放射性脑损伤是头颈部肿瘤放射治疗（放疗）常见的并发症，可发生于放疗后的任何时期，好发部位与放疗方案密切相关，多见于接受最高剂量放疗的区域。早期临床表现包括乏力、头晕、头痛，后期可出现癫痫发作、性格改变、进行性加重的神经认知功能下降。CT多显示为局灶性低密度影，常规MRI在水肿期表现为脑白质内出现“指状”分布的水肿，采用多模态MRI、正电子发射断层成像等影像技术有助于实现放射性脑损伤的早期诊断及鉴别诊断。治疗方式包括药物、高压氧、手术及间充质干细胞移植。常用药物包括贝伐珠单抗、地塞米松、胞二磷胆碱及神经节苷脂。随着对放射性脑损伤的日益重视，相关机制研究不断深入，相应治疗药物也取得良好疗效，但有效预防重于治疗。大脑结构和功能复杂，功能区受损后严重者可残疾甚至死亡，应优化放疗技术实现对肿瘤的精准照射，减少正常脑组织受照射体积。结合患者年龄、基础疾病、肿瘤位置等因素制定放疗计划，避免对放射敏感区域的过度照射。采用海马保护性放疗，降低海马区域受照射剂量，可显著降低记忆力下降风险，合理控制放疗剂量。放射性脑损伤的诊断和治疗是一个多学科协作的过程，应加强头颈部肿瘤放疗患者全生命周期管理，通过技术创新和个体化治疗，进一步降低脑损伤的发生率和危害。

Radiation-induced brain injury is a common complication after radiotherapy for head and neck tumors. It can occur at any time after radiotherapy. The common sites are closely related to the radiotherapy regimen and are more frequently seen in areas receiving the highest radiotherapy dose. Early symptoms include fatigue, dizziness and headaches. In the later stage, epileptic seizures, personality changes and progressive decline in neurocognitive function may occur. Brain computed tomography (CT) often shows focal low-density images, and brain magnetic resonance imaging (MRI) presents with “finger-like” edema in the white matter of the brain during the edema stage. The use of multimodal MRI, positron emission tomography (PET) and other imaging techniques can help to make early diagnosis and differential diagnosis of radiation-induced brain injury. The treatment options include medication, hyperbaric oxygen therapy, surgery and mesenchymal stem cell transplantation. Commonly used drugs in clinical practice include bevacizumab, dexamethasone, citicoline and gangliosides. With the increasing attention paid to radiation-induced brain injury, the research on related mechanisms has been continuously deepened and the corresponding therapeutic drugs have achieved good therapeutic effects. However, effective prevention is more important than treatment. As the brain has complicated structure and functions, damage to functional areas can lead to disability or even death. Optimizing radiotherapy techniques can achieve precise irradiation of tumors and reduce the volume of normal brain tissue exposed to radiation. Radiotherapy plans should be formulated based on factors such as the patient’s age, underlying diseases, and tumor location to avoid excessive exposure to radiation-sensitive areas. Using hippocampal protective radiotherapy to reduce the radiation dose to the hippocampal region can significantly decrease the risk of memory decline and allow the reasonable control of the radiotherapy. The diagnosis and treatment of radiation-induced brain injury is a multidisciplinary collaborative process. It is necessary to strengthen the full life cycle management of patients with head and neck tumors undergoing radiotherapy. Through technological innovation and individualized treatment, the incidence and harm of brain injury should be further reduced.