Yamakami I, Sugaya Y, Sato M, Osato K, Yamaura A, Makino H
Department of Neurological Surgery, Kasima Rosai Hospital.
No Shinkei Geka. 1990 Nov;18(11):1035-9.
We reported a case of a patient who developed a diffuse stenotic change in the large intracranial arteries and repeated episodes of cerebral infarction after irradiation therapy for medulloblastoma. A three-year-old girl underwent the subtotal removal of cerebellar medulloblastoma and the subsequent irradiation therapy in the whole brain and spine (30 Gy in the whole brain, 20 Gy in the local brain, and 25 Gy in the whole spine). Two years later, she again underwent surgery and irradiation therapy because a recurrence of medulloblastoma had manifested itself in the frontal lobe; (40 Gy in the whole brain, 20 Gy in the local brain, and 25 Gy in the whole spine). One and half years after the second irradiation, she started suffering from frequent and refractory cerebral ischemic attacks. Cerebral angiography revealed a diffuse narrowing, and multifocal stenoses in the bilateral anterior and middle cerebral arteries. Computerized tomography demonstrated multiple cerebral infarctions. Her neurological condition deteriorated because of recurring strokes and she died at ten years of age. Most of the reported cases of patients who developed stenotic arteriopathy were children in the first decade of their life, and who were irradiated for parasellar brain tumor of low malignancy. Stenotic arteriopathy after irradiation has rarely been recognized in patients with malignant brain tumor. However, life expectancy is increasing even for those with malignant brain tumor, and it may make stenotic arteriopathy after irradiation recognized more commonly in patients with malignant brain tumor. Careful irradiation and subsequent angiographical examination should be required even in patients with malignant brain tumor.
我们报告了一例患者，该患者在接受髓母细胞瘤放射治疗后，颅内大动脉出现弥漫性狭窄改变，并反复发作脑梗死。一名三岁女孩接受了小脑髓母细胞瘤次全切除及随后的全脑和脊髓放射治疗（全脑30 Gy，局部脑20 Gy，全脊髓25 Gy）。两年后，由于额叶出现髓母细胞瘤复发，她再次接受手术和放射治疗（全脑40 Gy，局部脑20 Gy，全脊髓25 Gy）。第二次放疗后一年半，她开始频繁发作且难以控制的脑缺血发作。脑血管造影显示双侧大脑前动脉和大脑中动脉弥漫性狭窄及多处狭窄。计算机断层扫描显示多发性脑梗死。由于反复中风，她的神经状况恶化，最终在10岁时死亡。大多数报道的发生狭窄性动脉病变的患者是10岁以内的儿童，且因低恶性度鞍旁脑肿瘤接受放疗。恶性脑肿瘤患者放疗后发生狭窄性动脉病变的情况很少见。然而，即使是恶性脑肿瘤患者，预期寿命也在增加，这可能使放疗后狭窄性动脉病变在恶性脑肿瘤患者中更常见。即使是恶性脑肿瘤患者，也需要谨慎进行放疗并随后进行血管造影检查。
