Gamma Knife Radiosurgery in the Management of Hypothalamic Glioma: A Case Report with Long-term Follow-up

Pediatric Brain Tumors ◽

Low Grade ◽

Long Term Follow Up ◽

Vulnerable Patient ◽

Complications Of Surgery ◽

Promising Treatment

Background Optic pathway/hypothalamic gliomas are rare pediatric brain tumors. The management paradigm for these challenging tumors includes chemotherapy, radiotherapy, or surgical resection, but the optimal management strategy remains elusive. Gamma Knife radiosurgery (GKRS) has emerged as a promising treatment for such lesions as documented by a small number of cases in the literature. Case Presentation Herein, we present a rare case of hypothalamic glioma in a 13-year-old girl who was referred to our service due to growth of a an incidentally diagnosed hypothalamic lesion following head injury at the age of 8 years. The lesion demonstrated hypointensity on T1 and hyperintensity on T2 without enhancement. Given the growth of the lesion on serial imaging, a stereotactic biopsy was performed demonstrating low-grade glioma. The patient underwent GKRS treatment with a marginal dose of 15 Gy at 50% isodose line for a tumor volume of 2.2 ml. Annual radiological surveillance over the next 17 years demonstrated a gradual shrinkage of the lesion until it completely disappeared. The patient is currently a healthy 31-year-old female without any visual, endocrine, or neurocognitive complaints. Conclusion The outcome obtained after extended follow-up in our patient highlights the safety and efficacy of GKRS in the management of hypothalamic gliomas in pediatrics, which in turn can avoid potentially serious complications of surgery in this vulnerable patient population in this sensitive location.

Gamma Knife Radiosurgery for Low-Grade Gliomas: Clinical Results at Long-Term Follow-Up of Tumor Control and Patients' Quality of Life

World Neurosurgery ◽

10.1016/j.wneu.2017.02.041 ◽

2017 ◽

Vol 101 ◽

pp. 540-553 ◽

Cited By ~ 5

Author(s):

Filippo Gagliardi ◽

Michele Bailo ◽

Alfio Spina ◽

Carmine A. Donofrio ◽

Nicola Boari ◽

...

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Clinical Results ◽

Tumor Control ◽

Low Grade ◽

Treating Vestibular Schwannomas with Gamma-Knife Radiosurgery Versus Microsurgery: Long-Term Follow-up of 702 Cases

The Medical Journal of Cairo University ◽

10.21608/mjcu.2019.54877 ◽

2019 ◽

Vol 87 (June) ◽

pp. 2599-2610

Author(s):

AHMED R. RIZK, M.D. GUIHERME LEPSLI, M.D. ◽

GERHARD A. HORSTMANN, M.D. MARCOS TATABIBA, M.D.

Keyword(s):

Gamma Knife ◽

Vestibular Schwannomas ◽

Gamma-Knife Radiosurgery for Cranial Base Meningiomas: Experience of Tumor Control, Clinical Course, and Morbidity in a Follow-Up of More than 8 Years

Neurosurgery ◽

10.1227/01.neu.0000190654.82265.a3 ◽

2006 ◽

Vol 58 (1) ◽

pp. 28-36 ◽

Cited By ~ 100

Author(s):

Iris Zachenhofer ◽

Stefan Wolfsberger ◽

Martin Aichholzer ◽

Alexander Bertalanffy ◽

Karl Roessler ◽

...

Keyword(s):

