Cerebral radionecrosis: is surgery necessary?

Seven patients with cerebral necrosis after radiotherapy for carcinoma of the nasopharynx are presented. The clinical features included seizures and a varying degree of intellectual impairment. In spite of significant mass effect on CT scan, the patients remained alert, ambulatory and independent. We believe that some cases of cerebral necrosis following radiotherapy for extra-cranial neoplasms present in a more benign fashion than has been portrayed in the literature, and in the absence of clinical evidence of raised intracranial pressure, surgical intervention is unnecessary. The importance of careful fractionation of an optimum radiation dose as a preventive measure is emphasised.