Redjal Navid, Agarwalla Pankaj K, Dietrich Jorg, Dinevski Nikolaj, Stemmer-Rachamimov Anat, Nahed Brian V, Loeffler Jay S
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
J Clin Neurosci. 2015 Aug;22(8):1367-9. doi: 10.1016/j.jocn.2015.02.017. Epub 2015 Apr 27.
We present a unique patient with delayed onset, acute demyelination that occurred distant to the effective field of radiation after proton beam radiotherapy for an optic nerve sheath meningioma. The use of stereotactic radiotherapy as an effective treatment modality for some brain tumors is increasing, given technological advances which allow for improved targeting precision. Proton beam radiotherapy improves the precision further by reducing unnecessary radiation to surrounding tissues. A 42-year-old woman was diagnosed with an optic nerve sheath meningioma after initially presenting with vision loss. After biopsy of the lesion to establish diagnosis, the patient underwent stereotactic proton beam radiotherapy to a small area localized to the tumor. Subsequently, the patient developed a large enhancing mass-like lesion with edema in a region outside of the effective radiation field in the ipsilateral frontal lobe. Given imaging features suggestive of possible primary malignant brain tumor, biopsy of this new lesion was performed and revealed an acute demyelinating process. This patient illustrates the importance of considering delayed onset acute demyelination in the differential diagnosis of enhancing lesions in patients previously treated with radiation.
我们报告了一例独特的患者，该患者在接受质子束放射治疗视神经鞘膜瘤后，出现了延迟发作的急性脱髓鞘，且病变位于放射有效区域之外。随着技术进步提高了靶向精度，立体定向放射治疗作为某些脑肿瘤的有效治疗方式的应用正在增加。质子束放射治疗通过减少对周围组织的不必要辐射进一步提高了精度。一名42岁女性最初因视力丧失就诊，后被诊断为视神经鞘膜瘤。在对病变进行活检以确诊后，患者接受了针对肿瘤局部小区域的立体定向质子束放射治疗。随后，患者在同侧额叶放射有效区域外的一个区域出现了一个伴有水肿的大的强化肿块样病变。鉴于影像学特征提示可能为原发性恶性脑肿瘤，对这个新病变进行了活检，结果显示为急性脱髓鞘过程。该患者说明了在先前接受过放射治疗的患者中，增强病变的鉴别诊断中考虑延迟发作急性脱髓鞘的重要性。
