Results of excision of cerebral radionecrosis: experience in patients treated with radiation therapy for nasopharyngeal carcinoma.
OBJECTIVE
In theory, the purpose of the treatment of cerebral radionecrosis (CRN), a nonneoplastic condition, is to minimize loss of brain function by preventing the progression and reversing some of the processes of CRN. In a practical sense, factors for achieving this purpose may include the following: removal of a CRN lesion that is causing mass effect, control of brain edema, prevention of recurrence of CRN lesions, minimization of adverse effects from treatments, and achievement of reasonably long and good-quality survivals. Based on these practical issues, the authors performed a retrospective study to evaluate the results of excision for the treatment of CRN.


METHODS
The authors retrospectively reviewed the results of excision of CRN lesions in a group of patients with temporal lobe CRN due to radiotherapy for nasopharyngeal carcinoma. Patients who had undergone surgery at the authors' institution between January 1998 and November 2008 were analyzed. Surgical results were evaluated by assessing postoperative resolution of brain edema, recurrence of temporal lobe CRN, surgery-related complications, and postoperative functional status and survival.


RESULTS
Twenty-four patients were included (age range 39-69 years; in 23 patients nasopharyngeal carcinoma was in remission). All patients underwent craniotomy for excision of the contrast-enhancing region. The indications for operation were temporal lobe CRN lesions with a mass-occupying effect beyond the temporal lobe. There were 32 craniotomies in all (mean postoperative follow-up 40 months). It was found that brain edema resolved rapidly postoperatively. The recurrence and reoperation rates were 6.3 and 3.1%, respectively. There were no surgery-related deaths. The median survival was 72 months, and 67% of the patients had a Karnofsky Performance Scale score of > or = 70% at the time of their last follow-up.


CONCLUSIONS
In a specific group of patients with CRN of the temporal lobe in whom the CRN lesions were causing a mass-occupying effect beyond the temporal lobe, excision of the contrast-enhancing region was safe and could achieve prompt resolution of brain edema and a low incidence of recurrence of CRN.
Department of Neurosurgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, Special Administrative Region, China. wongsuito@hotmail.com
Sui-To
ST
Wong
Ka-Tai
KT
Loo
Kwong-Yui
KY
Yam
Wai-Man
WM
Hung
Kam-Fuk
KF
Fok
Shing-Chau
SC
Yuen
Dawson
D
Fong
D000328:Adult; D000368:Aged; D001706:Biopsy; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000473:pathology; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011183:Postoperative Complications; D011832:Radiation Injuries / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed