Radiation-induced complications in endovascular neurosurgery

Incidence of skin effects and the feasibility of estimating risk of future tumor formation

Eric Peterson, Kalpana M. Kanal, Renee L. Dickinson, Brent K. Stewart, Louis J. Kim

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: The incidence of radiation-induced complications is increasingly part of the informed consent process for patients undergoing neuroendovascular procedures. Data guiding these discussions in the era of modern radiation-minimizing equipment is lacking. OBJECTIVE: To quantify the rates of skin and hair effects at a modern high-volume neurovascular center, and to assess the feasibility of accurately quantifying the risk of future central nervous system (CNS) tumor formation. METHODS: We reviewed a prospectively collected database of endovascular procedures performed at our institution in 2008. The entrance skin dose and brain dose were calculated. Patients receiving skin doses >2 Gy were contacted to inquire about skin and hair changes. We reviewed several recent publications from leading radiation physics bodies to evaluate the feasibility of accurately predicting future cancer risk from neurointerventional procedures. RESULTS: Seven hundred two procedures were included in the study. Of the patients receiving >2 Gy, 39.6% reported subacute skin or hair changes following their procedure, of which 30% were permanent. Increasing skin dose was significantly associated with permanent hair loss. We found substantial methodological difficulties in attempting to model the risk of future CNS tumor formation given the gaps in our current understanding of the brain's susceptibility to low-dose ionizing radiation. CONCLUSION: Radiation exposures exceeding 2 Gy are common in interventional neuroradiology despite modern radiation-minimizing technology. The incidence of side effects approaches 40%, although the majority is self-limiting. Gaps in current models of brain tumor formation after exposure to radiation preclude accurately quantifying the risk of future CNS tumor formation.

Original languageEnglish (US)
Pages (from-to)566-572
Number of pages7
JournalNeurosurgery
Volume72
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

Fingerprint

Neurosurgery
Radiation
Central Nervous System Neoplasms
Skin
Incidence
Hair
Neoplasms
Endovascular Procedures
Alopecia
Physics
Brain
Ionizing Radiation
Informed Consent
Brain Neoplasms
Databases
Technology
Equipment and Supplies

Keywords

  • Deterministic effects
  • Endovascular
  • Entrance skin dose
  • Lifetime attributable risk of cancer
  • Radiation exposure
  • Skin and hair side effects
  • Stochastic effects

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Radiation-induced complications in endovascular neurosurgery : Incidence of skin effects and the feasibility of estimating risk of future tumor formation. / Peterson, Eric; Kanal, Kalpana M.; Dickinson, Renee L.; Stewart, Brent K.; Kim, Louis J.

In: Neurosurgery, Vol. 72, No. 4, 04.2013, p. 566-572.

Research output: Contribution to journalArticle

Peterson, Eric ; Kanal, Kalpana M. ; Dickinson, Renee L. ; Stewart, Brent K. ; Kim, Louis J. / Radiation-induced complications in endovascular neurosurgery : Incidence of skin effects and the feasibility of estimating risk of future tumor formation. In: Neurosurgery. 2013 ; Vol. 72, No. 4. pp. 566-572.
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abstract = "BACKGROUND: The incidence of radiation-induced complications is increasingly part of the informed consent process for patients undergoing neuroendovascular procedures. Data guiding these discussions in the era of modern radiation-minimizing equipment is lacking. OBJECTIVE: To quantify the rates of skin and hair effects at a modern high-volume neurovascular center, and to assess the feasibility of accurately quantifying the risk of future central nervous system (CNS) tumor formation. METHODS: We reviewed a prospectively collected database of endovascular procedures performed at our institution in 2008. The entrance skin dose and brain dose were calculated. Patients receiving skin doses >2 Gy were contacted to inquire about skin and hair changes. We reviewed several recent publications from leading radiation physics bodies to evaluate the feasibility of accurately predicting future cancer risk from neurointerventional procedures. RESULTS: Seven hundred two procedures were included in the study. Of the patients receiving >2 Gy, 39.6{\%} reported subacute skin or hair changes following their procedure, of which 30{\%} were permanent. Increasing skin dose was significantly associated with permanent hair loss. We found substantial methodological difficulties in attempting to model the risk of future CNS tumor formation given the gaps in our current understanding of the brain's susceptibility to low-dose ionizing radiation. CONCLUSION: Radiation exposures exceeding 2 Gy are common in interventional neuroradiology despite modern radiation-minimizing technology. The incidence of side effects approaches 40{\%}, although the majority is self-limiting. Gaps in current models of brain tumor formation after exposure to radiation preclude accurately quantifying the risk of future CNS tumor formation.",
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N2 - BACKGROUND: The incidence of radiation-induced complications is increasingly part of the informed consent process for patients undergoing neuroendovascular procedures. Data guiding these discussions in the era of modern radiation-minimizing equipment is lacking. OBJECTIVE: To quantify the rates of skin and hair effects at a modern high-volume neurovascular center, and to assess the feasibility of accurately quantifying the risk of future central nervous system (CNS) tumor formation. METHODS: We reviewed a prospectively collected database of endovascular procedures performed at our institution in 2008. The entrance skin dose and brain dose were calculated. Patients receiving skin doses >2 Gy were contacted to inquire about skin and hair changes. We reviewed several recent publications from leading radiation physics bodies to evaluate the feasibility of accurately predicting future cancer risk from neurointerventional procedures. RESULTS: Seven hundred two procedures were included in the study. Of the patients receiving >2 Gy, 39.6% reported subacute skin or hair changes following their procedure, of which 30% were permanent. Increasing skin dose was significantly associated with permanent hair loss. We found substantial methodological difficulties in attempting to model the risk of future CNS tumor formation given the gaps in our current understanding of the brain's susceptibility to low-dose ionizing radiation. CONCLUSION: Radiation exposures exceeding 2 Gy are common in interventional neuroradiology despite modern radiation-minimizing technology. The incidence of side effects approaches 40%, although the majority is self-limiting. Gaps in current models of brain tumor formation after exposure to radiation preclude accurately quantifying the risk of future CNS tumor formation.

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