Hyperbaric Oxygen Therapy for Radio Necrosis in cerebral Arteriovenous Malformations after Stereotactic Radiosurgery
Pellot-Cestero, J.; Feleziano, C.; Nazario, J.; Rodriguez-Mercad, R.
Boletin de la Asociacion Medica de Puerto Rico 110(1): 25-28
2018
ISSN/ISBN: 0004-4849 Document Number: 703078
OBJECTIVE: The objective of this research is to present hyperbaric oxygen therapy (HBOT) as an effective treatment option in the management of symptomatic radiation-induced necrosis in patients with arteriovenous malformations (AVMs) treated with stereotactic radiosurgery. METHODS: We retrospectively reviewed all patients with diagnosis of brain AVMs who were treated at the University of Puerto Rico Hyperbaric Oxygen Medicine Center, who developed symptomatic radionecrosis after stereotactic radiosurgery with Gamma Knife from January 2003 through December March 2015. Patients who had no clinical or imaging follow-up after HBOT were excluded. RESULTS: Out of the 16 patients only 13 (81%) finished the HBOT protocol of 60 therapies. One patient died of unrelated causes during the treatment. Another patient developed seizures during the third therapy and abandoned treatment. A third patient was not compliant with the schedule. One patient is currently undergoing the second set of therapies and has improved his symptoms. Eight patients (62%) observed improvement of symptoms, four (31%), observed stabilization of them and one (8%) worsened symptoms and clinical status. CONCLUSION: In the presence of clinical and radiological diagnosis of radionecrosis after sterotactic radiosurgery we recommend starting on steroid therapy and prompt HBOT if no adequate response is observed to steroid therapy alone. HBOT should form part of the available therapeutic options at every center equipped with stereotactic radiosurgery technology or have easy access to a hyperbaric chamber facility. Nevertheless, due to our limited sample size we must continue research to further provide evidence that HBOT is a feasible and viable way to treat radiation necrosis.
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