Triology of neurosurgical complications after radiotherapy for nasopharyngeal carcinoma.
BACKGROUND
Radiotherapy is an effective treatment for NPC. With improved survival, radiation-induced neurological complications are being diagnosed more commonly. We presented a patient with a trilogy of radiation-induced pathologies after radiotherapy for NPC. The diagnostic and surgical implications are discussed.


METHODS
A 57-year-old man, previously irradiated for NPC, presented with mental confusion and was found to have radiation-induced carotid stenosis and bitemporal lobe necrosis on MR imaging. His condition deteriorated suddenly a year later, and a gliosarcoma was found to have developed within the area of right temporal lobe necrosis. Tumor removal was complicated by injury to the MCA branches, causing basal ganglion infarction. This was likely because of a combination of technical error and arterial insufficiency secondary to radiation-induced arterial stenosis.


CONCLUSIONS
In patients with known temporal lobe radiation-induced necrosis, alternative diagnosis such as gliosarcoma should be considered when there is sudden clinical deterioration. Radiation-induced carotid stenosis may reduce the safety margin during surgery. Preoperative carotid screening may be indicated.
Leung
Gilberto Ka Kit
GK
Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China. gilberto@hkucc.hku.hk
Chan
Siu Ki
SK
Hung
Kwan Ngai
KN
D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000209:etiology / Q000601:surgery; D003221:Confusion / Q000209:etiology; D018316:Gliosarcoma / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D009336:Necrosis; D009381:Neoplasms, Radiation-Induced / Q000601:surgery; D009422:Nervous System Diseases / Q000209:etiology* / Q000523:psychology / Q000601:surgery*; D019635:Neurosurgical Procedures; D011878:Radiotherapy / Q000009:adverse effects*; D015607:Stents; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery