Department of Neurosurgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, Special Administrative Region, China.
J Neurosurg. 2010 Aug;113(2):293-300. doi: 10.3171/2010.1.JNS091039.
In theory, the purpose of the treatment of cerebral radionecrosis (CRN), a nonneoplastic condition, is to minimize loss of brain function by preventing the progression and reversing some of the processes of CRN. In a practical sense, factors for achieving this purpose may include the following: removal of a CRN lesion that is causing mass effect, control of brain edema, prevention of recurrence of CRN lesions, minimization of adverse effects from treatments, and achievement of reasonably long and good-quality survivals. Based on these practical issues, the authors performed a retrospective study to evaluate the results of excision for the treatment of CRN.
The authors retrospectively reviewed the results of excision of CRN lesions in a group of patients with temporal lobe CRN due to radiotherapy for nasopharyngeal carcinoma. Patients who had undergone surgery at the authors' institution between January 1998 and November 2008 were analyzed. Surgical results were evaluated by assessing postoperative resolution of brain edema, recurrence of temporal lobe CRN, surgery-related complications, and postoperative functional status and survival.
Twenty-four patients were included (age range 39-69 years; in 23 patients nasopharyngeal carcinoma was in remission). All patients underwent craniotomy for excision of the contrast-enhancing region. The indications for operation were temporal lobe CRN lesions with a mass-occupying effect beyond the temporal lobe. There were 32 craniotomies in all (mean postoperative follow-up 40 months). It was found that brain edema resolved rapidly postoperatively. The recurrence and reoperation rates were 6.3 and 3.1%, respectively. There were no surgery-related deaths. The median survival was 72 months, and 67% of the patients had a Karnofsky Performance Scale score of > or = 70% at the time of their last follow-up.
In a specific group of patients with CRN of the temporal lobe in whom the CRN lesions were causing a mass-occupying effect beyond the temporal lobe, excision of the contrast-enhancing region was safe and could achieve prompt resolution of brain edema and a low incidence of recurrence of CRN.
理论上，放射性脑坏死（CRN）是一种非肿瘤性疾病，其治疗目的是通过防止 CRN 进展和逆转其部分进程来尽量减少脑功能丧失。实际上，达到这一目的的因素可能包括以下几点：切除导致占位效应的 CRN 病变、控制脑水肿、预防 CRN 病变复发、使治疗的不良反应最小化以及实现合理的长期高质量生存。基于这些实际问题，作者进行了一项回顾性研究，以评估切除治疗 CRN 的结果。
作者对因鼻咽癌放疗而导致颞叶 CRN 的一组患者的 CRN 病变切除术结果进行了回顾性研究。分析了作者所在机构于 1998 年 1 月至 2008 年 11 月间接受手术的患者。通过评估术后脑水肿的缓解情况、颞叶 CRN 的复发情况、手术相关并发症以及术后功能状态和生存情况来评估手术结果。
共纳入 24 例患者（年龄 39-69 岁；23 例患者鼻咽癌缓解）。所有患者均行开颅切除术切除强化区。手术指征为占位效应超过颞叶的颞叶 CRN 病变。共行 32 次开颅术（平均术后随访 40 个月）。术后发现脑水肿迅速缓解。复发和再次手术的发生率分别为 6.3%和 3.1%。无手术相关死亡。中位生存期为 72 个月，末次随访时 67%的患者 Karnofsky 表现量表评分≥70%。
在一组特定的颞叶 CRN 患者中，CRN 病变导致占位效应超过颞叶，切除强化区是安全的，可以迅速缓解脑水肿，CRN 复发率低。
