Late-onset vascular and tumor complications after childhood brain radiotherapy: A rare case of dual sequelae

Radiotherapy (RT) remains a mainstay of pediatric craniopharyngioma management. The long-term sequelae of intracranial RT are well documented and include radiation-induced brain tumors, cerebral vasculopathy, cognitive impairment, and an elevated risk of cerebrovascular accidents (CVAs). Patients treated for suprasellar or intrasellar tumors are at an increased risk of vasculopathy, likely because the Circle of Willis lies within the RT field. Here, we present a rare case of a patient who, 30 years after initial RT, developed multiple progressive late effects of cranial radiation, resulting in significant morbidity. To our knowledge, few case reports have described the concurrence of both a radiation-induced meningioma and radiation-induced vasculopathy, highlighting the rarity of this presentation and underscoring the importance of lifelong surveillance in pediatric brain tumor survivors especially within the RT treatment field.