Gamma Knife Radiosurgery for Pituitary Adenoma.

Case Summary:

50 years male from Baluchistan, underwent trans sphenoidal excision of adenoma  in March 19, 2022 presented with complaints of progressive loss of right vision for 1 year & decrease left vision for 1 year. Patient has no history of chemotherapy and radiation therapy. On clinical examination pt. is blind from right eye with left temporal defect. MRI brain with contrast dated January 06, 2023 shows heterogeneous enhancing abnormal signal intensity mass lesion seen in sellar & supra sellar region suggestive of adenoma. Histopathology dated April 05, 2022 shows adenoma. Perimetry dated January 05, 2023 shows left temporal defect. Hormones profile within normal range. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study December 15, 2023:

Patient visited the gamma knife center for the first follow up presented with recent MRI brain with contrast dated December 14, 2023 shows further regression in the size of tumor from 4.6cc to 3.6 cc when compared with previous MRI brain with contrast dated July 04, 2023, consistent with good response to Gamma Knife Therapy

 

Gamma Knife Radiosurgery for Craniopharyngioma.

Case Summary:

9 years old boy from Karachi, underwent insertion of VP shunt in May 27, 2023 & revision of shunt in June 09, 2023  presented with history of headache with vomiting . Patient has no history of radiation & chemotherapy. On clinical examination patient has no obvious deficit. CT brain with contrast dated June 06, 2023 shows lobulated solid / cystic hypo dense mass seen in supra sellar / sellar region causing significant compression over 3^rd ventricle resulting dilatation of left lateral ventricle with CSF seepage suggestive of Craniopharyngioma. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study March 28,2024:

Patient consulted the gamma knife center for the first routine follow up presented with recent MRI Brain with contrast dated december 06,2023 shows significant reduction in the targeted lesion from 20.20cc to 8.033cc when compared with previous MRI Brain with contrast datedJune 06, 2023  ,consistent with good ongoing control of lesion.

 Gamma Knife Radiosurgery for Right Occipital High Grade Glioma :

Case Summary:

40 years of male from Islamabad, underwent craniotomy for Excision of SOL in August 22, 2023 presented with the complaints of headache for 3 months & no history of visual disturbances. The patient has no history of radiation & chemotherapy. On clinical examination patient has no obvious deficit. MRI brain with contrast dated September 15, 2023 shows intra axial enhancing mass lesion seen in the right occipital region with post-surgical changes suggestive of residual high grade glioma. Histopathology dated September 01, 2023 shows malignant neoplasm (glioma). Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study 19-01-2024:

Patient consulted the gamma knife center for the second routine follow up presented with recent MRI brain with contrast dated January 15,2024 shows almost complete resolution of the targeted lesion with post radiation changes when compared with previous MRI brain with contrast dated September 15, 2023  consistent with excellent control of lesion.

 Gamma Knife Radiosurgery for CA Thyroid with Right Ventricle & Right Parietal Metastases.

Case Summary:

46 years of female from Dir, CA Thyroid underwent total thyroidectomy in June 23, 2023 presented with the complaints of headache with vomiting for few months, vertigo for 3 months & numbness in right limbs after surgery. Patient has no history of radiation & chemotherapy. On clinical examination patient has no obvious deficit. MRI brain with contrast dated August 12, 2023 shows recurrent lesion in left lobe of thyroid & metastasis lesions in right parietal lobe & right lateral ventricle suggestive of brain metastasis. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study January 13,2024:

Patient consulted the gamma knife center for the first follow up presented with recent MRI brain with contrast dated January 12,2024 shows good resolution of the targeted metastasis, no new growth seen when compared with previous MRI brain with contrast dated August 12, 2023,consistent with good ongoing control of tumor.

 

Gamma Knife Radiosurgery for Left Temporo-Parietal Glioma.

Case Summary:

23 years young male from Islamabad, presented with complaints of numbness in right limbs for 7-8 months & two episodes of LOC for 10-15 second for 8 months.  Patient has no history of surgery, chemotherapy & radiation. On clinical examination young man is sitting comfortably has no obvious deficit. MRI brain dated September 26, 2022 shows re-demonstrated mass lesion noted in left temporo-parietal region with surrounding white matter edema and mass effect evident by compression of the ipsilateral lateral ventricle. MR Spectroscopy dated July 25, 2022, shows neoplastic etiology likely low grade glioma. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study April 11,2023:

Patient consulted the gamma knife center for the first routine follow up presented with recent MRI Brain with contrast dated April 04,2023 shows significant regression in T2 hypertensity (from 66.9 to 42.5cc) when compared with previous MRI Brain with contrast dated September 26,2022 consistent with excellent response to gamma knife therapy.