Gamma Knife ◽

Open Surgery ◽

Clinical Course ◽

Cranial Base ◽

Long Term Results ◽

Tumor Control ◽

Abstract OBJECTIVE: Surgical resection of cranial base meningiomas is often limited owing to involvement of crucial neural structures. Within the last 2 decades Gamma Knife radiosurgery (GKRS) has gained increasing importance as an adjunct treatment after incomplete resection and as an alternative treatment to open surgery. However, reports of long-term results are still sparse. We therefore performed this study to analyze the long-term results of GKRS treatment of cranial base meningiomas, following our previously published early follow-up experience. METHODS: A retrospective analysis of the medical files for Gamma Knife and surgical treatments, clinicoradiological findings, and outcome was carried out focusing on tumor control, clinical course, and morbidity. RESULTS: Between 1992 and 1995, we treated 36 patients with cranial base meningiomas using GKRS (male:female ratio, 1:5; mean age, 59 yr; range, 44–89 yr). Twenty-five patients were treated with GKRS after open surgery, and 11 patients received GKRS alone. Tumor control, neurological outcomes, and adverse effects were analyzed after a long-term follow-up period (mean, 103 mo; range, 70–133 mo) and compared with our previous results after an early follow-up period (mean, 48 mo; range, 36–76 mo). Control of tumor growth was achieved in 94% of patients. Compared with the early follow-up period, the late neuroradiological effects of GKRS on cranial base meningiomas were continuing tumor shrinkage in 11 patients (33%), stable tumor size in 20 patients (64%) and tumor progression in two meningiomas (6%). The neurological status improved in 16 patients (44%), remained stable in 19 patients (52%), and deteriorated in one patient (4%). Adverse side effects of GKRS were found only during the early follow-up period. CONCLUSION: Our data confirm that GKRS is not only a safe and effective treatment modality for cranial base meningiomas in short-term observation, but also in a mean long-term follow-up period of more than 8 years. Tumor shrinkage and clinical improvement also continued during the longer follow-up period.

In Reply: Treatment of Asymptomatic Meningioma With Gamma Knife Radiosurgery: Long-Term Follow-up With Volumetric Assessment and Clinical Outcome

Neurosurgery ◽

10.1093/neuros/nyaa014 ◽

2020 ◽

Vol 86 (5) ◽

pp. E489-E489

Author(s):

Amitabh Gupta ◽

Zhiyuan Xu ◽

Jason P Sheehan

Keyword(s):

Clinical Outcome ◽

Gamma Knife ◽

Volumetric Assessment ◽

Long Term Follow Up ◽

Asymptomatic Meningioma

Angiographic Long-term Follow-up Data for Arteriovenous Malformations Previously Proven to Be Obliterated after Gamma Knife Radiosurgery

Neurosurgery ◽

10.1097/00006123-200004000-00006 ◽

2000 ◽

Vol 46 (4) ◽

pp. 803-810 ◽

Cited By ~ 17

Author(s):

Melker Lindqvist ◽

Bengt Karlsson ◽

Wan-Yuo Guo ◽

Lars Kihlström ◽

Bodo Lippitz ◽

...

Keyword(s):

Gamma Knife ◽

Arteriovenous Malformations ◽

Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long-term follow-up

Cephalalgia ◽

10.1177/0333102417698961 ◽

2017 ◽

Vol 38 (3) ◽

pp. 543-550 ◽

Cited By ~ 5

Author(s):

Pierre-Yves Borius ◽

Constantin Tuleasca ◽

Xavier Muraciole ◽

Laura Negretti ◽

Luis Schiappacasse ◽

...

Keyword(s):

Gamma Knife ◽

Rare Condition ◽

Glossopharyngeal Neuralgia ◽

University Hospitals ◽

Minimally Invasive Surgical ◽

Long Term Follow Up ◽

The Mean

Objective Glossopharyngeal neuralgia (GPN) is a very rare condition, affecting the patient’s quality of life. We report our experience in drug-resistant, idiopathic GPN, treated with Gamma Knife radiosurgery (GKRS), in terms of safety and efficiency, on a very long-term basis. Methods The study was opened, self-controlled, non-comparative and bicentric (Marseille and Lausanne University Hospitals). Patients treated with GKRS between 2003 and 2015 (models C, 4C and Perfexion) were included. A single 4-mm isocentre was positioned in the cisternal portion of the glossopharyngeal nerve, with a targeting based both on magnetic resonance imaging (MRI) and computed tomography (CT). The mean maximal dose delivered was 81.4 ± 6.7 Gy (median = 85 Gy, range = 60–90 Gy at the 100% isodose line). Results Twenty-one patients (11 women, 10 men) benefited from 25 procedures. The mean follow-up period was 5.2 ± 3 years (range = 0.9–12.1 years). Seventeen (81%) were initially pain-free after GKRS. At three months, six months and one year after radiosurgery, the percentage of patients with good outcome (BNI classes I to IIIA) was 87.6%, 100% and 81.8%, respectively. Ten cases (58.8%) from the initial pain-free ones had a recurrence, after a mean period of 13.6 ± 10.4 months (range = 3.1–36.6 months). Only three patients (14.2%) had recurrences (two for each one of them) requiring further surgeries. Three patients underwent a second GKRS procedure; one case needed a third GKRS. The former procedures were performed at 7, 17, 19 and 30 months after the first one, respectively. Furthermore, two patients needed additional interventions. At last follow-up, 17 cases (80.9%) were still pain-free without medication. The actuarial pain relief without new surgery was 83%. A transient complication (paraesthesia of the edge of the tongue) was seen in one case (4.8%). Conclusion GKRS is a valuable, minimally invasive, surgical alternative for idiopathic GPN, with a very high short- and long-term efficacy and without permanent complications. A quality imaging, including T2 CISS/Fiesta MRI and bone CT acquisitions for good visualisation of the nerve and the other bony anatomic landmarks, is essential for targeting accuracy and successful therapy.

