title: Repeated delayed onset cerebellar radiation injuries after linear accelerator-based stereotactic radiosurgery for vestibular schwannoma: case report.
abstract: A 63-year-old woman presented with right hearing disturbance and vertigo. Magnetic resonance (MR) imaging revealed the presence of right vestibular schwannoma (VS). Stereotactic radiosurgery (SRS) was performed with a tumor marginal dose of 14 Gy using two isocenters. She was followed up clinically and neuroradiologically using three-dimensional spoiled gradient-echo MR imaging. She experienced temporal neurological deterioration due to peritumoral edema in her right cerebellar peduncle and pons for a few months beginning 1.5 years after SRS, when she experienced transient right facial dysesthesia and hearing deterioration. Ten years after SRS, the patient presented with sudden onset of vertigo, gait disturbance, diplopia, dysarthria, and nausea. MR imaging demonstrated a new lesion in the right cerebellar peduncle, which was diagnosed as radiation-induced stroke. The patient was followed up conservatively and her symptoms disappeared within a few months. Multiple delayed onset radiation injuries are possible sequelae of SRS for VS.
authors.affiliation: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki.
authors.forename: Kenta
authors.initials: K
authors.lastname: Ujifuku
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsuo
authors.forename: Keisuke
authors.initials: K
authors.lastname: Toyoda
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Okunaga
authors.forename: Yukishige
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kamada
authors.forename: Minoru
authors.initials: M
authors.lastname: Morikawa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Suyama
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hayashi
mesh_terms: D001929:Brain Edema / Q000175:diagnosis; D002531:Cerebellum / Q000098:blood supply / Q000528:radiation effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009460:Neurologic Examination; D009464:Neuroma, Acoustic / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis*; D011832:Radiation Injuries / Q000175:diagnosis*; D016634:Radiosurgery / Q000009:adverse effects*; D020521:Stroke / Q000175:diagnosis*