title: Severe Radiation Necrosis Successfully Treated With Bevacizumab in an Infant with Low-Grade Glioma and Tumor-Associated Intractable Trigeminal Neuralgia.
abstract: We present a unique case of radiation necrosis in a child with brain stem low-grade glioma (LGG) presenting with trigeminal neuralgia. Despite extensive therapies, severe pain persisted. She received proton beam radiation with significant improvement. However, she developed radiation necrosis and hydrocephalus. Despite surgical correction of hydrocephalus, the patient remained critically ill. She was treated with dexamethasone and bevacizumab with rapid clinical improvement. Subsequent MRIs revealed almost complete resolution of the necrosis. This case illustrates the successful treatment of trigeminal neuralgia with radiation and a rare case of radiation necrosis in an LGG successfully treated with bevacizumab and dexamethasone.
authors.affiliation: Department of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Natasha
authors.initials: N
authors.lastname: Pillay Smiley
authors.affiliation: Department of Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Tord
authors.initials: T
authors.lastname: Alden
authors.affiliation: Proton Center of Northwestern Memorial Hospital, Warrenville, Illinois.|Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: William
authors.initials: W
authors.lastname: Hartsell
authors.affiliation: Department of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Jason
authors.initials: J
authors.lastname: Fangusaro
mesh_terms: D000068258:Bevacizumab / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000150:complications / Q000532:radiotherapy*; D005260:Female; D005910:Glioma / Q000150:complications / Q000532:radiotherapy*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007223:Infant; D009336:Necrosis; D061766:Proton Therapy / Q000009:adverse effects*; D011832:Radiation Injuries / Q000188:drug therapy*; D014277:Trigeminal Neuralgia / Q000532:radiotherapy*
chemical_list: D000068258:Bevacizumab
keywords: facial tics; infant low-grade glioma; pain; pilomyxoid astrocytoma; proton beam radiation