiotherapy. (C) 2000 by American Society of Cli nical Oncology.