Background: Radiotherapy is an effective treatment for NPC. With improved survival, radiation-induced neurological complications are being diagnosed more commonly. We presented a patient with a trilogy of radiation-induced pathologies after radiotherapy for NPC. The diagnostic and surgical implications are discussed.
Case description: A 57-year-old man, previously irradiated for NPC, presented with mental confusion and was found to have radiation-induced carotid stenosis and bitemporal lobe necrosis on MR imaging. His condition deteriorated suddenly a year later, and a gliosarcoma was found to have developed within the area of right temporal lobe necrosis. Tumor removal was complicated by injury to the MCA branches, causing basal ganglion infarction. This was likely because of a combination of technical error and arterial insufficiency secondary to radiation-induced arterial stenosis.
Conclusions: In patients with known temporal lobe radiation-induced necrosis, alternative diagnosis such as gliosarcoma should be considered when there is sudden clinical deterioration. Radiation-induced carotid stenosis may reduce the safety margin during surgery. Preoperative carotid screening may be indicated.