RADIATION-INDUCED BRAIN DAMAGE IN CHILDREN HISTOLOGICAL ANALYSIS OF SEQUENTIAL TISSUE CHANGES IN 34 AUTOPSY CASES
RADIATION-INDUCED BRAIN DAMAGE IN CHILDREN HISTOLOGICAL ANALYSIS OF SEQUENTIAL TISSUE CHANGES IN 34 AUTOPSY CASES
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DOI：
10.2176/nmc.30.36
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发表时间：
1990-01-01
影响因子：
1.9
通讯作者：
RAIMONDI A J
中科院分区：
文献类型：
--
作者：
OI S;KOKUNAL T;RAIMONDI A J
本文对34例脑胶质瘤患儿进行了死后放射性脑损伤的研究，其中22例接受了中枢神经系统放射治疗。20人接受全脑或全神经轴放射治疗，总平均剂量为4063 cGy。分析脑组织的变化，比较照射组与非照射组的组织学特征。显微镜检查结果包括脱髓鞘（7例）、局灶性坏死（6例）、皮质萎缩（4例）、内皮增生（4例）和毛细血管扩张血管增生伴血管增厚和浓稠液体渗出（1例）。这种发现在未接受放射治疗的患者中很少见。脱髓鞘最早见于放疗后5个月死亡的患者，9个月后更为常见。在照射后9个月首次观察到局灶性坏死，但在1年后更先进和广泛。仅在60个月后发现钙化灶。各种血管变化，如血管增厚和血栓形成，表明脑缺血性损伤是辐射损伤的晚期效应。这项研究的结果表明，未成熟的大脑可能比成年人的大脑更敏感的辐射，辐射引起的损伤的表现取决于照射后经过的时间。
The nature and sequence of the radiation-induced changes in the brain were studied postmortem in 34 children with glioma, 22 of whom underwent central nervous system radiation therapy. Twenty received whole-brain or whole-neuroaxis radiation at a total mean dosage of 4063 cGy. Brain tissue alterations were analyzed histological features of irradiated brains were compared with those of non-irradiated brains. Microscopic findings included demyelination (seven cases), focal necrosis (six cases), cortical atrophy (four cases), endothelial proliferation (four cases), and telangiectatic vascular proliferation with vascular thickening and oozing of a thick fluid (one case). Such findings were rare in non-irradiated patients. Demyelination was observed earliest in a patient who died 5 months after radiation therapy and was more common after 9 months. Focal necrosis was first observed 9 months post-irradiation but was more advanced and extensive after 1 year. Calcified foci were found only after 60 months. Various vascular changes such as vascular thickening and thrombosis suggested ischemic insult to the brain as a late effect of radiation injury. The results of this study suggest that the immature brain may be more sensitive to radiation than is the adult brain, and that the manifestations of radiation-induced injury depend on the time elapsed after irradiation.