Abstract

DURAN PINILLA, EDUARDO; VALDERRAMA SERRANO, GERMÁN  and  BUITRAGO SALINAS, ALEJANDRO. HYPERBARIC OXYGEN IN THE MANAGEMENT OF RADIONECROSIS BRAIN STEM IN A PATIENT WITH MEDULLOBLASTOMA. rev.fac.med [online]. 2013, vol.21, n.2, pp.104-109. ISSN 0121-5256.

Brain stem radionecrosis is a complication of radiotherapy in patients who have been treated for a tumor, and although fortunately not very common, its consequences can be devastating since the importance of the involved tissue causes generation of lesions which can give as a result highly disabling lesions or even the patient's death, as indeed happened in this case. According to the FDA (Food and Drug Administration), Hyperbaric Oxygen (HBO) is indicated in bone and soft tissues radionecrosis (Regulations, 2012), including in the latter the central nervous system. The reported case is a 28-year female patient presenting with a posterior fossa medulloblastoma that was treated with surgery and chemo-radiotherapy. Twenty one months after the initial treatment, she presents with symptoms suggestive of a brain stem lesion for which reason she consults once again, and after imaging studies, a brain stem lesion due to radionecrosis is ascertained. In July 2011 the patient was already presenting with dysarthria, bradilalia, left lateropulsion, diplopy, cephalea, ataxic gait and symmetrical spasticity with predominance of left hemibody. Upon treatment initiation with OHB (September 2011) nonfunctional quadriparesis was found. Six sessions with OHB were performed, and treatment with bevacizumab and corticosteroid agents was given despite which the patient's evolution was poor and fulminating leading to death within less than six months. The discussion rising from this clinical case is whether treatment with OHB should be more focused on prevention and prophylaxis than on treatment of lesions which, because of their anatomical location, entail high seriousness and can be irreversible once they are set up.

Keywords : atmosphere; atmosphere absolute; hyperbaric; hyperbaric oxygenation; hyperbaric oxygen; Hyperbaric Oxygen Therapy; Central Nervous System; Nuclear Magnetic Resonance Gadolinium.

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