title: Incidence of vasculopathy in children with hypothalamic/chiasmatic gliomas treated with brachytherapy.
abstract: BACKGROUND
  External brain irradiation in children can cause cognitive decline, endocrine dysfunctions and second malignancies. A rare complication is cerebral vasculopathy, which occurs most often in patients with neurofibromatosis type 1. Interstitial radiotherapy using transient Iodine-125 implants is a radiotherapy option, called brachytherapy, offering excellent survival rates, but little is known on treatment-related morbidity, especially long time vascular changes.
  
  
  METHODS
  Thirteen children with low-grade hypothalamic gliomas, four of them with neurofibromatosis type 1, were diagnosed and treated at the University Hospital Freiburg, Germany. They belong to a larger group of 44 children with suprasellar low-grade gliomas, treated with transient Iodine-125 seeds and include those who attended all routine follow-up examinations in Freiburg. After written informed consent from the parents or caregivers all patients underwent magnetic resonance imaging with angiographic techniques in 2001, 3 to 13 years after treatment.
  
  
  CONCLUSIONS
  Six out of 13 revealed cerebral vasculopathies, only one of them revealed symptoms of intermittent cerebral ischemia. Neurofibromatosis type 1 was present in one affected patient. The aetiology of the cerebral vascular changes is not fully understood so far. Tumour encasement, surgical damage and brachytherapy may contribute as a single risk factor or in combination. To get more information, we recommend MRA for artery vasculopathy at follow-up in all patients with suprasellar brain tumours irrespectively to their former treatment or presence of cerebrovascular symptoms.
authors.affiliation: Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Mathildenstr 1, 79106, Freiburg, Germany. uta.tacke@uniklinik-freiburg.de
authors.forename: U
authors.initials: U
authors.lastname: Tacke
authors.forename: D
authors.initials: D
authors.lastname: Karger
authors.forename: J
authors.initials: J
authors.lastname: Spreer
authors.forename: A
authors.initials: A
authors.lastname: Berlis
authors.forename: G
authors.initials: G
authors.lastname: Nikkhah
authors.forename: R
authors.initials: R
authors.lastname: Korinthenberg
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000453:epidemiology / Q000532:radiotherapy; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000453:epidemiology / Q000532:radiotherapy*; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D015994:Incidence; D007223:Infant; D008297:Male; D009897:Optic Chiasm / Q000473:pathology* / Q000528:radiation effects; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors