Kim Tae-Gon, Kim Dong-Seok, Chung Sang-Sup, Choi Joong-Uhn
Department of Neurosurgery, CHA University College of Medicine, Seongnam-City, Seoul, Korea.
Pediatr Neurosurg. 2011;47(2):138-42. doi: 10.1159/000330541. Epub 2011 Sep 2.
Potentially harmful effects of irradiation on the developing central nervous system have been well documented. We report 2 pediatric patients with moyamoya syndrome developed after irradiation.
A 3-year-old girl had received 4,860 cGy of postoperative radiation for optic pathway glioma. Cerebral angiography 7 months after completion of the radiation therapy revealed progressive cerebral arterial occlusive disease, involving the internal carotid artery on either side of the circle of Willis, with abnormal netlike vessels. Another 5-year-old girl had received 3,600 cGy of postoperative radiation on the cerebrum for a medulloblastoma. Two years later, she was diagnosed with moyamoya syndrome and treated with indirect revascularization. She died due to further progressive obstruction of the right M1 and A1 on the unoperated hemisphere, in spite of well-developed collateral circulation from the superficial temporal artery and middle meningeal artery on the operated left hemisphere. We suggest that radiation therapy with portals typically including carotid siphon may particularly cause vascular damage, regardless of the tumor pathology and lead to radiation-induced moyamoya syndrome. The prognosis may be poorer in case of poor collateral flow and rapid progression. The radiation therapy may cause fatal vascular damage so it should be taken into consideration when a treatment plan is being formulated for young patients.
辐射对发育中的中枢神经系统的潜在有害影响已有充分记录。我们报告了2例放疗后发生烟雾病综合征的儿科患者。
一名3岁女孩因视神经通路胶质瘤接受了4860 cGy的术后放疗。放疗结束7个月后进行的脑血管造影显示，大脑动脉闭塞性疾病进展，累及 Willis 环两侧的颈内动脉，伴有异常的网状血管。另一名5岁女孩因髓母细胞瘤接受了3600 cGy的大脑术后放疗。两年后，她被诊断为烟雾病综合征并接受了间接血管重建治疗。尽管手术侧左半球颞浅动脉和脑膜中动脉的侧支循环发育良好，但她仍因未手术侧半球右侧M1和A1进一步渐进性阻塞而死亡。我们认为，通常包括颈动脉虹吸部的放疗野可能特别会导致血管损伤，无论肿瘤病理如何，并导致放射性烟雾病综合征。侧支血流不良和快速进展的情况下预后可能更差。放疗可能会导致致命的血管损伤，因此在为年轻患者制定治疗方案时应予以考虑。
