Fulminant radiation-induced necrosis after stereotactic radiation therapy to the posterior fossa - Case report and review of the literature

The problem of radiation-induced necrosis of normal brain surrounding the t arget area has been a major catalyst for the development of stereotacticall y focused radiation therapy. According to current opinion, the effects of s tereotactic irradiation are confined to the region targeted. The authors pr esent a case in which the administration of a conventional dose of stereota ctically focused irradiation for treatment of a pilocytic astrocytoma produ ced fulminant necrosis that necessitated a combination of intensive surgica l and medical management, after which the patient improved over the course of 1 year. Concomitant with his improvement, the initially remarkable findi ngs on magnetic resonance imaging gradually resolved. In this presentation the authors emphasize the need to evaluate alternative s carefully before a decision is made to administer therapeutic irradiation . Furthermore, they explore the roles that target, host, and dosage factors play in hypersensitivity to radiation injury, the detection of these facto rs before treatment, and the administration of radioprotective agents. With the growing use of stereotactically focused irradiation as a primary treat ment modality for a variety of neurosurgical conditions, it is important to be cognizant of its uncommon but potentially lethal side effects. A cooper ative multicenter database in which the outcomes and morbidity following st ereotactic irradiation are recorded is essential to the detection of relati vely uncommon but severe complications such as those observed in this case.