Cranial Nerve Palsies, Vascular Damage, and Brainstem Injury

Balancing the therapeutic index for radiation therapy to the brain starts with treatment planning and reducing the dose to adjacent critical structures. History taking, clinical examination, and imaging are critical to the diagnosis of complications. Radiation-induced optic neuropathy, cranial nerve palsies, vascular injury, and brainstem injury can all occur and result in permanent deficits for patients several months after radiation therapy is complete. Treatment is largely focused on using steroids, although hyperbaric oxygen and other treatments have also been attempted with limited success. Radiation planning guidelines continue to evolve as does our understanding of the longer-term complications that can result.