REVIEWS   

Journal of Neurosurgical Sciences 2015 June;59(2):157-67

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Post-stereotactic radiosurgery brain metastases: a review

Fabiano A. J. ^{1, 2}, Qiu J. ³ ✉

¹ Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, NY, USA; ² Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; ³ Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA

Stereotactic radiosurgery (SR) is a standard therapy for brain metastases. Radiation necrosis (RN) of the brain is a syndrome of brain coagulative and fibrinoid necrosis and cortical irritation that occurs following radiotherapy. RN following SR peaks in a delayed fashion at 9-12 months postprocedure. Vasogenic cerebral edema secondary to necrosis occurs and can affect surrounding brain function. No definitive non-invasive diagnostic study exists to differentiate post-SR RN from recurrent metastatic tumor. Magnetic resonance (MR) imaging, MR spectroscopy, positron emission tomography, and perfusion-weighted MR imaging have been used to evaluate RN and are discussed. Treatment options for post-SR brain metastases include observation, corticosteroids, pentoxifylline and vitamin E, bevacizumab, radiotherapy, laser-interstitial thermal therapy, and surgical resection.