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Neuropediatrics 2021; 52(01): 012-018
DOI: 10.1055/s-0040-1709452
Original Article

Cerebral Autoregulation and Neurovascular Coupling after Craniospinal Irradiation in Long-Term Survivors of Malignant Pediatric Brain Tumors of the Posterior Fossa

Wibke G. Janzarik
1   Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, University Medical Center Freiburg, University of Freiburg, Germany
,
Milena Sander
1   Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, University Medical Center Freiburg, University of Freiburg, Germany
,
Jochen Rößler
2   Department of Pediatric Hematology and Oncology, Center for Pediatrics, University Medical Center Freiburg, University of Freiburg, Germany
3   Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Linda Sommerlade
4   Institute for Complex Systems and Mathematical Biology, King's College, University of Aberdeen, Aberdeen, United Kingdom
,
Arthur Allignol
5   Institute of Statistics, Ulm University, Ulm, Germany
,
Matthias Reinhard
6   Department of Neurology and Clinical Neurophysiology, Medical Center Esslingen, Academic Teaching Hospital of the University of Tübingen, Germany
7   Department of Neurology and Neurophysiology, University Medical Center Freiburg, University of Freiburg, Germany
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Abstract

Introduction Long-term survivors of craniospinal irradiation have an increased risk for stroke which increases with radiation dose and follow-up time. Radiotherapy induces structural changes of the cerebral vasculature, affecting both, large, and small vessels. It is unknown how these structural changes affect functional mechanisms of cerebral blood flow regulation such as cerebral autoregulation and neurovascular coupling.

Methods Using the transcranial Doppler, we compared dynamic cerebral autoregulation and neurovascular coupling of 12 patients after long-term survival of craniospinal irradiation due to a malignant pediatric brain tumor of the posterior fossa and 12 age- and sex-matched healthy patients. Mean arterial blood pressure and cerebral blood flow velocities in the middle and posterior cerebral artery were recorded at rest during normal breathing to assess cerebral autoregulation (transfer function parameters phase and gain, as well as the correlation coefficient indices Mx, Sx, and Dx), and during 10 cycles of a visual task to assess neurovascular coupling (parameters time delay, natural frequency, gain, attenuation, and rate time).

Results Parameters of cerebral autoregulation showed a consistent trend toward reduced cerebral autoregulation in patients that did not reach statistical significance. Neurovascular coupling was not altered after craniospinal irradiation.

Conclusion In this pilot study, we demonstrated a trend toward reduced cerebral autoregulation, and no alteration of neurovascular coupling after irradiation in long-term survivors of malignant pediatric brain tumors of the posterior fossa.

Keywords

cerebral autoregulation - neurovascular coupling - cerebral hemodynamics pediatric brain tumor - irradiation


