Lew Sean M, Morgan Joseph N, Psaty Estee, Lefton Daniel R, Allen Jeffrey C, Abbott Rick
Department of Neurosurgery, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
J Neurosurg. 2006 Feb;104(2 Suppl):103-7. doi: 10.3171/ped.2006.104.2.103.
The goal of this study was to determine the incidence of radiation-induced cavernomas in children treated for medulloblastoma.
A retrospective chart and film review was performed for all patients treated for medulloblastoma at the Insitute for Neurology and Neurosurgery/Beth Israel Medical Center between August 1996 and the present. The clinical and radiographic histories of pediatric patients (ages 3-21 years at diagnosis) with a histologically confirmed diagnosis of medulloblastoma who received craniospinal radiation therapy were reviewed. Fifty-nine patients were identified, with a mean age at radiation treatment of 7.7 years and a mean follow-up time of 7.2 years. The dose to the craniospinal axis was 24 Gy (31 patients) or 36 Gy (28 patients). The radiation energy in the craniospinal axis was provided by photons in 55 patients and protons in four. All patients received a posterior fossa boost of 54 Gy (46 patients) or 72 Gy (13 patients). Twenty-six lesions developed in 18 patients (31%) during the observation period. The cumulative incidence of lesion development was 5.6, 14, and 43%, at 3, 5, and 10 years, respectively. The sites of occurrence were cerebral (20 cases) and cerebellar (six cases). There was no significant correlation between age at diagnosis, sex, craniospinal radiation dose or energy source, and lesion development. Only one patient required surgical intervention for a symptomatic hemorrhagic lesion in the frontal lobe. Histological analysis in this case was consistent with cavernoma.
Cavernomas are common after cranial irradiation in children, and their incidence increases over time. Most of these lesions follow a benign course and do not require intervention.
本研究的目的是确定接受髓母细胞瘤治疗的儿童中放射性海绵状血管瘤的发生率。
对1996年8月至目前在神经病学和神经外科研究所/贝斯以色列医疗中心接受髓母细胞瘤治疗的所有患者进行了回顾性病历和影像学检查。对组织学确诊为髓母细胞瘤且接受颅脊髓放射治疗的儿科患者（诊断时年龄3至21岁）的临床和影像学病史进行了回顾。共确定了59例患者，放射治疗时的平均年龄为7.7岁，平均随访时间为7.2年。颅脊髓轴的剂量为24 Gy（31例患者）或36 Gy（28例患者）。55例患者的颅脊髓轴放射能量由光子提供，4例由质子提供。所有患者均接受了54 Gy（46例患者）或72 Gy（13例患者）的后颅窝增强照射。在观察期内，18例患者（31%）出现了26个病灶。病灶发生的累积发生率在3年、5年和10年时分别为5.6%、14%和43%。发生部位为脑（20例）和小脑（6例）。诊断时的年龄、性别、颅脊髓放射剂量或能量来源与病灶发生之间无显著相关性。只有1例患者因额叶有症状性出血性病灶而需要手术干预。该病例的组织学分析与海绵状血管瘤一致。
儿童颅脑照射后海绵状血管瘤很常见，且其发生率随时间增加。这些病灶大多呈良性病程，无需干预。