Follow up Comparative Study March 20,2024:

Patient consulted the gamma knife center for the second routine follow up presented with recent MRI Brain with contrast dated March 09,2024 shows further sizeable reduction in the targeted lesion when compared with previous MRI Brain with contrast dated April 04,2023  consistent with ongoing control of tumor.

 

Gamma Knife Radiosurgery for Left Temporo Parietal Low Grade Glioma:

Case Summary:

43 years lady from Haripur Hazara, presented with complaints of impairment of memory for few years & fits for 2 weeks. Patient has no history of surgery, radiation & chemotherapy. On clinical examination middle age lady  has slightly affected working memory. MRI brain with contrast dated November 23, 2022 shows non enhancing abnormal signal intensity mass lesion seen in left temporal lobe insular cortex, inferior frontal lobe & part of parietal lobe suggestive of low grade glioma. MRS shows elevated choline with reduced NAA & Cr peak suggestive of neoplastic lesion. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study July 11,2023:

Patient visited the gamma knife center for the first follow up presented with recent MRI brain with contrast dated June 19,2023 shows interval decrease of the targeted lesion in T2 hyper intensity signal when compared with previous MRI brain with contrast dated November 23,2022 , consistent with good ongoing control of tumor.

 Gamma Knife Radiosurgery for Nasal Angio Fibroma with Intra cranial Extension:

Case Summary:

14 years boy from Sanghar, underwent excision biopsy of tumor in March 26, 2022 by Dr. Imran presented with complaints of nasal blockage & nasal discharge for 1 year. The patient has no history of radiation & chemotherapy. On clinical examination boy is sitting on a chair comfortably has no obvious deficit. MRI brain & Para nasal sinuses dated January 10, 2022 shows a large infiltrating abnormally enhancing soft tissue intensity tumor is appreciated predominantly arising from the right lateral wall of naso pharynx close to the sphenopalantine fossa with extra axial intracranial extension. Histopathology dated April 08, 2022 shows nasal angiofibroma. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up comparative study dated June 14,2023 :

Patient visited the gamma knife center for the first routine follow up presented with recent MRI brain with contrast dated June 14, 2023 shows 50% regression in the targeted lesion when compared with previous MRI brain with contrast dated January 10, 2022 consistent with good ongoing control of lesion.

Follow up comparative study dated January 12,2024 :

Patient visited the gamma knife center for the second routine follow up presented with recent MRI brain with contrast dated January 11, 2024 shows further regression in the targeted lesion when compared with previous MRI brain with contrast dated June 14, 2023  consistent with good ongoing control of lesion.

 

Gamma Knife Radiosurgery for Left Parietal Glioma.

Case Summary:

52 years male from Karachi, K/C of D.M presented with complaint of single episodes of loss of consciousness 10 days back. The patient has no history of surgery, chemo radiation. On clinical examination middle age man is sitting on a chair comfortably has slightly affected working memory. MRI brain with contrast dated September 29, 2022 shows extra axial enhancing mass lesion seen in the left parietal region & no enhancement on post contrast study suggests of low grade glioma. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study 11-05-2023:

Patient visited the gamma knife center for first routine follow up presented with recent MRI brain with contrast dated May 10, 2023 shows significant regression in hyper intensity on T2WI with central necrotic changes seen when compared with previous MRI brain with contrast dated October 10, 2022 consistent with ongoing control of tumor.

 

 

Gamma Knife Radiosurgery for Pineal Region SOL.:

Case Summary:

22 years male, underwent insertion of VP shunt in November 11,2022 presented with complaints of headache, weakness in left limbs and blurring of vision for 3-4 months. Patient has no history of radiation & chemotherapy. On clinical examination young male is sitting on chair comfortably has squint and 4/5 power in left limbs. MRI brain with contrast dated November 05, 2022 shows enhancing mass seen in the midline causing compression of the aqueduct of sylvius with dilation of ventricles bilaterally. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study 06-04-2023:

Patient consulted the gamma knife center for the first routine follow up presented with recent MRI brain with contrast dated April 04,2023 shows good resolution of targeted lesion when compared with previous MRI brain with contrast dated November 05, 2022, excellent results in response to gamma knife therapy.

Follow up Comparative Study 25-01-2024:

Patient consulted the gamma knife center for the second routine follow up presented with recent MRI brain with contrast dated January  25,2024 shows almost complete resolution of the targeted lesion when compared with previous MRI brain with contrast dated April 04,2023, excellent results in response to gamma knife therapy.

