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Microglia drive transient insult-induced brain injury by chemotactic recruitment of CD8 + T lymphocytes. Neuron 2023; 111:696-710.e9. [PMID: 36603584 DOI: 10.1016/j.neuron.2022.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/03/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023]
Abstract
The crosstalk between the nervous and immune systems has gained increasing attention for its emerging role in neurological diseases. Radiation-induced brain injury (RIBI) remains the most common medical complication of cranial radiotherapy, and its pathological mechanisms have yet to be elucidated. Here, using single-cell RNA and T cell receptor sequencing, we found infiltration and clonal expansion of CD8+ T lymphocytes in the lesioned brain tissues of RIBI patients. Furthermore, by strategies of genetic or pharmacologic interruption, we identified a chemotactic action of microglia-derived CCL2/CCL8 chemokines in mediating the infiltration of CCR2+/CCR5+ CD8+ T cells and tissue damage in RIBI mice. Such a chemotactic axis also participated in the progression of cerebral infarction in the mouse model of ischemic injury. Our findings therefore highlight the critical role of microglia in mediating the dysregulation of adaptive immune responses and reveal a potential therapeutic strategy for non-infectious brain diseases.
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Cerebral Radiation Necrosis: Incidence, Pathogenesis, Diagnostic Challenges, and Future Opportunities. Curr Oncol Rep 2019; 21:66. [PMID: 31218455 DOI: 10.1007/s11912-019-0818-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Cerebral radiation necrosis (CRN) is a major dose-limiting adverse event of radiotherapy. The incidence rate of RN varies with the radiotherapy modality, total dose, dose fractionation, and the nature of the lesion being targeted. In addition to these known and controllable features, there is a stochastic component to the occurrence of CRN-the genetic profile of the host or the lesion and their role in the development of CRN. RECENT FINDINGS Recent studies provide some insight into the genetic mechanisms underlying radiation-induced brain injury. In addition to these incompletely understood host factors, the diagnostic criteria for CRN using structural and functional imaging are also not clear, though multiple structural and functional imaging modalities exist, a combination of which may prove to be the ideal diagnostic imaging approach. As the utilization of novel molecular therapies and immunotherapy increases, the incidence of CNR is expected to increase and its diagnosis will become more challenging. Tissue biopsies can be insensitive and suffer from sampling biases and procedural risks. Liquid biopsies represent a promising, accurate, and non-invasive diagnostic strategy, though this modality is currently in its infancy. A better understanding of the pathogenesis of CRN will expand and optimize the diagnosis and management of CRN by better utilizing existing treatment options including bevacizumab, pentoxifylline, hyperbaric oxygen therapy, and laser interstitial thermal therapy.
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Kailaya-Vasan A, Samuthrat T, Walsh DC. Severe adverse radiation effects complicating radiosurgical treatment of brain arteriovenous malformations and the potential benefit of early surgical treatment. J Clin Neurosci 2018; 55:25-31. [PMID: 30029956 DOI: 10.1016/j.jocn.2018.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Abstract
Treatment of brain arteriovenous malformations (AVM) with stereotactic radiosurgery is rarely complicated by severe adverse radiation effects (ARE). The treatment of these sequelae is varied and often ineffectual. We present three cases of brain AVMs treated with SRS, all complicated by severe AREs. All three cases failed to respond to what is currently considered the standard treatment - corticosteroids - and indeed one patient died as a result of the side effects of their extended use. Two cases were successfully treated with surgical excision of the necrotic lesion resulting in immediate clinical improvement. Having considered the experience described in this paper and reviewed the published literature to date we suggest that surgical treatment of AREs should be considered early in the management of this condition should steroid therapy not result in early improvement.
