Surgical Neurology
Volume 68, Issue 4 , Pages 466-470, October 2007

Triology of neurosurgical complications after radiotherapy for nasopharyngeal carcinoma

  • Gilberto Ka Kit Leung, MD

      Affiliations

    • Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
    • Corresponding Author InformationCorresponding author. Tel.: +852 2855 3368; fax: +1 852 2818 4350.
    • ,
  • Siu Ki Chan, MD

      Affiliations

    • Division of Anatomical Pathology, Department of Pathology and Clinical Biochemistry, Queen Mary Hospital, Hong Kong SAR, China
    • ,
  • Kwan Ngai Hung, MD

      Affiliations

    • Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China

Received 8 May 2006; accepted 26 October 2006.

Abstract 

Background

Radiotherapy is an effective treatment for NPC. With improved survival, radiation-induced neurological complications are being diagnosed more commonly. We presented a patient with a trilogy of radiation-induced pathologies after radiotherapy for NPC. The diagnostic and surgical implications are discussed.

Case Description

A 57-year-old man, previously irradiated for NPC, presented with mental confusion and was found to have radiation-induced carotid stenosis and bitemporal lobe necrosis on MR imaging. His condition deteriorated suddenly a year later, and a gliosarcoma was found to have developed within the area of right temporal lobe necrosis.

Tumor removal was complicated by injury to the MCA branches, causing basal ganglion infarction. This was likely because of a combination of technical error and arterial insufficiency secondary to radiation-induced arterial stenosis.

Conclusions

In patients with known temporal lobe radiation-induced necrosis, alternative diagnosis such as gliosarcoma should be considered when there is sudden clinical deterioration. Radiation-induced carotid stenosis may reduce the safety margin during surgery. Preoperative carotid screening may be indicated.

Abbreviations: ACA, anterior cerebral artery, CAM 5.2, anticytokeratin monoclonal antibodies clone CAM 5.2 (Becton Dickinson, San Jose, Calif), CCA, common carotid arteries, DWI, diffusion weighted images, EBER, Epstein-Barr virus-encoded early small RNA, EBV, Epstein-Barr virus, FLAIR, fluid-attenuated inversion-recovery, GFAP, glial fibrillary acidic protein, ICA, internal carotid arteries, MCA, middle cerebral artery, MEP, motor-evoked potential, MFH, malignant fibrous histiocytoma, MIB-1, monoclonal antibodies for Ki-67 labeling index, MNF116, anti-cytokeratin monoclonal antibodies clone MNF116 (DAKO, Carpinteria, Calif), MR, magnetic resonance, NAA, N-acetyl aspartate, NPC, nasopharyngeal carcinoma, T2W, T2-weighted

Keywords: Carotid stenosis, Temporal lobe necrosis, Gliosarcoma, Radiotherapy, Nasopharyngeal carcinoma

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PII: S0090-3019(06)01097-4

doi:10.1016/j.surneu.2006.10.066

Surgical Neurology
Volume 68, Issue 4 , Pages 466-470, October 2007

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