Incidence of vasculopathy in children with hypothalamic/chiasmatic gliomas treated with brachytherapy.

Abstract

INTRODUCTION:

External brain irradiation in children can cause cognitive decline, endocrine dysfunctions and second malignancies. A rare complication is cerebral vasculopathy, which occurs most often in patients with neurofibromatosis type 1. Interstitial radiotherapy using transient Iodine-125 implants is a radiotherapy option, called brachytherapy, offering excellent survival rates, but little is known on treatment-related morbidity, especially long time vascular changes.

PATIENTS AND METHODS:

Thirteen children with low-grade hypothalamic gliomas, four of them with neurofibromatosis type 1, were diagnosed and treated at the University Hospital Freiburg, Germany. They belong to a larger group of 44 children with suprasellar low-grade gliomas, treated with transient Iodine-125 seeds and include those who attended all routine follow-up examinations in Freiburg. After written informed consent from the parents or caregivers all patients underwent magnetic resonance imaging with angiographic techniques in 2001, 3 to 13 years after treatment.

RESULTS AND DISCUSSION:

Six out of 13 revealed cerebral vasculopathies, only one of them revealed symptoms of intermittent cerebral ischemia. Neurofibromatosis type 1 was present in one affected patient. The aetiology of the cerebral vascular changes is not fully understood so far. Tumour encasement, surgical damage and brachytherapy may contribute as a single risk factor or in combination. To get more information, we recommend MRA for artery vasculopathy at follow-up in all patients with suprasellar brain tumours irrespectively to their former treatment or presence of cerebrovascular symptoms.

• Authors: U Tacke, D Karger, J Spreer, A Berlis, G Nikkhah, R Korinthenberg
• Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (Childs Nerv Syst) Vol. 27 Issue 6 Pg. 961-6 (Jun 2011) ISSN: 1433-0350 [Electronic] Germany
• PMID: 21416133 (Publication Type: Comparative Study, Journal Article)

Topics

• Brachytherapy (adverse effects)
• Brain Neoplasms (epidemiology, radiotherapy)
• Cerebrovascular Disorders (epidemiology, etiology)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Glioma (epidemiology, radiotherapy)
• Humans
• Hypothalamic Neoplasms (epidemiology, radiotherapy)
• Incidence
• Infant
• Male
• Optic Chiasm (pathology, radiation effects)
• Radiation Injuries (epidemiology, etiology)
• Retrospective Studies
• Risk Factors