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Radiation Necrosis Secondary to Trigeminal Nerve TomoTherapy: A Cautionary Case Study.

Montoure A, Zaidi H, Sheehy JP, Shetter AG, Spetzler R - Cureus (2015)

Bottom Line: The patient improved postoperatively, but at her two-year follow up, she continued to have persistent bilateral TN and new onset seizures.Stereotactic radiosurgery (SRS) is an evolving field with broadening indications, which makes it ever more important for physicians to be aware of differences between various SRS modalities.This case report highlights a cautionary example, and emphasizes the need for a more systematic evaluation of novel SRS methods before clinical application.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Barrow Neurological Institute.

ABSTRACT
New radiation delivery modalities have recently challenged Gamma Knife surgery as the historic gold standard in the treatment of trigeminal neuralgia (TN). TomoTherapy, a relative newcomer, has been approved by the U.S. FDA for various intracranial pathologies but is currently off label for the treatment of TN. A 73-year-old female presented with gait instability, intermittent headaches, and confusion. She was treated with TomoTherapy for refractory TN at an outside facility, which failed to reduce her symptoms. Magnetic resonance imaging demonstrated a lesion in the right mesial temporal lobe. A standard right anterior temporal lobectomy was performed and the final pathological report was notable for necrosis, gliosis, and edema consistent with a remote radiation injury. The patient improved postoperatively, but at her two-year follow up, she continued to have persistent bilateral TN and new onset seizures. Imaging revealed no new mass in the resection field. Stereotactic radiosurgery (SRS) is an evolving field with broadening indications, which makes it ever more important for physicians to be aware of differences between various SRS modalities. This case report highlights a cautionary example, and emphasizes the need for a more systematic evaluation of novel SRS methods before clinical application.

No MeSH data available.


Related in: MedlinePlus

Radiation Necrosis Magnetic resonance images at presentation of a 73-year-old female with a history of trigeminal neuralgia, which was treated previously by TomoTherapy radiosurgery, shows significant mass effect in close proximity to Meckel’s cave. (A) Axial T1-weighted image with contrast; (B) axial FLAIR; (C) coronal T1-weighted image with contrast; and (D) coronal T2-weighted image. Used with permission from Barrow Neurological Institute.
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FIG1: Radiation Necrosis Magnetic resonance images at presentation of a 73-year-old female with a history of trigeminal neuralgia, which was treated previously by TomoTherapy radiosurgery, shows significant mass effect in close proximity to Meckel’s cave. (A) Axial T1-weighted image with contrast; (B) axial FLAIR; (C) coronal T1-weighted image with contrast; and (D) coronal T2-weighted image. Used with permission from Barrow Neurological Institute.

Mentions: Upon admission to our institution, the patient was confused and had evidence of a minimally diminished left upper-quadrant visual field. Hematological evaluation was notable for severe hyponatremia (124 mEq/L), which was slowly corrected over the course of 48 hours. During this time, a magnetic resonance image (MRI) study was ordered, and a 2.7x1.5x1.7 cm heterogeneously enhancing mass in the right mesial temporal lobe with perilesional edema was incidentally found (Figure 1).


Radiation Necrosis Secondary to Trigeminal Nerve TomoTherapy: A Cautionary Case Study.

Montoure A, Zaidi H, Sheehy JP, Shetter AG, Spetzler R - Cureus (2015)

Radiation Necrosis Magnetic resonance images at presentation of a 73-year-old female with a history of trigeminal neuralgia, which was treated previously by TomoTherapy radiosurgery, shows significant mass effect in close proximity to Meckel’s cave. (A) Axial T1-weighted image with contrast; (B) axial FLAIR; (C) coronal T1-weighted image with contrast; and (D) coronal T2-weighted image. Used with permission from Barrow Neurological Institute.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494583&req=5

FIG1: Radiation Necrosis Magnetic resonance images at presentation of a 73-year-old female with a history of trigeminal neuralgia, which was treated previously by TomoTherapy radiosurgery, shows significant mass effect in close proximity to Meckel’s cave. (A) Axial T1-weighted image with contrast; (B) axial FLAIR; (C) coronal T1-weighted image with contrast; and (D) coronal T2-weighted image. Used with permission from Barrow Neurological Institute.
Mentions: Upon admission to our institution, the patient was confused and had evidence of a minimally diminished left upper-quadrant visual field. Hematological evaluation was notable for severe hyponatremia (124 mEq/L), which was slowly corrected over the course of 48 hours. During this time, a magnetic resonance image (MRI) study was ordered, and a 2.7x1.5x1.7 cm heterogeneously enhancing mass in the right mesial temporal lobe with perilesional edema was incidentally found (Figure 1).

Bottom Line: The patient improved postoperatively, but at her two-year follow up, she continued to have persistent bilateral TN and new onset seizures.Stereotactic radiosurgery (SRS) is an evolving field with broadening indications, which makes it ever more important for physicians to be aware of differences between various SRS modalities.This case report highlights a cautionary example, and emphasizes the need for a more systematic evaluation of novel SRS methods before clinical application.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Barrow Neurological Institute.

ABSTRACT
New radiation delivery modalities have recently challenged Gamma Knife surgery as the historic gold standard in the treatment of trigeminal neuralgia (TN). TomoTherapy, a relative newcomer, has been approved by the U.S. FDA for various intracranial pathologies but is currently off label for the treatment of TN. A 73-year-old female presented with gait instability, intermittent headaches, and confusion. She was treated with TomoTherapy for refractory TN at an outside facility, which failed to reduce her symptoms. Magnetic resonance imaging demonstrated a lesion in the right mesial temporal lobe. A standard right anterior temporal lobectomy was performed and the final pathological report was notable for necrosis, gliosis, and edema consistent with a remote radiation injury. The patient improved postoperatively, but at her two-year follow up, she continued to have persistent bilateral TN and new onset seizures. Imaging revealed no new mass in the resection field. Stereotactic radiosurgery (SRS) is an evolving field with broadening indications, which makes it ever more important for physicians to be aware of differences between various SRS modalities. This case report highlights a cautionary example, and emphasizes the need for a more systematic evaluation of novel SRS methods before clinical application.

No MeSH data available.


Related in: MedlinePlus