Treatment of delayed brain injury after pituitary irradiation
Fujii, T.; Misumi, S.; Shibasaki, T.; Tamura, M.; Kunimine, H.; Hayakawa, K.; Niibe, H.; Miyazaki, M.; Miyagi, O.
No Shinkei Geka. Neurological Surgery 16(3): 241-247
1988
ISSN/ISBN: 0301-2603 PMID: 2453809 Document Number: 308592
Treatment for delayed brain injury after irradiation is discussed. Six cases with delayed brain injury were treated with a combination of decamethasone or betamethasone, with heparin, glycerol, dextran 40 and some vasodilators. Two cases with temporal lobe syndrome were treated in the early stages of brain injury for a period of over 12 months were almost completely cured, another two cases with chiasma syndrome were treated in the relatively late stages, showed a partial improvement. One case which was irradiated 120 GY during 13 years did not improve. The final case treated with steroids for a short period also resulted in failure and the patient underwent an operation for the removal of the necrotic mass three years after the radiotherapy. Steroid therapy started in the early stages of brain injury after irradiation for over the 12 months is thought to be effective. Heparin therapy was also effective in one out of three cases, but in one of the cases subarachnoid hemorrhage from a traumatic aneurysm occurred during the therapy. In an acute phase, showing edematous change of the injured brain, the administration of glycerol is also thought to be useful. But the effectiveness of the other medicines containing some vasodilators was obscure or doubtful. We propose the following : (1) A meticulous observation is essential for the patients who recieved high doses of irradiation to diagnose brain injury in the early reversible stage. (2) Steroids should be given immediatley in this reversible stage of brain injury before the irreversible "necrosis" occurs. (3) Steroids should be maintained for a long period over 12 months. (4) Heparin therapy is also thought to be effective, but careful precautions to avoid hemorrhagic complications before the therapy should be scheduled. This recommended plan may also be used for the treatment of brain injuries after cranial irradiation for other intracranial tumors.