Radiation optic neuropathy: report of cases, role of hyperbaric oxygen therapy, and literature review

Borruat, F.–X.; Schatz, Norman J.; Giaser, J. S.; Matos, Luis A.; Feuer, William J.

doi:10.3109/01658109609044633

Cited by 35 publications

(38 citation statements)

References 39 publications

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“…The first results were met with controversy [18,19]. Borruat et al [20] found a significant improvement of visual function using a constant protocol: 100% oxygen at 2.4 ATA (240 kPa) for 30 treatments over 90 minutes. These authors pointed out that hyperbaric oxygen at 2 ATA (200 kPa) did not reach statistical significance compared to no therapy.…”

Section: Discussionmentioning

confidence: 96%

Treatment of Cerebral Radionecrosis by Hyperbaric Oxygen Therapy

Leber¹,

Eder²,

Kovac³

et al. 1998

Stereotact Funct Neurosurg

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Clinically observed adverse radiation effects (ARE) are rather uncommon, but modern imaging reveals that they are more common after radiosurgery than previously believed. Little is known about the pathogenesis, and current treatment is mostly empirical. The benefit of hyperbaric oxygen therapy (HBO) on radiation-induced bone and soft tissue necrosis is known in lesions in the maxillofacial area, the mouth and in the head and neck. HBO raises the tissue pO₂ and initiates a cellular and vascular repair mechanism. This forms the basis for the hypothesis that it might also help alleviate the results of cerebral radionecrosis. This study is a preliminary attempt to test this hypothesis. Two patients with arteriovenous malformations (AVMs) were chosen for the study. They had been treated with Gamma Knife radiosurgery (GKRS) and had developed imaging signs consistent with ARE. They were treated by breathing 100% oxygen at 2.5 atmospheres absolute (250 kPa) in sessions of 60 minutes per day. This treatment was repeated 40 times in cycles of ten sessions. Both responded well to HBO, one lesion disappeared and the other was reduced significantly in size. No adjuvant steroids were given. These results give evidence that HBO has a potential value in treating ARE but further experience will be needed to confirm its definite benefit.

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Section: Discussionmentioning

confidence: 96%

Treatment of Cerebral Radionecrosis by Hyperbaric Oxygen Therapy

Leber¹,

Eder²,

Kovac³

et al. 1998

Stereotact Funct Neurosurg

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“…Symptoms develop, on average, 12 months after conventional treatment; the onset may be acute and is followed by the progressive loss of vision in one or both eyes, to the point of total blindness (3,4). This complication generally occurs after cumulative doses of radiation exceeding 50 Gy, or single doses greater than 10 Gy delivered to the visual apparatus.…”

Section: Introductionmentioning

confidence: 99%

“…This complication generally occurs after cumulative doses of radiation exceeding 50 Gy, or single doses greater than 10 Gy delivered to the visual apparatus. Visual loss may result from lesions of the disc, the retrobulbar segment of the optic nerve, optic chiasm, or even the retrogeniculate pathways (3,4). The second eye may develop abnormalities and clinical manifestations of optic neuropathy from days to months after the diagnosis in the first eye involved.…”

Section: Introductionmentioning

confidence: 99%

Partial visual recovery from radiation-induced optic neuropathy after hyperbaric oxygen therapy in a patient with Cushing disease

Boschetti¹,

Lucchi

Giusti³

et al. 2006

eur j endocrinol

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Here we describe the case of a 41-year-old woman with a history of Cushing disease who had previously undergone unsuccessful neurosurgery, followed by stereotactic radiosurgery. More than 4 years after this treatment, she presented severe visual impairment, which started in the left eye and was documented by neuro-ophthalmic evaluation. Radiological assessment by contrast-enhanced magnetic resonance (MR) imaging initially suggested the diagnosis of glioma of the optic nerve and the patient started corticosteroid treatment (first with prednisone, 80 mg/day, followed by dexamethasone, 8 mg/day). Despite the therapy, vision in the left eye rapidly worsened until light was no longer perceptible; similar symptoms and signs also developed in the right eye, evolving to complete temporal hemianopsia. The clinical evidence was confirmed by the rapid progression of the MR picture, which showed homogeneous enhancement of the chiasm and optic nerves. On the basis of these findings, the original diagnosis of glioma was excluded, and radiation-induced optic neuropathy was diagnosed. As corticosteroids had proved inefficacious, hyperbaric oxygen (HBO) therapy was promptly instituted and vision steadily started to improve. This improvement was documented and confirmed by the progressive recovery of the visual field in the right eye and the changes in the sequential follow-up MR scanning. Optic neuropathy is an infrequent but dramatic complication of radiation therapy. Symptoms develop, on average, 12 months after treatment, and the onset may be acute and characterized by the progressive loss of vision in one or both eyes. HBO has already been used to treat this complication, but its efficacy is still controversial. Here, in addition to describing this particular case, which presented a significantly delayed radiation injury of the optic pathways, we provide a brief literature review and discuss some important points. 154 813-818 European Journal of Endocrinology

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“…14,31) As is known from conventional fractionated radiotherapy, the latency period between the radiation therapy and the first signs of injury to the visual pathway is 6 to 50 months, with 90% of patients developing radiation-related optic neuropathy within the first 3 years after radiation therapy. 7,14) The follow-up period in the present case is still too short to assess the long-term risk of radiation-related optic neuropathy. Furthermore, a longer follow-up period is needed to confirm the durability of the tumor control and visual preservation.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Pituitary Tumor From Renal Cell Carcinoma Treated by Fractionated Stereotactic Radiotherapy-Case Report-

Yokoyama

Yoshino

Katayama

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 63-year-old man presented with rapidly progressive visual field deficit and hypopituitarism including diabetes insipidus, 8 years after treatment for a renal cell carcinoma. Neuroimaging studies revealed a dumbbell-shaped pituitary mass that had destroyed the sellar floor and abutted against the optic apparatus. Fractionated stereotactic radiotherapy (SRT), employing computer-image integration techniques and a frame that could be relocated to facilitate a fractionated dosing scheme, was carried out under a plan for reducing the treatment risk to the optic apparatus. Three months later, the patient exhibited marked improvement in the visual field deficit and visual acuity concomitant with a reduction in tumor volume. Magnetic resonance imaging of the sellar region confirmed striking shrinkage of the metastasis. His neurological status remained stable at 12 months after the SRT with no complications. Fractionated SRT appears to be effective for preserving or improving the residual vision in patients with visual loss secondary to metastatic tumor of the pituitary gland, and may result in a longer and better quality of life.

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Radiation optic neuropathy: report of cases, role of hyperbaric oxygen therapy, and literature review

Cited by 35 publications

References 39 publications

Treatment of Cerebral Radionecrosis by Hyperbaric Oxygen Therapy

Treatment of Cerebral Radionecrosis by Hyperbaric Oxygen Therapy

Partial visual recovery from radiation-induced optic neuropathy after hyperbaric oxygen therapy in a patient with Cushing disease

Metastatic Pituitary Tumor From Renal Cell Carcinoma Treated by Fractionated Stereotactic Radiotherapy-Case Report-

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