Publikationsverlauf

Eingereicht: 27. November 2019

Angenommen: 28. Februar 2020

Artikel online veröffentlicht:
16. Oktober 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Zapotocky M, Beera K, Adamski J. et al. Survival and functional outcomes of molecularly defined childhood posterior fossa ependymoma: Cure at a cost. Cancer 2019; 125 (11) 1867-1876
    CrossrefPubMedGoogle Scholar
  • 2 Kim JH, Brown SL, Jenrow KA, Ryu S. Mechanisms of radiation-induced brain toxicity and implications for future clinical trials. J Neurooncol 2008; 87 (03) 279-286
    CrossrefPubMedGoogle Scholar
  • 3 Balentova S, Adamkov M. Molecular, cellular and functional effects of radiation-induced brain injury: a review. Int J Mol Sci 2015; 16 (11) 27796-27815
    CrossrefPubMedGoogle Scholar
  • 4 Moxon-Emre I, Bouffet E, Taylor MD. et al. Impact of craniospinal dose, boost volume, and neurologic complications on intellectual outcome in patients with medulloblastoma. J Clin Oncol 2014; 32 (17) 1760-1768
    CrossrefPubMedGoogle Scholar
  • 5 Laughton SJ, Merchant TE, Sklar CA. et al. Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial. J Clin Oncol 2008; 26 (07) 1112-1118
    CrossrefPubMedGoogle Scholar
  • 6 Salloum R, Chen Y, Yasui Y. et al. Late morbidity and mortality among medulloblastoma survivors diagnosed across three decades: a report from the childhood cancer survivor study. J Clin Oncol 2019; 37 (09) 731-740
    CrossrefPubMedGoogle Scholar
  • 7 El-Fayech C, Haddy N, Allodji RS. et al. Cerebrovascular diseases in childhood cancer survivors: role of the radiation dose to Willis circle arteries. Int J Radiat Oncol Biol Phys 2017; 97 (02) 278-286
    CrossrefPubMedGoogle Scholar
  • 8 Roongpiboonsopit D, Kuijf HJ, Charidimou A. et al. Evolution of cerebral microbleeds after cranial irradiation in medulloblastoma patients. Neurology 2017; 88 (08) 789-796
    CrossrefPubMedGoogle Scholar
  • 9 Passos J, Nzwalo H, Marques J. et al. Late cerebrovascular complications after radiotherapy for childhood primary central nervous system tumors. Pediatr Neurol 2015; 53 (03) 211-215
    CrossrefPubMedGoogle Scholar
  • 10 Wang C, Roberts KB, Bindra RS, Chiang VL, Yu JB. Delayed cerebral vasculopathy following cranial radiation therapy for pediatric tumors. Pediatr Neurol 2014; 50 (06) 549-556
    CrossrefPubMedGoogle Scholar
  • 11 Morris B, Partap S, Yeom K, Gibbs IC, Fisher PG, King AA. Cerebrovascular disease in childhood cancer survivors: a children's oncology group report. Neurology 2009; 73 (22) 1906-1913
    CrossrefPubMedGoogle Scholar
  • 12 Tanikawa S, Kato Y, Tanino M. et al. Autopsy report of a late delayed radiation injury after a period of 45 years. Neuropathology 2019; 39 (02) 106-110
    CrossrefPubMedGoogle Scholar
  • 13 Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990; 2 (02) 161-192
    PubMedGoogle Scholar
  • 14 Xiong L, Liu X, Shang T. et al. Impaired cerebral autoregulation: measurement and application to stroke. J Neurol Neurosurg Psychiatry 2017; 88 (06) 520-531
    CrossrefPubMedGoogle Scholar
  • 15 Iadecola C. The neurovascular unit coming of age: a journey through neurovascular coupling in health and disease. Neuron 2017; 96 (01) 17-42
    CrossrefPubMedGoogle Scholar
  • 16 Reinhard M, Müller T, Guschlbauer B, Timmer J, Hetzel A. Transfer function analysis for clinical evaluation of dynamic cerebral autoregulation--a comparison between spontaneous and respiratory-induced oscillations. Physiol Meas 2003; 24 (01) 27-43
    CrossrefPubMedGoogle Scholar
  • 17 Rosengarten B, Huwendiek O, Kaps M. Neurovascular coupling in terms of a control system: validation of a second-order linear system model. Ultrasound Med Biol 2001; 27 (05) 631-635
    CrossrefPubMedGoogle Scholar
  • 18 Intharakham K, Beishon L, Panerai RB, Haunton VJ, Robinson TG. Assessment of cerebral autoregulation in stroke: A systematic review and meta-analysis of studies at rest. J Cereb Blood Flow Metab 2019; 39 (11) 2105-2116
    CrossrefPubMedGoogle Scholar
  • 19 Janzarik WG, Ehlers E, Ehmann R. et al. Dynamic cerebral autoregulation in pregnancy and the risk of preeclampsia. Hypertension 2014; 63 (01) 161-166
    CrossrefPubMedGoogle Scholar
  • 20 Janzarik WG, Gerber A-K, Markfeld-Erol F, Sommerlade L, Allignol A, Reinhard M. No long-term impairment of cerebral autoregulation after preeclampsia. Pregnancy Hypertens 2018; 13: 171-173
    CrossrefPubMedGoogle Scholar
  • 21 Janzarik WG, Jacob J, Katagis E. et al. Preeclampsia postpartum: Impairment of cerebral autoregulation and reversible cerebral hyperperfusion. Pregnancy Hypertens 2019; 17: 121-126
    CrossrefPubMedGoogle Scholar
  • 22 Vavilala MS, Kincaid MS, Muangman SL, Suz P, Rozet I, Lam AM. Gender differences in cerebral blood flow velocity and autoregulation between the anterior and posterior circulations in healthy children. Pediatr Res 2005; 58 (03) 574-578
    CrossrefPubMedGoogle Scholar
  • 23 Vavilala MS, Newell DW, Junger E. et al. Dynamic cerebral autoregulation in healthy adolescents. Acta Anaesthesiol Scand 2002; 46 (04) 393-397
    CrossrefPubMedGoogle Scholar
  • 24 Peebles KC, Horsman H, Tzeng Y-C. The influence of tobacco smoking on the relationship between pressure and flow in the middle cerebral artery in humans. PLoS One 2013; 8 (08) e72624
    CrossrefPubMedGoogle Scholar
  • 25 Di Stefano AL, Berzero G, Ducray F. et al. Stroke-like events after brain radiotherapy: a large series with long-term follow-up. Eur J Neurol 2019; 26 (04) 639-650
    CrossrefPubMedGoogle Scholar
  • 26 Reinhard M, Schork J, Allignol A, Weiller C, Kaube H. Cerebellar and cerebral autoregulation in migraine. Stroke 2012; 43 (04) 987-993
    CrossrefPubMedGoogle Scholar
  • 27 Farid K, Meissner WG, Samier-Foubert A. et al. Normal cerebrovascular reactivity in stroke-like migraine attacks after radiation therapy syndrome. Clin Nucl Med 2010; 35 (08) 583-585
    CrossrefPubMedGoogle Scholar
  • 28 Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 2005; 4 (04) 287-291
    CrossrefPubMedGoogle Scholar