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Affiliation(s)
- Ahilan Kailaya-Vasan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.
| | - Thiti Samuthrat
- The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Daniel C Walsh
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK; Institute of Psychiatry, King's College London, DeCrespigny Park, London, UK
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Abstract
ABSTRACT:Background:Stereotactically-focused radiosurgery (SRS) for the treatment of arteriovenous malformations (AVM) has been in widespread use for over two decades. Over this timeframe the indications for treatment, standardization of radiation dosage, and the results expected from treatment have been elaborated. Less well known are the long-term complications associated with SRS. We report three patients who had SRS for the treatment of AVM who developed a cyst at the site of treatment as a late complication.Methods:From 201 patients treated by SRS for an AVM, three developed a cyst at the treatment site. Their clinical presentation, the characteristics of the AVMs and the treatment were reviewed, as well as similar cases gleaned from the literature.Results:Three women, aged 28-43 years, had an AVM treated by: craniotomy and clipping of arterial feeders followed by SRS, by craniotomy for resection followed by SRS or by endo vascular embolization and SRS. The patients did well following treatment but two of them developed a symptomatic and the other an asymptomatic cyst at the treatment site 3-19 years later. The symptomatic patients underwent marsupialization of the cyst and the other is under observation.Conclusion:Stereotactic radiosurgery is an established and safe treatment for patients with AVMs. Delayed cyst formation can occur many years after treatment and long term follow-up is indicated in patients whose AVM has been treated with SRS.
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Wilkinson H. Long Follow-Up of Radiosurgery for Brainstem Cavernoma. World Neurosurg 2015; 85:366.e5-8. [PMID: 26370289 DOI: 10.1016/j.wneu.2015.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a relative paucity of long-term follow-up of treatment of brainstem cavernous angiomas. This has led to uncertainty and a lack of consensus regarding optimum therapy, especially radiosurgery. METHODS Report of a single case with a 24-year follow-up. RESULTS This patient was minimally symptomatic before her radiosurgery procedure. She developed an acute complication, from which she incompletely recovered. Two decades later she has become more symptomatic, with new deficits, and magnetic resonance imagings disclose progressive brainstem atrophy. CONCLUSIONS Long-term follow-up of patients treated with radiosurgery is important.
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Affiliation(s)
- Harold Wilkinson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Almefty KK, Spetzler RF. Management of Brainstem Cavernous Malformations. World Neurosurg 2015; 83:317-9. [DOI: 10.1016/j.wneu.2014.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
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Luther N, Kondziolka D, Kano H, Mousavi SH, Flickinger JC, Lunsford LD. Motor function after stereotactic radiosurgery for brain metastases in the region of the motor cortex. J Neurosurg 2013; 119:683-8. [DOI: 10.3171/2013.6.jns122081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors sought to better define the clinical response of patients who underwent stereotactic radiosurgery (SRS) for brain metastases located in the region of the motor cortex.
Methods
A retrospective analysis was performed in 2026 patients with brain metastasis who underwent SRS with the Gamma Knife between 2002 and 2012, and multiple factors that affect motor function before and after SRS were evaluated. Ninety-four patients with tumors ≥ 1.5 cm in diameter located in or adjacent to the motor strip were identified, including 2 patients with bilateral motor strip metastases.
Results
Motor function improved after SRS in 30 (31%) of 96 cases, remained stable in 48 (50%), and worsened over time in 18 (19%) instances. Forty-seven patients had no motor weakness prior to radiosurgery; 10 (22%) developed new Grade 3/5–4/5 weakness. Thirty (68%) of 44 patients with ≥ 3/5 pre-SRS weakness improved, 6 (14%) remained stable, and 8 (18%) worsened. Three of 5 patients with < 3/5 pre-SRS motor function improved. Motor deficits prior to SRS did not correlate with a worse outcome; however, worse outcomes were associated with larger tumor volumes. The median tumor volume in patients whose function improved or remained stable was 5.3 cm3, but it was 9.2 cm3 in patients who worsened (p < 0.05). Tumor volumes > 9 cm3 were associated with a higher risk of worsening motor function. Adverse radiation effects occurred in 5 patients.
Conclusions
Most intact patients with brain metastases in or adjacent to motor cortex maintained neurological function after SRS, and most patients with symptomatic motor weakness remained stable or improved. Larger tumor volumes were associated with less satisfactory outcomes.
