title: Surgical techniques in radiation induced temporal lobe necrosis in nasopharyngeal carcinoma patients.
abstract: BACKGROUND
  Radiation induced brain injury ranges from acute reversible edema to late, irreversible radiation necrosis. Radiation induced temporal lobe necrosis is associated with permanent neurological deficits and occasionally progresses to death.
  
  
  OBJECTIVE
  We present our experience with surgery on radiation induced temporal lobe necrosis (RTLN) in nasopharyngeal carcinoma (NPC) patients with special consideration of clinical presentation, surgical technique, and outcomes.
  
  
  METHODS
  This retrospective study includes 12 patients with RTLN treated by the senior author between January 2010 and December 2014. Patients initially sought medical treatment due to headache; other symptoms were hearing loss, visual deterioration, seizure, hemiparesis, vertigo, memory loss and agnosia. A temporal approach through a linear incision was performed for all cases. RTLN was found in one side in 7 patients, and bilaterally in 5. 4 patients underwent resection of necrotic tissue bilaterally and 8 patients on one side.
  
  
  RESULTS
  No death occurred in this series of cases. There were no post-operative complications, except 1 patient who developed aseptic meningitis. All 12 patients were free from headache. No seizure occurred in patients with preoperative epilepsy. Other symptoms such as hemiparesis and vertigo improved in all patients. Memory loss, agnosia and hearing loss did not change post-operatively in all cases. The follow-up MR images demonstrated no recurrence of necrotic lesions in all 12 patients.
  
  
  CONCLUSIONS
  Neurosurgical intervention through a temporal approach with linear incision is warranted in patients with radiation induced temporal lobe necrosis with significant symptoms and signs of increased intracranial pressure, minimum space occupying effect on imaging, or neurological deterioration despite conservative management.
authors.affiliation: Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 West Road of Riverside, Guangzhou 510120, China; Department of Neurosurgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Road, Guangzhou 510623, China.
authors.forename: Gobran Taha Ahmed
authors.initials: GT
authors.lastname: Alfotih
authors.affiliation: Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 West Road of Riverside, Guangzhou 510120, China.
authors.forename: Mei Guang
authors.initials: MG
authors.lastname: Zheng
authors.affiliation: Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 West Road of Riverside, Guangzhou 510120, China.
authors.forename: Wang Qing
authors.initials: WQ
authors.lastname: Cai
authors.affiliation: Department of Neurosurgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Road, Guangzhou 510623, China.
authors.forename: Xin Ke
authors.initials: XK
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 West Road of Riverside, Guangzhou 510120, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Neurosurgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Road, Guangzhou 510623, China. Electronic address: gtaaf@126.com.
authors.forename: Fang Cheng
authors.initials: FC
authors.lastname: Li
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000209:etiology / Q000601:surgery*; D002277:Carcinoma; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D009336:Necrosis / Q000209:etiology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011832:Radiation Injuries / Q000601:surgery*; D013702:Temporal Lobe / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome
keywords: Nasopharyngeal cancer; Neurosurgery; Radiation therapy; Temporal lobe necrosis