手术治疗鼻咽癌放射性脑损伤临床分析

Neurosurgery in treatment of radiation encephalopathy of patients with nasopharyngeal carcinoma

目的 探讨鼻咽癌放射后脑损伤患者手术治疗的时机、手术方式、病情改善机制.方法 回顾性分析中山大学附属第二医院神经外科自1996年1月至2008年12月采用手术治疗的9例鼻咽癌放射后脑损伤患者的临床资料,总结分析其临床表现、影像学检查、手术方式、病理改变、术后疗效及后期随访结果.结果多数放射后脑损伤患者MRI显示颞叶水肿坏死典型脑损伤改变,部分患者则表现为单侧脑水肿病灶,占位效应明显且有中线移位,或表现为脑内囊性液化坏死灶;病理检查显示脑组织水肿,液化坏死,小血管呈透明样变性、闭塞;坏死病灶清除术后MRI显示水肿减轻,8例患者在2～3周内出院,生命体征平稳,症状获得改善,8例患者头痛完全缓解,1例患者仅轻度头痛.结论 鼻咽癌放射治疗后如内科治疗效果欠佳,脑水肿占位或囊样液化坏死灶明显时采用手术治疗,可有效改善症状缓解病情,并可明确诊断,对后续治疗具有指导意义.

Objective To explore the best operation time and approach, and the improvement mechanism of radiation encephalopathy in patients with nasopharyngeal carcinoma. Methods The data of 9 patients with radiation eneephalopathy after radiotherapy for nasopharyngeal carcinoma who admitted to our hospital from January 1996 and December 2008 were retrospectively analyzed. The neurological manifestations, imaging, neurosurgery strategies and pathological features of the patients were collected and analyzed. The efficacy and the follow-up results were compared. Results MRI showed such typical encephalopathy as severe edema or necrosis in the temporal lobe in most patients adopted radiotherapy; edema and necrosis in the brain tissues, hyaline degeneration and blocking in the small blood vessels were showed by pathologic examination. Some patients manifested as having unilateral edema or liquefactive necrosis in the brain with marked mass effect. After the surgery, the edema in the patients＇ brain was alleviated; 8 patients got improvement and discharged from the hospital in 2-3 weeks with stable vital signs. Eight patients achieved complete remission of headache with 1 having mild headache. Conclusion When medical treatment is not effective in patients who developed edema or liquefactive necrosis after radiotherapy, neurosurgery is a good therapeutic strategy, which can alleviate the symptoms, help clarify the diagnosis and guide the follow-up treatment.