Kestle J R, Hoffman H J, Mock A R
Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Neurosurg. 1993 Jul;79(1):32-5. doi: 10.3171/jns.1993.79.1.0032.
The role of radiotherapy in the management of patients with optic pathway glioma is controversial. In a series of patients with optic pathway glioma treated at The Hospital for Sick Children in Toronto, five children were encountered who developed moyamoya phenomenon after radiotherapy. A retrospective review of the medical records was undertaken in order to assess the relationship between optic pathway glioma, neurofibromatosis type 1 (NF1), radiation therapy, and moyamoya disease. Forty-seven patients with optic pathway glioma were operated on at The Hospital for Sick Children between 1971 and 1990. The moyamoya phenomenon did not occur in any of the 19 patients not receiving radiotherapy. Among the 28 patients who received radiotherapy, five developed moyamoya disease (two of 23 without NF1 and three of five with NF1). There was a statistically significant relationship between radiotherapy and moyamoya disease when the analysis was stratified according to the presence of NF1 (Mantel-Haensel chi-squared test 15.23, p < 0.01). The high incidence of moyamoya disease (three of five cases, or 60%) in patients with NF1 who have undergone radiotherapy suggests a synergistic relationship that should be considered when formulating a treatment plan for NF1 patients with optic pathway glioma.
放射治疗在视神经通路胶质瘤患者的治疗中所起的作用存在争议。在多伦多病童医院接受治疗的一系列视神经通路胶质瘤患者中，发现有5名儿童在放疗后出现了烟雾病现象。为了评估视神经通路胶质瘤、1型神经纤维瘤病（NF1）、放射治疗与烟雾病之间的关系，对病历进行了回顾性研究。1971年至1990年间，有47例视神经通路胶质瘤患者在多伦多病童医院接受了手术。在19例未接受放疗的患者中，均未出现烟雾病现象。在28例接受放疗的患者中，有5例患上了烟雾病（23例无NF1的患者中有2例，5例有NF1的患者中有3例）。根据是否存在NF1进行分层分析时，放疗与烟雾病之间存在统计学上的显著关系（Mantel-Haensel卡方检验15.23，p<0.01）。接受放疗的NF1患者中烟雾病的高发病率（5例中有3例，即60%）表明存在一种协同关系，在为患有视神经通路胶质瘤的NF1患者制定治疗方案时应予以考虑。