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Affiliation(s)
- Neal Luther
- 1Center for Image-Guided Neurosurgery, Department of Neurological Surgery, and
| | - Douglas Kondziolka
- 1Center for Image-Guided Neurosurgery, Department of Neurological Surgery, and
- 3Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Hideyuki Kano
- 1Center for Image-Guided Neurosurgery, Department of Neurological Surgery, and
| | - Seyed H. Mousavi
- 1Center for Image-Guided Neurosurgery, Department of Neurological Surgery, and
| | - John C. Flickinger
- 2Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | - L. Dade Lunsford
- 1Center for Image-Guided Neurosurgery, Department of Neurological Surgery, and
- 2Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
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Kivelev J, Niemelä M, Hernesniemi J. Treatment strategies in cavernomas of the brain and spine. J Clin Neurosci 2012; 19:491-7. [PMID: 22325075 DOI: 10.1016/j.jocn.2011.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/27/2011] [Accepted: 08/01/2011] [Indexed: 12/25/2022]
Abstract
The management of brain and spinal cavernomas includes two main options: (i) conservative treatment or (ii) surgical removal. Clinical experience related to cavernoma patients falls into four major categories: the surgical or conservative treatment of incidental or symptomatic cavernomas. In many patients, cavernomas exist as fairly benign lesions, frequently remaining clinically silent for life. This observation argues against the active treatment of all cavernoma patients; rather for the meticulous selection of only those more likely to benefit from surgery. Thus, the most crucial task in successful management of cavernomas is appropriate patient selection. In this review, we present our institutional experience on cavernoma management supplemented with data from the literature.
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Affiliation(s)
- Juri Kivelev
- Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki 00260, Finland.
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Rahmathulla G, Recinos PF, Valerio JE, Chao S, Barnett GH. Laser Interstitial Thermal Therapy for Focal Cerebral Radiation Necrosis: A Case Report and Literature Review. Stereotact Funct Neurosurg 2012; 90:192-200. [DOI: 10.1159/000338251] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/28/2012] [Indexed: 11/19/2022]
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Schipani S, Jain R, Shah K, Rock JP, Movsas B, Rosenblum M, Ryu S. Clinical, dosimetric, and radiographic correlation of radiation injury involving the brainstem and the medial temporal lobes following stereotactic radiotherapy for neoplasms of central skull base. J Neurooncol 2010; 98:177-84. [PMID: 20376551 DOI: 10.1007/s11060-010-0171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 03/31/2010] [Indexed: 11/30/2022]
Abstract
Stereotactic Radiotherapy (SRT) is more commonly used for skull base tumors in conjunction with the technical development of radiation intensity modulation. Purpose of this study is to correlate clinical and radiographic characteristics of delayed radiation injury (RI) occurring around central skull base following SRT with SRT dosimetric data. Total of six patients were identified to have developed RI in the vicinity of SRT target volume out of 141 patients who received SRT in he center or near-center of the skull base. The images and medical records were retrospectively reviewed. The analysis was performed for RI location, time of development, imaging and clinical characteristics and evolution of RI and correlated with SRT dosimetric analysis using image fusion with follow-up MRI scans. Mean follow-up time was 24 +/- 9 months. During the follow-up period, twelve sites of RI were found in 6 patients. They were clinically symptomatic in 4/6 patients (66.6%) at median 12.5 months after SRT. Mean time interval between SRT and detection of RI was 9 +/- 3, 18.5 +/- 5, and 13.5 months for brainstem, temporal lobe, and cerebellum/labyrinth lesions, respectively. All RI lesions were included in the region of high SRT doses. After steroid and symptomatic treatment, 50% of RI lesions showed complete response, and 40% showed partial response. RI can occur around the skull base because of irregular shape of target tumor, its close proximity to normal brain parenchyma, and inhomogeneity of dose distribution. Brainstem lesions occurred earlier than temporal lobe RI. The majority of the RI lesions, not mixed with the tumor in this study, showed radiographic and clinical improvement with steroid and symptomatic treatments.
