Tatalaksana Anestesi pada Pasien Anak dengan Cystic Craniopharyngioma yang Menjalani Gamma Knife Radiosurgery

Craniopharyngioma is a benign tumor characterized by cystic and calcification, surrounded by vital structures therefor it is difficult to perform total tumor resection. Combination with Gamma knife radiosurgery (GKRS) is the best treatment option. The complexities of GKRS consisting of several phases lasts for 6-10 hours. Anesthesia is needed for uncooperative patients. This is a case of a 4-year-old girl with cystic craniopharyngioma. The patient had chief complaint of blurry vision, physical examinations revealed bilateral papil atrophy. Result of MRI showed tumor mass compressing inferior hypophyse. Patient underwent the procedure under moderate sedation with Propofol at 75 mcg/kg/min for 6 hours. Intraoperative hemodynamic condition was stable without adverse events. Choice of anesthesia either general anesthesia or sedation, depends on the condition of patient, considerations from anesthesiologist dan neurosurgeon, dan availability of facilities. Unique considerations for GKRS are; a non-operating room anesthesia, long duration, transportation to other units such as radiology and cathlab, head of the patients need to be immobilized to prevent frame displacement, the patient will be alone in the treatment room, and principles of pediatric anesthesia and neuroanesthesia.

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Gamma knife radiosurgery for jugular foramen schwannomas

Journal of Neurosurgery ◽

10.3171/jns.2002.97.supplement_5.0456 ◽

2002 ◽

Vol 97 ◽

pp. 456-458 ◽

Cited By ~ 29

Author(s):

Nan Zhang ◽

Li Pan ◽

Jia Zhong Dai ◽

Bin Jiang Wang ◽

En Min Wang ◽

...

Keyword(s):

Gamma Knife ◽

Symptom Relief ◽

Clinical Status ◽

Tumor Resection ◽

Gamma Knife Radiosurgery ◽

Treatment Method ◽

Jugular Foramen ◽

Content Type ◽

The Mean ◽

Fine Print

Object. The purpose of this study was to evaluate the effect on tumor growth and symptom relief in patients with jugular foramen schwannomas after undergoing gamma knife radiosurgery (GKS). Methods. Between November 1993 and December 2000, 27 patients were treated for jugular foramen schwannomas. The results of GKS in these cases are reviewed. Twelve patients had undergone previous tumor resection and the others underwent GKS as their primary treatment. The mean tumor volume was 13.5 cm3 (range 4.7–35.7 cm3). The mean margin dose was 14.6 Gy (range 9.8–20 Gy). The mean maximum dose was 32.6 Gy (range 25.4–50 Gy). The prescription isodose was 35 to 55%. Twenty-five patients were followed for a mean period of 38.7 months (range 9–90 months). Tumors shrank in 11 patients, remained stable in 13, and enlarged in one patient who underwent a second GKS procedure. Sixteen patients improved and nine remained at their pre-GKS clinical status. No patient developed new cranial nerve deficits after GKS. Conclusions. The follow-up results indicate that GKS is a safe and effective primary or adjuvant treatment method for the control of jugular foramen schwannomas.

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PETROCLIVAL MENINGIOMAS

Neurosurgery ◽

10.1227/01.neu.0000255472.52882.d6 ◽

2007 ◽

Vol 60 (6) ◽

pp. 965-981 ◽

Cited By ~ 101

Author(s):

Sabareesh K. Natarajan ◽

Laligam N. Sekhar ◽

David Schessel ◽

Akio Morita

Keyword(s):

