Surgical management of XXXX after failed radiation treatment.

@entity1 @entity5513 @entity1183 @entity5 @entity2103 @entity260 @entity2319 @entity51 @entity392 @entity158 @entity1296 @entity531
UNASSIGNED: Increasing numbers of @entity1 with @entity5513 ( @entity5513 ) have been treated with focused-beam stereotactic radiation treatment (SRT) including Gamma knife, CyberKnife, X-knife, Novalis, or proton beam therapy. The purpose of this study was to document the incidence of @entity5 regrowth or symptoms that worsened or first developed following SRT and to discuss surgical strategies for @entity1 who have failed SRT for @entity5513 . A consecutive series of 39 @entity1 with SRT failed @entity5513 were surgically treated. Clinical symptoms, @entity5 regrowth at follow-up, intraoperative findings, and surgical outcome were evaluated. There were 15 males and 24 females with a mean age of 51.8  years. Thirty-six @entity1 (92.3  %) demonstrated steady @entity5 growth after SRT. Two (5.1  %) @entity1 with slight increase of the mass underwent surgical resection because of development of unbearable @entity158 . Symptoms that worsened or newly developed following SRT in this series were @entity2319 (41  %), @entity1296 (35.9  %), facial @entity1183 (25.6  %), @entity392 (20.5  %), @entity2103 (7.7  %), and @entity158 (7.7  %). Intraoperative findings demonstrated fibrous changes of the @entity5 mass, cyst formation, and brownish-yellow or purple discoloration of the @entity5 capsule. Severe adhesions between the @entity5 capsule and cranial nerves, vessels, and the brainstem were observed in 69.2  %. Additionally, the facial nerve was more fragile and irritable in all cases. Gross total resection (GTR) was achieved in 33.3  % of @entity1 , near-total resection (NTR) in 35.9  %, and subtotal resection (STR) in 30.8  % of @entity1 . New @entity2103 was seen in seven @entity1 (19.4  %) postoperatively. Our findings suggest that @entity1 with @entity5513 who fail SRT with either @entity5 progression or worsening of clinical symptoms will have an increased rate of adhesions to the @entity531 and may have radiation-influenced neuromalacia. Salvage surgery of radiation-failed @entity5 is more difficult and will have a higher risk of @entity260 . Radical total resection may not be feasible, and conservative modality of subtotal resection needs to be considered to avoid new @entity51 .
