The management of brain necrosis as a result of SRS treatment for intra-cranial tumors

Uresh Patel, Ankush Patel, Charles Cobb, Tara Benkers, Sandra Vermeulen


Background: Stereotactic radiosurgery (SRS) is now a standard of care for recurrent malignant, metastatic and non-malignant brain tumors. Fortunately only a small number of tumors treated will result in asymptomatic or symptomatic necrosis. Radiographic determination of necrosis and then the implementation of treatment are important to alleviate new neurological symptoms. This article will review the identification and treatment for brain necrosis.
Methods: Although asymptomatic necrosis rarely needs treatment, brain necrosis resulting in neurologic change can be treated with steroids, surgery, bevacizumab and/or hyperbaric oxygen therapy.
Results: All the above methods have been used successfully in the treatment for SRS induced neurological complications from brain necrosis.
Conclusions: Corticosteroids, surgery, bevacizumab and HBO are all possible good treatment options for symptomatic RN. The treatment goal is to provide the patient with resolution of neurologic systems with the least toxicity and invasiveness.