Lynn Michael, Friedman William A
Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA.
Neurosurgery. 2007 Mar;60(3):E579; discussion E579. doi: 10.1227/01.NEU.0000255343.41206.6F.
Hyperbaric oxygenation is a rarely used method of treatment for steroid-refractory radiation-induced edema after stereotactic radiosurgery. We present its successful implementation for a radiosurgical complication after the treatment of a deep, large arteriovenous malformation. We also review the literature on hyperbaric oxygenation for radiation-induced complications.
A 25-year-old man underwent radiosurgical treatment for a large arteriovenous malformation. Three years later, substantially smaller remaining nidus was retreated. Five months after that treatment, the patient developed edema around the nidus and hemiparesis. This problem was refractory to high-dose steroids.
The patient underwent a course of 25 hyperbaric oxygenation treatments. Within 1 month, the edema and hemiparesis had improved, allowing steroids to be tapered. A follow-up examination 1 year later revealed complete thrombosis of the arteriovenous malformation and minimal neurological deficit.
This technical case report adds to the few studies in the literature suggesting that hyperbaric oxygenation therapy, in conjunction with a slow steroid taper, is a reasonable addition to the treatment armamentarium for radiation-induced cerebral edema associated with clinically evident neurological deficits.
高压氧疗是一种很少用于治疗立体定向放射外科术后类固醇难治性放射性水肿的方法。我们报告了其在治疗深部大型动静脉畸形后放射性外科并发症中的成功应用。我们还回顾了关于高压氧疗治疗放射性并发症的文献。
一名25岁男性接受了大型动静脉畸形的放射外科治疗。三年后，对残留的明显较小的病灶进行了再次治疗。在那次治疗五个月后，患者在病灶周围出现水肿和偏瘫。这个问题对高剂量类固醇治疗无效。
该患者接受了25次高压氧疗疗程。在1个月内，水肿和偏瘫有所改善，类固醇药物得以逐渐减量。1年后的随访检查显示动静脉畸形完全血栓形成，神经功能缺损轻微。
本技术病例报告补充了文献中少数研究，表明高压氧疗结合缓慢减少类固醇用量，是治疗伴有临床明显神经功能缺损的放射性脑水肿的合理补充治疗手段。
