| Popis: |
Background: Hyperbaric oxygenation therapy (HBOT) is a method rarely used for patients with complications associated with the management of inoperable arteriovenous malformations, such as brain edema, treated with stereotactic radiosurgery. We present a successful treatment protocol in a series of steroid-refractory patients. Methods: Five patients diagnosed with arteriovenous malformations and 1 patient diagnosed with cavernous malformation were irradiated using stereotactic radiosurgery with linac. After radiosurgery they presented new or increasing neurological deficits in association with imaging changes compatible with cerebral edema. All vascular disorders were located in eloquent areas (2 visual primary cortex), (2 mesencephalus), (1 parasplenial), (1 thalamus). These patients were treated with steroids without response. The initial evaluation includes classification of the neurological deficit before inclusion in the HBOT protocol. This consisted of 30 sessions at 2.0 atm. The patients were evaluated clinically every 2 months, radiographically every 6 months or less as needed, and the average follow-up was 3 years. Results: Clinical improvements associated with imaging changes were observed as early as 3 weeks in all patients and no HBOT toxicity was observed. All patients survived without any major neurologic deficit. We present the evolution and controls with 36 months of follow-up. Conclusions: HBOT can play an important role in the management of radiosurgery-induced brain edema. Further randomized studies are needed in order to establish the importance of this modality. |
