open access

Vol 50, No 3 (2016)
Original research articles
Submitted: 2015-08-22
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Surgical techniques in radiation induced temporal lobe necrosis in nasopharyngeal carcinoma patients

Gobran Taha Ahmed Alfotih, Mei Guang Zheng, Wang Qing Cai, Xin Ke Xu, Zhen Hu, Fang Cheng Li
DOI: 10.1016/j.pjnns.2016.02.007
·
Neurol Neurochir Pol 2016;50(3):172-179.

open access

Vol 50, No 3 (2016)
Original research articles
Submitted: 2015-08-22

Abstract

Background

Radiation induced brain injury ranges from acute reversible edema to late, irreversible radiation necrosis. Radiation induced temporal lobe necrosis is associated with permanent neurological deficits and occasionally progresses to death.

Objective

We present our experience with surgery on radiation induced temporal lobe necrosis (RTLN) in nasopharyngeal carcinoma (NPC) patients with special consideration of clinical presentation, surgical technique, and outcomes.

Method

This retrospective study includes 12 patients with RTLN treated by the senior author between January 2010 and December 2014. Patients initially sought medical treatment due to headache; other symptoms were hearing loss, visual deterioration, seizure, hemiparesis, vertigo, memory loss and agnosia. A temporal approach through a linear incision was performed for all cases. RTLN was found in one side in 7 patients, and bilaterally in 5. 4 patients underwent resection of necrotic tissue bilaterally and 8 patients on one side.

Results

No death occurred in this series of cases. There were no post-operative complications, except 1 patient who developed aseptic meningitis. All 12 patients were free from headache. No seizure occurred in patients with preoperative epilepsy. Other symptoms such as hemiparesis and vertigo improved in all patients. Memory loss, agnosia and hearing loss did not change post-operatively in all cases. The follow-up MR images demonstrated no recurrence of necrotic lesions in all 12 patients.

Conclusion

Neurosurgical intervention through a temporal approach with linear incision is warranted in patients with radiation induced temporal lobe necrosis with significant symptoms and signs of increased intracranial pressure, minimum space occupying effect on imaging, or neurological deterioration despite conservative management.

Abstract

Background

Radiation induced brain injury ranges from acute reversible edema to late, irreversible radiation necrosis. Radiation induced temporal lobe necrosis is associated with permanent neurological deficits and occasionally progresses to death.

Objective

We present our experience with surgery on radiation induced temporal lobe necrosis (RTLN) in nasopharyngeal carcinoma (NPC) patients with special consideration of clinical presentation, surgical technique, and outcomes.

Method

This retrospective study includes 12 patients with RTLN treated by the senior author between January 2010 and December 2014. Patients initially sought medical treatment due to headache; other symptoms were hearing loss, visual deterioration, seizure, hemiparesis, vertigo, memory loss and agnosia. A temporal approach through a linear incision was performed for all cases. RTLN was found in one side in 7 patients, and bilaterally in 5. 4 patients underwent resection of necrotic tissue bilaterally and 8 patients on one side.

Results

No death occurred in this series of cases. There were no post-operative complications, except 1 patient who developed aseptic meningitis. All 12 patients were free from headache. No seizure occurred in patients with preoperative epilepsy. Other symptoms such as hemiparesis and vertigo improved in all patients. Memory loss, agnosia and hearing loss did not change post-operatively in all cases. The follow-up MR images demonstrated no recurrence of necrotic lesions in all 12 patients.

Conclusion

Neurosurgical intervention through a temporal approach with linear incision is warranted in patients with radiation induced temporal lobe necrosis with significant symptoms and signs of increased intracranial pressure, minimum space occupying effect on imaging, or neurological deterioration despite conservative management.

Get Citation

Keywords

Nasopharyngeal cancer, Radiation therapy, Temporal lobe necrosis, Neurosurgery

About this article
Title

Surgical techniques in radiation induced temporal lobe necrosis in nasopharyngeal carcinoma patients

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 50, No 3 (2016)

Pages

172-179

DOI

10.1016/j.pjnns.2016.02.007

Bibliographic record

Neurol Neurochir Pol 2016;50(3):172-179.

Keywords

Nasopharyngeal cancer
Radiation therapy
Temporal lobe necrosis
Neurosurgery

Authors

Gobran Taha Ahmed Alfotih
Mei Guang Zheng
Wang Qing Cai
Xin Ke Xu
Zhen Hu
Fang Cheng Li

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