Institute of Neurobiology, University of Puerto Rico, Medical Sciences Campus, Puerto Rico.
Exp Neurol. 2012 Jun;235(2):517-27. doi: 10.1016/j.expneurol.2012.03.011. Epub 2012 Mar 23.
Radiosurgery is an important non-invasive procedure for the treatment of tumors and vascular malformations. However, in addition to killing target tissues, cranial irradiation induces damage to adjacent healthy tissues leading to neurological deterioration in both pediatric and adult patients, which is poorly understood and insufficiently treatable. To minimize irradiation damage to healthy tissue, not the optimal therapeutic irradiation dose required to eliminate the target lesion is used but lower doses. Although the success rate of irradiation surgery is about 95%, 5% of patients suffer problems, most commonly neurological, that are thought to be a direct consequence of irradiation-induced inflammation. Although no direct correlation has been demonstrated, the appearance and disappearance of inflammation that develops following irradiation commonly parallel the appearance and disappearance of neurological side effects that are associated with the neurological function of the irradiated brain regions. These observations have led to the hypothesis that brain inflammation is causally related to the observed neurological side effects. Studies indicate that hyperbaric oxygen therapy (HBOT) applied after the appearance of irradiation-induced neurological side effects reduces the incidence and severity of those side effects. This may result from HBOT reducing inflammation, promoting angiogenesis, and influencing other cellular functions thereby suppressing events that cause the neurological side effects. However, it would be significantly better for the patient if rather than waiting for neurological side effects to become manifest they could be avoided. This review examines irradiation-induced neurological side effects, methods that minimize or resolve those side effects, and concludes with a discussion of whether HBOT applied following irradiation, but before manifestation of neurological side effects may prevent or reduce the appearance of irradiation-induced neurological side effects.
放射外科是治疗肿瘤和血管畸形的重要非侵入性方法。然而，除了杀死靶组织外，颅照射还会导致相邻健康组织损伤，导致儿童和成人患者的神经恶化，这一点了解甚少，也无法充分治疗。为了将对健康组织的照射损伤降至最低，并非使用消除靶病变所需的最佳治疗照射剂量，而是使用较低剂量。尽管放射外科手术的成功率约为 95%，但仍有 5%的患者出现问题，最常见的是神经系统问题，被认为是照射诱导炎症的直接后果。尽管没有直接相关性，但照射后发展的炎症的出现和消失通常与与照射脑区的神经功能相关的神经系统副作用的出现和消失相平行。这些观察结果导致了炎症是与观察到的神经系统副作用相关的假设。研究表明，在出现照射诱导的神经系统副作用后应用高压氧治疗（HBOT）可降低这些副作用的发生率和严重程度。这可能是由于 HBOT 降低了炎症、促进了血管生成，并影响了其他细胞功能，从而抑制了导致神经系统副作用的事件。然而，如果患者能够避免而不是等待神经系统副作用显现出来，对患者会更好。本综述检查了照射诱导的神经系统副作用、最大限度减少或解决这些副作用的方法，并讨论了在神经系统副作用显现之前，在照射后应用 HBOT 是否可以预防或减少照射诱导的神经系统副作用。
