Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1987 Nov;50(11):1407–1414. doi: 10.1136/jnnp.50.11.1407

Cerebral radionecrosis: is surgery necessary?

E Woo 1, K Lam 1, Y L Yu 1, P W Lee 1, C Y Huang 1
PMCID: PMC1032549  PMID: 3694200

Abstract

Seven patients with cerebral necrosis after radiotherapy for carcinoma of the nasopharynx are presented. The clinical features included seizures and a varying degree of intellectual impairment. In spite of significant mass effect on CT scan, the patients remained alert, ambulatory and independent. We believe that some cases of cerebral necrosis following radiotherapy for extra-cranial neoplasms present in a more benign fashion than has been portrayed in the literature, and in the absence of clinical evidence of raised intracranial pressure, surgical intervention is unnecessary. The importance of careful fractionation of an optimum radiation dose as a preventive measure is emphasised.

Full text

PDF
1410

Images in this article

1410Image
on p.1410
1411Image
on p.1411
1412Image
on p.1412

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Eyster E. F., Nielsen S. L., Sheline G. E., Wilson C. B. Cerebral radiation necrosis simulating a brain tumor. Case report. J Neurosurg. 1974 Feb;40(2):267–271. doi: 10.3171/jns.1974.40.2.0267. [DOI] [PubMed] [Google Scholar]
  2. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  3. Fontana M., Mastrostefano R., Bernabei A., Cianfrone G., Pompili A., Tanfani G., Riccio A. Bilateral temporal lobectomy for late radionecrosis after radiotherapy for acromegaly. A case report. J Neurosurg Sci. 1984 Apr-Jun;28(2):107–112. [PubMed] [Google Scholar]
  4. Glass J. P., Hwang T. L., Leavens M. E., Libshitz H. I. Cerebral radiation necrosis following treatment of extracranial malignancies. Cancer. 1984 Nov 1;54(9):1966–1972. doi: 10.1002/1097-0142(19841101)54:9<1966::aid-cncr2820540930>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  5. Kingsley D. P., Kendall B. E. CT of the adverse effects of therapeutic radiation of the central nervous system. AJNR Am J Neuroradiol. 1981 Sep-Oct;2(5):453–460. [PMC free article] [PubMed] [Google Scholar]
  6. Kramer S. The hazards of therapeutic iradiation of the central nervous system. Clin Neurosurg. 1968;15:301–318. doi: 10.1093/neurosurgery/15.cn_suppl_1.301. [DOI] [PubMed] [Google Scholar]
  7. Kusske J. A., Williams J. P., Garcia J. H., Pribram H. W. Radiation necrosis of the brain following radiotherapy of extracerebral neoplasms. Surg Neurol. 1976 Jul;6(1):15–20. [PubMed] [Google Scholar]
  8. LAMPERT P. W., DAVIS R. L. DELAYED EFFECTS OF RADIATION ON THE HUMAN CENTRAL NERVOUS SYSTEM; "EARLY" AND "LATE" DELAYED REACTIONS. Neurology. 1964 Oct;14:912–917. doi: 10.1212/wnl.14.10.912. [DOI] [PubMed] [Google Scholar]
  9. Littman P., James H., Zimmerman R., Slater R. Radionecrosis of the brain presenting as a mass lesion: a case report. J Neurol Neurosurg Psychiatry. 1977 Aug;40(8):827–829. doi: 10.1136/jnnp.40.8.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Lorenzo N. D., Nolletti A., Palma L. Late cerebral radionecrosis. Surg Neurol. 1978 Nov;10(5):281–290. [PubMed] [Google Scholar]
  11. Martins A. N., Johnston J. S., Henry J. M., Stoffel T. J., Di Chiro G. Delayed radiation necrosis of the brain. J Neurosurg. 1977 Sep;47(3):336–345. doi: 10.3171/jns.1977.47.3.0336. [DOI] [PubMed] [Google Scholar]
  12. Matsumura H., Ross E. R. Delayed cerebral radionecrosis following treatment of carcinoma of the scalp: clinicopathologic and ultrastructural study. Surg Neurol. 1979 Sep;12(3):193–204. [PubMed] [Google Scholar]
  13. Mikhael M. A. Radiation necrosis of the brain: correlation between computed tomography, pathology, and dose distribution. J Comput Assist Tomogr. 1978 Jan;2(1):71–80. [PubMed] [Google Scholar]
  14. Rottenberg D. A., Chernik N. L., Deck M. D., Ellis F., Posner J. B. Cerebral necrosis following radiotherapy of extracranial neoplasms. Ann Neurol. 1977 Apr;1(4):339–357. doi: 10.1002/ana.410010406. [DOI] [PubMed] [Google Scholar]
  15. Takeuchi J., Hanakita J., Abe M., Handa H. Brain necrosis after repeated radiotherapy. Surg Neurol. 1976 Feb;5(2):89–93. [PubMed] [Google Scholar]
  16. Yamashita J., Handa H., Yumitori K., Abe M. Reversible delayed radiation effect on the brain after radiotherapy of malignant astrocytoma. Surg Neurol. 1980 Jun;13(6):413–417. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES