Radiation-induced Cavernous Malformation as a Late Sequelae of Stereotactic Radiosurgery for Epilepsy.
Radiation-induced Cavernous Malformation as a Late Sequelae of Stereotactic Radiosurgery for Epilepsy.
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DOI：
10.7759/cureus.2308
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发表时间：
2018-03-11
期刊：
影响因子：
--
通讯作者：
Chang EF
中科院分区：
文献类型：
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作者：
Winkler EA;Rutledge C;Ward M;Tihan T;Sneed PK;Barbaro N;Garcia P;McDermott M;Chang EF
立体定向放射外科（SRS）是治疗难治性内侧颞叶癫痫的一种有前途的治疗方法。立体定向放射外科治疗癫痫具有可接受的安全性，有报道称放射诱发的血管畸形仅限于具有显着血管生成的中枢神经系统病变，即原发性脑肿瘤、转移瘤和动静脉畸形。癫痫放射外科手术后放射诱发病变的理论风险尚未确定。在一项针对内侧颞叶癫痫的试点试验中，有 13 名患者接受治疗，其中一名患者在放射外科手术后出现了多发性迟发性放射诱发的海绵状血管瘤。 该患者接受了 20 Gy 的处方剂量，照射至杏仁核、海马前回和海马旁回。治疗八年后，计算机断层扫描显示内侧颞叶不断出现高密度。磁共振成像证实左侧海马旁回和颞前叶存在多个 T2 低信号病变，具有混合信号强度核心。患者最初接受保守治疗。然而，反复出血最终导致精神状态急剧恶化、失语和偏瘫，需要手术切除。病理学证实辐射诱发的海绵状血管瘤。这是放射引起的血管病变作为癫痫放射外科长期后遗症的第一例，并说明了即使在没有血管生成病变的患者中使用低剂量时也可能出现这种并发症。在出现神经系统症状之前手术切除放射性海绵状血管瘤的最佳时机和适应症需要进一步完善。 需要长期警惕和临床监测。
Stereotactic radiosurgery (SRS) is a promising treatment for medically intractable mesial temporal lobe epilepsy. SRS for epilepsy has had an acceptable safety profile with reports of radiation-induced vascular malformations confined to central nervous system pathologies with prominent angiogenesis – namely, primary brain tumors, metastases, and arteriovenous malformations. Theoretical risks for radiation-induced lesions following radiosurgery for epilepsy have yet to be established. Of 13 patients treated in a pilot trial for medial temporal lobe epilepsy, one developed multiple delayed radiation-induced cavernous malformations following radiosurgery. This patient received a prescription dose of 20 Gy delivered to the amygdala, anterior hippocampus, and parahippocampal gyrus. Eight years following treatment, computed tomography imaging demonstrated an evolving hyperdensity in the mesial temporal lobe. Magnetic resonance imaging confirmed multiple T2 hypointense lesions with a mixed-signal intensity core in the left parahippocampal gyrus and anterior temporal lobe. The patient was initially managed conservatively. However, recurrent hemorrhage ultimately caused an acute deterioration in mental status, aphasia, and hemiparesis, necessitating surgical resection. Pathology confirmed radiation-induced cavernous malformations. This represents the first case of a radiation-induced vascular lesion as a long-term sequela of radiosurgery for epilepsy and illustrates the potential for this complication even when low doses are used in patients without angiogenic lesions. Optimal timing and indications for surgical resection of radiation-induced cavernous malformations prior to the development of neurologic symptoms warrant further refinement. Long-term vigilance and clinical monitoring are required.