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伽玛刀放射外科治疗下丘脑错构瘤后的神经并发症。

Neurological complications after gamma-knife radiosurgery for hypothalamic hamartoma.

作者信息

Butragueño Laiseca Laura, Oikonomopoulou Niki, Miranda Herrero María Concepción, Barredo Valderrama Estíbaliz, Vázquez López María, Jiménez de Domingo Ana, Aguado Del Hoyo Alejandra, García-Leal Roberto, Meiriño Rosa M

机构信息

Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Department of Neuropediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

出版信息

Eur J Paediatr Neurol. 2016 Sep;20(5):745-9. doi: 10.1016/j.ejpn.2016.05.008. Epub 2016 May 25.

Abstract

BACKGROUND

The Gamma-knife technique is a safe and effective option for the treatment of hypothalamic hamartomas that produce epileptic seizures refractory to medical treatment and/or serious behavioral disorders. After this type of radiosurgery, an adequate symptomatic control is normally achieved, with notable decrease or even disappearance of the seizures. Radiological changes, such as a decrease in the size of the tumor or adjacent edema secondary to non-necrotizing radioinduced inflammatory reaction are unusual consequences. Side effects and neurological complications are also rare events.

CASE PRESENTATION

This report describes an unusual case of complete radiological resolution of a hypothalamic hamartoma as well as neurological complications after Gamma-knife surgery (receiving 13 Gy to the 85% isodose line, 1 cm(3) of tumor volume) in a 8-year-old boy who suffered from severe refractory seizures. After radiosurgery, the patient experienced a notable improvement in his symptoms, achieving seizure cessation within 3 months. However, 4 months after the procedure he presented drowsiness, fever and decreased level of consciousness due to a direct effect on the hypothalamus with local and regional edema secondary to the radiosurgery that was performed. He was successfully treated with corticosteroids (with a total duration of 11 months), and twelve months after the surgery, complete disappearance of both the nodular lesion and the secondary edema was observed. The patient remains seizure-free in the last 16 months, with remarkable changes in his behavior.

CONCLUSIONS

The present case shows that complete radiological resolution of a hypothalamic hamartoma after Gamma-knife technique is unusual but possible, without long-term neurological consequences. Nevertheless, despite its low incidence, if a patient presents neurological symptoms, primarily during the first year after intervention, possible complications of this type of surgery must be taken into account.

摘要

背景

伽玛刀技术是治疗下丘脑错构瘤的一种安全有效的选择,这些错构瘤会引发药物治疗难治的癫痫发作和/或严重行为障碍。在进行这种放射外科手术后,通常能实现充分的症状控制,癫痫发作显著减少甚至消失。放射学变化,如肿瘤大小减小或因非坏死性放射诱导炎症反应导致的相邻水肿,是不常见的结果。副作用和神经并发症也是罕见事件。

病例报告

本报告描述了一名8岁患有严重难治性癫痫发作的男孩,在接受伽玛刀手术(85%等剂量线接受13 Gy,肿瘤体积1 cm³)后,下丘脑错构瘤出现罕见的完全放射学消退以及神经并发症的病例。放射外科手术后,患者症状明显改善,3个月内癫痫发作停止。然而,术后4个月,由于放射外科手术对下丘脑的直接影响,出现局部和区域水肿,患者出现嗜睡、发热和意识水平下降。他通过皮质类固醇成功治疗(总疗程11个月),术后12个月,结节性病变和继发性水肿均完全消失。在过去16个月里,患者一直无癫痫发作,行为有显著变化。

结论

本病例表明,伽玛刀技术治疗后下丘脑错构瘤出现完全放射学消退虽不常见但有可能,且无长期神经后果。然而,尽管其发生率低,但如果患者出现神经症状,主要是在干预后的第一年,必须考虑这种手术可能的并发症。

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