Radiation necrosis after cavernoma radiosurgery simulating brain high-grade glioma-a case report and review of the literature

We report a 62-year-old female patient who came to our institution due to pain and limited movements in the neck area, nausea, and headache. The magnetic reso-nance imaging (MRI) revealed a single larger and two smaller lesions with the appearance of cavernomas in the left parietal brain region. The patient was consulted with a neurosurgeon and was judged to be inoperable. Radio -surgery was performed in the cavernoma with a total fo-cal dose of 15Gy. 11 months after the radiotherapy, dur-ing a routine follow-up MRI scan, a tumor-like lesion with extensive perifocal edema and midline dislocation, with heterogenous structure and ring-like enhancement was reported in the left parietal brain region. After fol-low-up for 15 months, the last MRI showed almost com-plete reverse development of the described lesion, with marked reduction of volume, edema, and contrast en-hancement. Along with MRI features of the lesion, some of which overlap with high-grade glioma characteristics, the evolution of the lesion is in favor of a radiation necro-sis zone.