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Affiliation(s)
- Stefano Schipani
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Blvd, Detroit, MI, 48202, USA
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Neoadjuvant targeting of glioblastoma multiforme with radiolabeled DOTAGA–substance P—results from a phase I study. J Neurooncol 2010; 100:129-36. [DOI: 10.1007/s11060-010-0153-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 02/23/2010] [Indexed: 12/01/2022]
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12
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OYOSHI T, HIRAHARA K, UETSUHARA K, YATSUSHIRO K, ARITA K. Delayed Radiation Necrosis 7 Years After Gamma Knife Surgery for Arteriovenous Malformation -Two Case Reports-. Neurol Med Chir (Tokyo) 2010; 50:62-6. [DOI: 10.2176/nmc.50.62] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tatsuki OYOSHI
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | | | - Kazutaka YATSUSHIRO
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Kazunori ARITA
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
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13
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Cihan YB, Uzun G, Yildiz Ş, Dönmez H. Hyperbaric oxygen therapy for radiation-induced brain necrosis in a patient with primary central nervous system lymphoma. J Surg Oncol 2009; 100:732-5. [DOI: 10.1002/jso.21387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wanebo JE, Kidd GA, King MC, Chung TS. Hyperbaric oxygen therapy for treatment of adverse radiation effects after stereotactic radiosurgery of arteriovenous malformations: case report and review of literature. ACTA ACUST UNITED AC 2009; 72:162-7; discussion 167-8. [DOI: 10.1016/j.surneu.2008.03.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 03/11/2008] [Indexed: 11/30/2022]
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Djalilian HR, Benson AG, Ziai K, Safai Y, Thakkar KH, Mafee MF. Radiation necrosis of the brain after radiosurgery for vestibular schwannoma. Am J Otolaryngol 2007; 28:338-41. [PMID: 17826537 DOI: 10.1016/j.amjoto.2006.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 09/14/2006] [Accepted: 09/24/2006] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of this study was to obtain a better understanding of radiation-induced brain necrosis after stereotactic radiation therapy for vestibular schwannomas. STUDY DESIGN We conducted a retrospective case analysis. SETTING The study took place at a tertiary referral center. PATIENTS We report on the case of a patient treated with stereotactic radiation who developed radiation-induced necrosis of the ipsilateral temporal lobe. INTERVENTION The various interventions in patients with radiation-induced necrosis include steroid treatment, decompression, and hyperbaric oxygen therapy; these are discussed briefly in this article. Owing to the limited symptoms in our patient, she was observed. MAIN OUTCOME MEASURE The outcome measure that we evaluated was radiation-induced necrosis of the brain after stereotactic radiation therapy for a vestibular schwannoma. RESULTS Patients who undergo stereotactic radiation therapy for vestibular schwannomas are at risk for radiation-induced brain necrosis. CONCLUSION We support the development of a national database that would track the long-term complications of stereotactic radiation therapy to help patients make a more informed decision for the treatment of their vestibular schwannomas.
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Affiliation(s)
- Hamid R Djalilian
- Department of Otolaryngology, University of California, Irvine Medical Center, Orange, CA 92868, USA.
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16
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Hsu PW, Chang CN, Tseng CK, Wei KC, Wang CC, Chuang CC, Huang YC. Treatment of Epileptogenic Cavernomas: Surgery versus Radiosurgery. Cerebrovasc Dis 2007; 24:116-20; discussion 121. [PMID: 17536202 DOI: 10.1159/000103126] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 12/08/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Epilepsy is the most common symptom of cavernoma. Although microsurgery is the mainstay treatment for epileptogenic cavernoma, this procedure may cause severe complications for some lesions. This report aimed to study if linear accelerator (LINAC) radiosurgery was an alternative treatment modality for epileptogenic cavernoma. METHODS In this retrospective study, 29 patients were diagnosed with epileptogenic cavernomas from September 1995 to March 2005. Fifteen patients were treated with surgical excision and 14 with LINAC radiosurgery. The evaluation of epilepsy control was according to Engel's classification. RESULTS In the surgical group, 13 (86.7%) of 15 patients had a class I seizure-free outcome. In the radiosurgery group, class I control was achieved in 9 (64.3%) of 14 patients. However, there was no significant difference in the results of treatment between the two groups. CONCLUSIONS LINAC radiosurgery is an alternative treatment for epileptogenic cavernomas, especially when the lesions are located in the central regions or eloquent areas of the brain.
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Affiliation(s)
- Peng-Wei Hsu
- Brain Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Tao Yuan, Taiwan, ROC
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Lynn M, Friedman WA. HYPERBARIC OXYGEN IN THE TREATMENT OF A RADIOSURGICAL COMPLICATION. Neurosurgery 2007; 60:E579; discussion E579. [PMID: 17327770 DOI: 10.1227/01.neu.0000255343.41206.6f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE
Hyperbaric oxygenation is a rarely used method of treatment for steroid-refractory radiation-induced edema after stereotactic radiosurgery. We present its successful implementation for a radiosurgical complication after the treatment of a deep, large arteriovenous malformation. We also review the literature on hyperbaric oxygenation for radiation-induced complications.
