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[Fulminating midbrain irradiation injury of pediatric brain tumor]
Satoko Ochi1, Yoshio Takahashi, Shigeaki Yokoyama
1Department of Neurosurgery, Hokkaido Children's Hospital and Medical Center, 1-10-1 Zenibako, Otaru-shi, Hokkaido 047-0261, Japan.
Insights
Pediatric radiation therapy can cause severe midbrain damage, leading to serious neurological issues. Careful planning is crucial, especially for children, due to the midbrain
Area of Science:
- Pediatric Neurology
- Radiation Oncology
- Neuro-oncology
Background:
- Radiation therapy is a critical treatment for pediatric brain tumors.
- The midbrain's complex anatomy presents unique challenges for radiation delivery.
- Delayed radiation effects in pediatric midbrain injuries are infrequently reported.
Observation:
- Two pediatric cases illustrate severe neurological sequelae following midbrain radiation.
- A boy with tectal glioma developed oculomotor palsy and drowsiness post-gamma knife surgery.
- A girl with medulloblastoma experienced coma and acute aqueduct obstruction after conventional radiotherapy.
Findings:
- Pathological diagnosis revealed early delayed radiation reaction in one case.
- Tumor progression occurred despite initial treatment, necessitating surgical intervention.
- Diffuse midbrain damage and aqueduct obstruction resolved in the second patient.
Implications:
- Midbrain radiation injuries in children, though rare, can manifest as severe, emergent symptoms.
- Meticulous radiation planning and delivery are essential for pediatric midbrain tumors.
- These cases highlight the need for vigilance regarding potential neurological complications in pediatric radiation oncology.
Abstract:
We report two children with post radiation midbrain damage causing severe neurological symptoms. A twelve-year-old boy with a four year history of hydrocephalus was diagnosed with tectal glioma, which endoscopic biopsy revealed to be low grade. He underwent gamma knife radiation surgery (central 24 Gy/peripheral 12 Gy). Two months later bilateral ptosis followed by total oculomotor palsy and drowsiness developed. Despite pulsed-steroid therapy the tumor size increased up to 4.6 times in volume. The tumor was totally removed and was diagnosed as an early delayed radiation reaction pathologically. His symptoms disappeared except for a slight upper gaze palsy. The second patient was a six-year-old girl with a medulloblastoma. Following total resection and a VP shunt she received conventional radiation therapy along with chemotherapy. After the final irradiation she became comatose (JCS II-2) and MRI revealed diffuse midbrain damage with acute aqueduct obstruction, which recovered in two weeks. Reports of irradiation injuries of the midbrain in childhood are rare but it should be considered as a possible cause of fulminant symptoms requiring emergency treatment. Because of midbrain anatomical complexity, midbrain radiation therapy requires great care, especially in children.