Long-Term Follow-Up of Quality of Life after Gamma Knife Radiosurgery Treatment for Arteriovenous Malformations

Radiosurgery ◽

10.1159/000093734 ◽

2006 ◽

pp. 211-220

Author(s):

Michael J. Jr. Musacchio ◽

Brian Kuchay ◽

Nimesh H. Patel ◽

Sepehr B. Sani ◽

Demetrius K. Lopes

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Arteriovenous Malformations ◽

Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study

Journal of Neurosurgery ◽

10.3171/2017.8.jns171281 ◽

2019 ◽

Vol 130 (2) ◽

pp. 388-397 ◽

Cited By ~ 11

Author(s):

Josa M. Frischer ◽

Elise Gruber ◽

Verena Schöffmann ◽

Adolf Ertl ◽

Romana Höftberger ◽

...

Keyword(s):

Gamma Knife ◽

Acoustic Neuroma ◽

Hearing Preservation ◽

Tumor Control ◽

Long Term Outcome ◽

Acoustic Neuromas ◽

OBJECTIVEThe authors present long-term follow-up data on patients treated with Gamma Knife radiosurgery (GKRS) for acoustic neuroma.METHODSSix hundred eighteen patients were radiosurgically treated for acoustic neuroma between 1992 and 2016 at the Department of Neurosurgery, Medical University Vienna. Patients with neurofibromatosis and patients treated too recently to attain 1 year of follow-up were excluded from this retrospective study. Thus, data on 557 patients with spontaneous acoustic neuroma of any Koos grade are presented, as are long-term follow-up data on 426 patients with a minimum follow-up of 2 years. Patients were assessed according to the Gardner-Robertson (GR) hearing scale and the House-Brackmann facial nerve function scale, both prior to GKRS and at the times of follow-up.RESULTSFour hundred fifty-two patients (81%) were treated with radiosurgery alone and 105 patients (19%) with combined microsurgery-radiosurgery. While the combined treatment was especially favored before 2002, the percentage of cases treated with radiosurgery alone has significantly increased since then. The overall complication rate after GKRS was low and has declined significantly in the last decade. The risk of developing hydrocephalus after GKRS increased with tumor size. One case (0.2%) of malignant transformation after GKRS was diagnosed. Radiological tumor control rates of 92%, 91%, and 91% at 5, 10, and 15 years after GKRS, regardless of the Koos grade or pretreatment, were observed. The overall tumor control rate without the need for additional treatment was even higher at 98%. At the last follow-up, functional hearing was preserved in 55% of patients who had been classified with GR hearing class I or II prior to GKRS. Hearing preservation rates of 53%, 34%, and 34% at 5, 10, and 15 years after GKRS were observed. The multivariate regression model revealed that the GR hearing class prior to GKRS and the median dose to the cochlea were independent predictors of the GR class at follow-up.CONCLUSIONSIn small to medium-sized spontaneous acoustic neuromas, radiosurgery should be recognized as the primary treatment at an early stage. Although minimizing the cochlear dose seems beneficial for hearing preservation, the authors, like others before, do not recommend undertreating intracanalicular tumors in favor of low cochlear doses. For larger acoustic neuromas, radiosurgery remains a reliable management option with tumor control rates similar to those for smaller acoustic neuromas; however, careful patient selection and counseling are recommended given the higher risk of side effects. Microsurgery must be considered in acoustic neuromas with significant brainstem compression or hydrocephalus.