CLINICAL PRESENTATION
A 25-year-old man underwent radiosurgical treatment for a large arteriovenous malformation. Three years later, substantially smaller remaining nidus was retreated. Five months after that treatment, the patient developed edema around the nidus and hemiparesis. This problem was refractory to high-dose steroids.
INTERVENTION
The patient underwent a course of 25 hyperbaric oxygenation treatments. Within 1 month, the edema and hemiparesis had improved, allowing steroids to be tapered. A follow-up examination 1 year later revealed complete thrombosis of the arteriovenous malformation and minimal neurological deficit.
CONCLUSION
This technical case report adds to the few studies in the literature suggesting that hyperbaric oxygenation therapy, in conjunction with a slow steroid taper, is a reasonable addition to the treatment armamentarium for radiation-induced cerebral edema associated with clinically evident neurological deficits.
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Affiliation(s)
- Michael Lynn
- Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA
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Chen HI, Burnett MG, Huse JT, Lustig RA, Bagley LJ, Zager EL. Recurrent late cerebral necrosis with aggressive characteristics after radiosurgical treatment of an arteriovenous malformation. J Neurosurg 2006; 105:455-60. [PMID: 16961142 DOI: 10.3171/jns.2006.105.3.455] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓Late cerebral radiation necrosis usually occurs within 3 years of stereotactic radiosurgery. The authors report on a case of recurrent radiation necrosis with rapid clinical deterioration and imaging findings resembling those of a malignant glioma. This 68-year-old man, who had a history of a left posterior temporal and thalamic arteriovenous malformation (AVM) treated with linear accelerator radiosurgery 13 years before presentation and complicated by radiation necrosis 11 years before presentation, exhibited new-onset mixed aphasia, right hemiparesis, and right hemineglect. Imaging studies demonstrated hemorrhage and an enlarging, heterogeneously enhancing mass in the region of the previously treated AVM. The patient was treated medically with corticosteroid agents, and stabilized temporarily. Unfortunately, his condition worsened precipitously soon thereafter, requiring the placement of a shunt for relief of obstructive hydrocephalus. Further surgical intervention was offered, but the patient’s family opted for hospice care instead. The patient died 10 weeks after initially presenting to the authors’ institution, and the results of an autopsy demonstrated radiation necrosis.
Symptomatic radiation necrosis can occur more than a decade after stereotactic radiosurgery, necessitating patient follow up during a longer period of time than currently practiced. Furthermore, there is a need for more careful reporting on the natural history of such cases to clarify the pathogenesis of very late and recurrent radiation necrosis after radiosurgery and to define patient groups with a higher risk for these entities.
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Affiliation(s)
- H Isaac Chen
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Pasquier D, Hoelscher T, Schmutz J, Dische S, Mathieu D, Baumann M, Lartigau E. Hyperbaric oxygen therapy in the treatment of radio-induced lesions in normal tissues: a literature review. Radiother Oncol 2004; 72:1-13. [PMID: 15236869 DOI: 10.1016/j.radonc.2004.04.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Accepted: 04/29/2004] [Indexed: 11/29/2022]
Abstract
Late complications are one of the major factors limiting radiotherapy treatment, and their treatment is not codified. Hyperbaric oxygen (HBO) has been used in combination with radiotherapy for over half a century, either to maximise its effectiveness or in an attempt to treat late complications. In this latter case, retrospective trials and case reports are prevailing in literature. This prompted European Society for Therapeutic Radiotherapy and Oncology and European Committee for Hyperbaric Medicine to organise a consensus conference in October 2001, dealing with the HBO indications on radiotherapy for the treatment and prevention of late complications. This updated literature review is part of the documents the jury based its opinion on. A systematic search was done on literature from 1960 to 2004, by only taking into account the articles that appeared in peer review journals. Hyperbaric oxygen treatment involving complications to the head and neck, pelvis and nervous system, and the prevention of complications after surgery in irradiated tissues have been studied. Despite the small number of controlled trials, it may be indicated for the treatment of mandibular osteoradionecrosis in combination with surgery, haemorrhagic cystitis resistant to conventional treatments and the prevention of osteoradionecrosis after dental extraction, whose level of evidence seems to be the most significant though randomised trials are still necessary. The other treatment methods are also outlined for each location.
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Affiliation(s)
- David Pasquier
- Department of Radiotherapy, Centre Oscar Lambret, 59020 Lille, France
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