Subacute cognitive dysfunction due to bilateral mesial temporal radionecrosis after hypophiysal macroadenoma surgery: report of a case
Sharifi G.1, Daneshpajouh B.2
۱ associate professor of neurosurgery,Loghman Hakim Hospital,shahid beheshty university of medical sciences,Tehran,iran
۲assistant professor on neurosurgery,Imam khomeiny Hospital,Urmye university of medical sciences,Urmye ,Iran
Introduction
There are different modalities to treat remnant sellar and parasellar tumor, especially hypophysial macro adenoma, such as revision surgery, drug treatment or radiotherapy (conventional, stereotactic, gamma knife).radiotherapy is used as radical or palliative modality with definite survival benefits1. However, the
treatment is not harmless and many patients suffer neurologic complications after radiation exposure. One possible sequel is the occurrence of radionecrosis which has been reported in many irradiated populations2,3-11,12,13.
After 40–۵۰ grays (Gy) of conventional, single, daily-fractionated radiation for brain tumors, the incidence rate of radiation brain injury at 5 years after treatment is about 5%. The rate increases up to 50% after a total dose of 60–۷۰ Gy.5,14,15
Cognitive impairment due to radionecrosis has been investigated in several articles, and a decline in the cognitive function of patients with brain lesions due to radiation generally has been reported2,16-19. In this article we express a case of bilateral mesial temporal radionecrosis presenting with severe cognitive dysfunctions. Similar cases have been reported with a history of radiation therapy because of nasopharyngeal carcinomas2,12.