Cranial neuropathies after intracranial Photofrin-photodynamic therapy for malignant supratentorial gliomas-a report on 3 cases.
BACKGROUND
In an RCT of PDT in the treatment of malignant gliomas, 3 patients developed cranial neuropathies after photoillumination. We are aware of no previous reports on cranial neuropathy after intracranial PDT.


METHODS
In a cohort of 80 patients, there were 41 men and 39 women; 47 were newly diagnosed and 33 had recurrent tumors. All patients underwent surgical tumor extirpation. There were 77 malignant gliomas, 2 meningiomas, and 1 metastatic tumor. The tumor locations were as follows: 39 frontal, 25 temporal, 12 parietal, and 4 occipital. Of the 25 patients with temporal lobe tumors, 18 received PDT.


RESULTS
Three of the 18 patients with temporal lobe tumors developed cranial neuropathies after PDT. The floor of the middle fossa received photoillumination in all 3 patients. This complication was not seen in any other patient with tumors in the frontal, parietal, or occipital regions, or patients with temporal lobe tumors who did not receive PDT. The first patient developed seventh nerve paresis and hypoesthesia in fifth nerve distribution, which resolved only partially. The second patient developed a seventh nerve paresis that resolved completely. The third patient developed transient neuralgic pain in the trigeminal nerve distribution.


CONCLUSIONS
Cranial neuropathies could be the result of photoillumination of fifth and seventh cranial nerves during PDT of the temporal fossa. We recommend shielding of the middle fossa floor during PDT.
Varma
Abhay K
AK
Division of Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA. varma@musc.edu
Muller
Paul J
PJ
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D035301:Cranial Fossa, Middle / Q000473:pathology; D003389:Cranial Nerve Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D017323:Dihematoporphyrin Ether / Q000009:adverse effects*; D005154:Facial Nerve / Q000033:anatomy & histology / Q000187:drug effects / Q000503:physiopathology; D005155:Facial Nerve Diseases / Q000139:chemically induced / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D008027:Light / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D010775:Photic Stimulation / Q000009:adverse effects; D010778:Photochemotherapy / Q000009:adverse effects*; D011300:Preoperative Care / Q000592:standards; D015173:Supratentorial Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology; D014276:Trigeminal Nerve / Q000033:anatomy & histology / Q000187:drug effects / Q000503:physiopathology; D020433:Trigeminal Nerve Diseases / Q000139:chemically induced / Q000378:metabolism / Q000503:physiopathology
D000970:Antineoplastic Agents; D017323:Dihematoporphyrin Ether