Survival Rate ◽

Gamma Knife ◽

Cranial Nerve ◽

Tumor Resection ◽

Gamma Knife Radiosurgery ◽

Free Survival ◽

Petroclival Meningiomas ◽

Long Term Follow Up

Abstract OBJECTIVE To evaluate patients' clinical outcome, survival, and performance status, at the long-term follow-up evaluation after aggressive microsurgical resection of petroclivaTl meningiomas. METHODS During a 13-year period (1991–2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3.44 cm. Tumors extended into adjoining regions in 57% of the patients. Thirty patients (20%) previously underwent operation or irradiation. One hundred patients (66%) had a single operation, 43 patients (29%) had two operations, and seven patients (5%) had three operations. Gross tumor resection was accomplished in 48 patients (32%), subtotal resection in 65 patients (43%), and partial resection in 37 patients (25%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 33 patients (22%). Postoperative radiation or radiosurgery was administered to 47 of the 102 patients who had residual tumors. The outcome and survival of patients were evaluated by questionnaires, telephone calls, and review of their recent radiological images. RESULTS At the conclusion of the study, 87 patients (58%) were alive with disease and 45 patients (30%) were alive without disease. The mean follow-up period was 102 months (range, 15–180 mo). Seven patients (5%; five of the subtotal and partially resected patients and two of the total resection patients) had recurrence; of these patients, two underwent repeat resection and four were treated with gamma knife radiosurgery. One of the patients died of tumor progression with no response to gamma knife radiosurgery. The recurrence-free survival rate was 100% at 3 years, 92.7% at 7 years, and 85% at 12 years; the progression-free survival rate was 96% at 3 years, 86.8% at 7 years, and 79.5% at 12 years. The Karnofsky Performance Scale score was 78 ± 11 preoperatively, 76 ± 11 at 1 year postoperatively, and 84 ± 9 at the time of the latest follow-up evaluation. Common disabilities at the time of the follow-up evaluation included diplopia, loss of hearing, balance problems, and loss of sensation in the V1 and V2 cranial nerve distribution. Most patients developed coping mechanisms. CONCLUSION This series has the largest number of patients with the longest follow-up period, to our knowledge, reported in the literature to date. The excellent quality of life at the time of the long-term follow-up examination for these patients warrants aggressive but judicious tumor resection, with or without radiosurgical treatment of tumor remnants.

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Gamma Knife radiosurgery for hemangioma of the cavernous sinus

Journal of Neurosurgery ◽

10.3171/2016.4.jns152097 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1498-1505 ◽

Cited By ~ 6

Author(s):

Cheng-Chia Lee ◽

Jason P. Sheehan ◽

Hideyuki Kano ◽

Berkcan Akpinar ◽

Roberto Martinez-Alvarez ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Gamma Knife ◽

Cavernous Sinus ◽

Cranial Nerve ◽

Tumor Resection ◽

Gamma Knife Radiosurgery ◽

Vascular Tumors ◽

Tumor Control ◽

Gradual Improvement ◽

Cranial Nerve Dysfunction

OBJECTIVECavernous sinus hemangiomas (CSHs) are rare vascular tumors. A direct microsurgical approach usually results in massive hemorrhage and incomplete tumor resection. Although stereotactic radiosurgery (SRS) has emerged as a therapeutic alternative to microsurgery, outcome studies are few. Authors of the present study evaluated the role of SRS for CSH.METHODSAn international multicenter study was conducted to review outcome data in 31 patients with CSH. Eleven patients had initial microsurgery before SRS, and the other 20 patients (64.5%) underwent Gamma Knife SRS as the primary management for their CSH. Median age at the time of radiosurgery was 47 years, and 77.4% of patients had cranial nerve dysfunction before SRS. Patients received a median tumor margin dose of 12.6 Gy (range 12–19 Gy) at a median isodose of 55%.RESULTSTumor regression was confirmed by imaging in all 31 patients, and all patients had greater than 50% reduction in tumor volume at 6 months post-SRS. No patient had delayed tumor growth, new cranial neuropathy, visual function deterioration, adverse radiation effects, or hypopituitarism after SRS. Twenty-four patients had presented with cranial nerve disorders before SRS, and 6 (25%) of them had gradual improvement. Four (66.7%) of the 6 patients with orbital symptoms had symptomatic relief at the last follow-up.CONCLUSIONSStereotactic radiosurgery was effective in reducing the volume of CSH and attaining long-term tumor control in all patients at a median of 40 months. The authors' experience suggests that SRS is a reasonable primary and adjuvant treatment modality for patients in whom a CSH is diagnosed.

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