Radiation‐Induced Cutaneous Tissue Reactions in Neurointerventional Procedures: A Systematic Review of Reported Effects and Associated Dose Levels

Neurointerventional procedures can deliver high localised skin doses and may cause radiation-induced cutaneous tissue reactions, yet the doses at which these occur have not been synthesised specifically for this setting. We systematically reviewed reported cutaneous reactions and associated radiation doses after fluoroscopy- or digital subtraction angiography-guided cranial or spinal neurointerventional procedures. Following PRISMA 2020, Ovid MEDLINE, Embase, Scopus and the Cochrane Library were searched in April 2026; case reports, case series and observational studies reporting a cutaneous reaction and/or a relevant skin dose were eligible. Screening and extraction were performed by two independent reviewers, and studies were appraised with the Joanna Briggs Institute checklists; findings were synthesised narratively, with cohort-derived incidence reported separately from case-level data. Twenty-five studies (approximately 686 patients; 11 countries) were included. Alopecia/epilation was the dominant reaction (21 studies); dermatitis/erythema (4) and ulceration/necrosis (2) were less frequent. Among cohorts, incidence ranged from approximately 5% to 56% and rose with skin dose and procedural complexity. Reported onset doses tracked established deterministic thresholds: temporary epilation clustered around the approximately 3 Gy threshold, whereas erythema and ulceration occurred at higher, usually cumulative, doses, and epilation below approximately 2 Gy was reported in radiosensitive patients. Alopecia appeared 2-5 weeks after the procedure and ulceration months to years later. Dose metrics were inconsistent, and 4 of 25 studies reported no dose. Standardised reporting of peak skin dose and dose-triggered, structured follow-up is needed.