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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0045-1806840
Brief Report

A Diagnostic Conundrum: Cerebral Radiation Necrosis Masquerading as Tumor in the Contralateral Hemisphere

Tanshi Daljit
1   Radiation Oncology, Maulana Azad Medical College, Delhi, India
,
Saarthak Miglani
1   Radiation Oncology, Maulana Azad Medical College, Delhi, India
,
Daljit Singh
2   Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), Delhi, India
,
Ravindra K. Saran
3   Pathology, Gobind Ballabh Pant Hospital, Delhi, India
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Abstract

Cerebral radiation necrosis (CRN) is a recognized late complication following cranial irradiation. This article describes a unique case of CRN occurring contralaterally to the original irradiation site in a male treated for atypical meningioma with surgery and subsequent radiation therapy. This case highlights the diagnostic challenge of differentiating CRN from tumor recurrence or progression and highlights the importance of advanced imaging techniques and biopsy for diagnosis.

Keywords

cerebral radiation necrosis - contralateral cerebral radiation necrosis - radiation-induced brain necrosis

Authors' Contribution

T.D. contributed to literature search and manuscript preparation. S.M. contributed to manuscript preparation. D.S. was the operating surgeon. R.K.S. was the pathologist. The manuscript has been read and approved by all the authors, requirements for authorship have been met, and each author believes that the manuscript represents honest work.




Publication History

Article published online:
02 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Valk PE, Dillon WP. Radiation injury of the brain. AJNR Am J Neuroradiol 1991; 12 (01) 45-62
    PubMedSearch in Google Scholar
  • 2 Wang YX, King AD, Zhou H. et al. Evolution of radiation-induced brain injury: MR imaging-based study. Radiology 2010; 254 (01) 210-218
    PubMedSearch in Google Scholar
  • 3 Brandsma D, Stalpers L, Taal W, Sminia P, van den Bent MJ. Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol 2008; 9 (05) 453-461
    CrossrefPubMedSearch in Google Scholar
  • 4 Kumar AJ, Leeds NE, Fuller GN. et al. Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology 2000; 217 (02) 377-384
    CrossrefPubMedSearch in Google Scholar
  • 5 Schüttrumpf LH, Niyazi M, Nachbichler SB. et al. Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1-3 cerebral metastases. Radiat Oncol 2014; 9: 105
    PubMedSearch in Google Scholar
  • 6 Wang TM, Shen GP, Chen MY. et al. Genome-wide association study of susceptibility loci for radiation-induced brain injury. J Natl Cancer Inst 2019; 111 (06) 620-628
    PubMedSearch in Google Scholar
  • 7 Chambless LB, Angel FB, Abel TW, Xia F, Weaver KD. Delayed cerebral radiation necrosis following treatment for a plasmacytoma of the skull. Surg Neurol Int 2010; 1: 65
    PubMedSearch in Google Scholar
  • 8 Na A, Haghigi N, Drummond KJ. Cerebral radiation necrosis. Asia Pac J Clin Oncol 2014; 10 (01) 11-21
    PubMedSearch in Google Scholar
  • 9 Ali FS, Arevalo O, Zorofchian S. et al. Cerebral radiation necrosis: incidence, pathogenesis, diagnostic challenges, and future opportunities. Curr Oncol Rep 2019; 21 (08) 66
    PubMedSearch in Google Scholar
  • 10 Levin VA, Bidaut L, Hou P. et al. Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys 2011; 79 (05) 1487-1495
    CrossrefPubMedSearch in Google Scholar
  • 11 Yang X, Ren H, Fu J. Treatment of radiation-induced brain necrosis. Oxid Med Cell Longev 2021; 2021: 4793517
    PubMedSearch in Google Scholar