Hyperbaric oxygen in the treatment of a radiosurgical complication: technical case report.
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Lynn
Michael
M
Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA.
Friedman
William A
WA
D000328:Adult; D001929:Brain Edema / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000601:surgery; D016634:Radiosurgery / Q000009:adverse effects*; D016896:Treatment Outcome