脑桥神经胶质瘤治疗后中脑放射诱导海绵状畸形1例

IF 0.4 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-06-19 DOI:10.1016/j.inat.2025.102079

Rong-Tse Hsu , Hung-Lin Lin , Ji-An Liang

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引用次数: 0

摘要

成人脑干胶质瘤是一种罕见的肿瘤，同时放射治疗（RT）和替莫唑胺是标准治疗方法。另一种罕见的情况，成人脑干辐射诱导的海绵状血管瘤（RICM），具有出血和局灶性神经功能缺损的显著风险。虽然有症状的RICM通常推荐手术治疗，但其在脑干的位置使手术风险更大。我们报告一例脑干胶质瘤治疗与放化疗，随后发展为脑干RICM 10年后。患者通过常规影像学随访进行监测，显示稳定的临床和影像学表现。病例描述：一名36岁女性，出现头晕、步态不稳、感觉异常2-3个月。2014年10月MRI示浸润性脑干肿瘤。活检证实为WHO 3级间变性星形细胞瘤。主要治疗包括并发放疗，56格雷（Gy）超过28个分数，以及替莫唑胺。替莫唑胺辅助治疗持续10年。2024年10月，后续MRI显示中脑出现新的海绵状畸形（CM）。由于患者神经系统状态稳定，选择继续观察影像学监测。结论本病例突出了我们治疗成人脑干胶质瘤和脑干RICM的经验。对于这些罕见疾病的标准管理尚无既定的共识。本病例中采用的治疗策略似乎有助于脑干胶质瘤的长期生存和脑干RICM的短期稳定状态。需要进一步的研究来制定治疗这些罕见疾病的标准化方法。

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Midbrain radiation-induced cavernous malformation after treatment for Pontine Glioma: A case report

Background

Adult brainstem gliomas are rare tumors, with concurrent radiation therapy (RT) and temozolomide being the standard treatment approach. Another uncommon condition, adult brainstem radiation-induced cavernous malformation (RICM), presents a significant risk of hemorrhage and focal neurological deficits. While surgery is typically recommended for symptomatic RICM, its location in the brainstem makes the procedure riskier.

We report a case of a brainstem glioma treated with chemoradiation, followed by the development of a brainstem RICM 10 years later. The patient was monitored with routine imaging follow-ups, demonstrating stable clinical and radiographic findings.

Case Description

A 36-year-old woman experienced dizziness, unsteady gait, and paresthesia for 2–3 months. Brain magnetic resonance imaging (MRI) in October 2014 revealed an infiltrative brainstem tumor. Biopsy confirmed a WHO grade 3 anaplastic astrocytoma. The primary treatment consisted of concurrent RT, 56 Gray (Gy) over 28 fractions, along with temozolomide. Adjuvant temozolomide therapy was continued for 10 years. In October 2024, a follow-up MRI showed a new cavernous malformation (CM) in the midbrain. Owing to the patient’s stable neurological status, continued observation with imaging surveillance was chosen.

Conclusions

This case highlights our experience in treating adult brainstem glioma and brainstem RICM. There is no established consensus on the standard management for these uncommon conditions. The treatment strategies employed in our case appeared to contribute to favorable long-term survival for the brainstem glioma and short-term stable condition for the brainstem RICM. Further studies are necessary to develop a standardized approach to treating these rare diseases.

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