|
Results of Contemporary Surgical
Management of Radiation Necrosis using Frameless Stereotaxis and Intraoperative
Magnetic Resonance Imaging
Christopher M. McPherson, Ronald E. Warnick
The Neuroscience Institute, Department
of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH,
USA (C.M.M., R.E.W.); Mayfield Clinic, Cincinnati, OH, USA (R.E.W.)
Objective.
Radiation necrosis is a well-known complication of radiotherapy for malignant
brain tumors.
Although surgery was once considered the mainstay of treatment, no recent
reports have evaluated the use of intraoperative magnetic resonance imaging
(IOMRI) and frameless stereotaxis during surgical resection of radiation
necrosis.
In this retrospective review, we evaluate the effectiveness of surgical
resection using frameless stereotaxis and IOMRI for the treatment of radiation
necrosis.
Methods. From October 1999 through February 2002, 11
patients who had malignant brain tumors underwent surgery for radiation
necrosis.
The diagnosis of radiation necrosis was based primarily on MRI and clinical
suspicion.
Frameless stereotaxis was used in all patients and IOMRI was used in nine.
All patients underwent at least one radiation treatment before surgery and nine
patients had multiple treatments.
Patient outcome was based on changes in steroid dose, Karnofsky Performance
Score (KPS), and neurologic deficit.
Results. Optimal resection as confirmed by IOMRI was
achieved in all patients by the use of frameless stereotaxis alone; no
additional resection was performed in any patient.
For nine patients taking steroids (mean preoperative dose 24
mg/day) before treatment of necrosis, all had a substantial reduction in
steroid dosage (mean postoperative dose 8 mg/day)
after surgical treatment.
Postoperatively, KPS improved in four patients, remained stable in four, and
worsened in three.
Three complications that resulted from surgery included wound infection,
asymptomatic carotid dissection, and pulmonary embolism; thus, overall morbidity
including both surgical complications and neurologic deterioration was 54%.
Conclusions.
In this review, frameless stereotaxis was helpful in guiding the surgeon;
however, IOMRI did not provide any additional benefit for the surgical treatment
of radiation necrosis.
Surgical treatment of radiation necrosis was associated with high risks of
complication or neurologic deficit.
Given the success of medical therapies, including hyperbaric oxygen, we believe
that surgical treatment of radiation necrosis should be reserved for symptomatic
patients in whom medical therapy has failed.
Keywords: frameless stereotaxis, hyperbaric oxygen therapy, intraoperative MRI,
radiation necrosis, surgery
Copyright
©
2004 Kluwer Academic Publishers.
All rights reserved
Source: http://journals.kluweronline.com/article.asp?PIPS=5268433
|
