Hong Christopher S, Gokozan Hamza N, Otero José J, Guiou Michael, Elder J Bradley
Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, Doan Hall N1052, Columbus, OH 43210, USA.
Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Case Rep Neurol Med. 2014;2014:717984. doi: 10.1155/2014/717984. Epub 2014 Sep 30.
Cerebral radiation necrosis (CRN) is a well described possible complication of radiation for treatment of intracranial pathology. However, CRN as sequelae of radiation to extracranial sites is rare. Neutron beam radiation is a highly potent form of radiotherapy that may be used to treat malignant tumors of the salivary glands. This report describes a patient who underwent neutron beam radiation for a parotid adenocarcinoma and who developed biopsy-confirmed temporal lobe radiation necrosis thirty months later. This represents the longest time interval described to date, from initial neutron radiation for extracranial pathology to development of CRN. Two other detailed case studies exist in the literature and are described in this report. These reports as well as our patient's case are reviewed, and additional recommendations are made to minimize the development of CRN after extracranial neutron beam radiation. Physicians should include the possible diagnosis of CRN in any patient with new neurologic signs or symptoms and a history of head and neck radiation that included planned fields extending to the base of the skull. Counseling of patients prior to neutron beam radiation should include potential neurologic complications associated with CRN and risks of treatment for CRN including neurosurgical intervention.
脑放射坏死（CRN）是一种已被充分描述的颅内病变放射治疗可能出现的并发症。然而，CRN作为颅外部位放射治疗的后遗症却很罕见。中子束放射是一种高效的放射治疗形式，可用于治疗唾液腺恶性肿瘤。本报告描述了一名接受中子束放射治疗腮腺腺癌的患者，该患者在三十个月后经活检确诊为颞叶放射坏死。这是迄今为止所描述的从最初对颅外病变进行中子放射到发生CRN的最长时间间隔。文献中还存在另外两个详细的病例研究，并在本报告中进行了描述。对这些报告以及我们患者的病例进行了回顾，并提出了其他建议，以尽量减少颅外中子束放射后CRN的发生。对于任何有新的神经系统体征或症状且有头颈部放射治疗史（包括计划野延伸至颅底）的患者，医生应考虑CRN的可能诊断。在进行中子束放射治疗前，对患者的咨询应包括与CRN相关的潜在神经系统并发症以及CRN治疗的风险，包括神经外科干预。