 Gamma Knife Radiosurgery for Recurrent Posterior Fossa Hemangioblastoma:

Case Summary:

This 47 year lady , diagnosed case of hemangioblastoma since 2014 underwent excision of posterior fossa SOL & insertion of VP shunt in 2014 & received cyber knife treatment 7 Gy x 3 fraction in MAY 2015 now presented with complaints of headache with vomiting & vertigo for 5 months & difficulty in walking for 1 month. Patient has no history of chemotherapy. On clinical examination middle aged lady is sitting on wheel chair comfortably has decrease both near vision & ataxia. MRI brain with contrast dated March 09, 2022 shows abnormal signal intensity enhancing mass lesion seen in posterior fossa in the region of brain stem involving the cerebellar vermis & progression in disease when compared with previous MRI brain with contrast. Histopathology dated December 16, 2014 shows hemangioblastoma. Risk of GKSRS have been explained. Written and valid consent obtained to proceed. 

Follow-up Comparative Study October 03, 2022:

Patient visited the gamma knife center for first routine follow up presented with recent MRI brain with contrast dated October 01, 2022 shows good resolution of previously targeted hemangioblastoma from 27.9 to 2.8 cc when compared with previous MRI brain with contrast dated May 19, 2022 consistent with good lesion control.

 

 

Gamma Knife Radiosurgery for Pituitary Adenoma.

Case Summary:

50 years male , underwent trans sphenoidal excision of adenoma  in March 19, 2022 presented with complaints of progressive loss of right vision for 1 year & decrease left vision for 1 year. Patient has no history of chemotherapy and radiation therapy. On clinical examination middle male is sitting on chair is blind from right eye & left temporal defect. MRI brain with contrast dated January 06, 2023 shows heterogeneous enhancing abnormal signal intensity mass lesion seen in sellar & supra sellar region suggestive of adenoma. Histopathology dated April 05, 2022 shows adenoma. Perimetry dated January 05, 2023 shows left temporal defect. Hormones profile within normal range. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study December 15, 2023:

Patient visited the gamma knife center for  follow up presented with recent MRI brain with contrast dated December 14, 2023 shows further regression in the size of tumor from 4.6cc to 3.6 cc when compared with previous MRI brain with contrast dated July 04, 2023, consistent with good response to Gamma Knife Therapy.

 Gamma Knife Radiosurgery for Craniopharyngioma.

Case Summary:

6 years child , underwent bilateral insertion of VP shunt in April 10, 2023 presented with history of headache for 6 months & visual symptoms before shunt now recovered. Patient has no history of radiation & chemotherapy. On clinical examination patient has no obvious deficit. MRI brain with contrast dated March 04, 2023 shows solid / cystic mass lesion supra sellar region extending superiorly indenting the floor of ventricle & inferiorly in sellar region suggestive of Craniopharyngioma. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study December 21,2023 ;

Patient visited the GKSRS clinic for 1st follow up presented with recent MRI Brain with contrast dated December 21,2023 shows good reduction in the targeted lesion when compared with previous MRI brain with contrast dated March 04,2023 , consistent with good ongoing regression of the lesion.

 Gamma Knife Radiosurgery for Left Parietal Glioblastoma.

Case Summary:

73 years man, K/C of HTN underwent excision of SOL  in 07 October 2022, presented with complaints of weakness in right limb for 4 months. Patient has no history of chemotherapy and radiation.  On clinical examination old age man is sitting comfortably has 4/5 power on left limbs. MRI brain with contrast dated October 07, 2022 shows ill defined abnormal signal intensity mass is noted in left parietal lobe medially along the para falcine region with intense peripheral post contrast enhancement suggestive of glioma. Histopathology dated October 16, 2022 shows IDH wild type glioblastoma, WHO Grade 4. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study 31-04-2023:

Patient consulted the gamma knife center for first routine follow up presented with recent MRI brain with contrast dated March 31, 2023 shows central necrotic changes with peri lesional T2 hyper intensities when compared with previous MRI brain with contrast dated November 01, 2022 consistent with good lesion control.

Gamma Knife Radiosurgery for Large B-Cell Lymphoma with Brain Stem Metastasis.

 

Case Summary:

34 years male from Karachi, K/C of Diffuse Large B Cell Lymphoma since April 2023 presented with weakness in right limbs for 2 weeks. Patient underwent hepatic & abdominal lymph node biopsy in April 13, 2023 & also received chemotherapy in September 2023. Patient has no history of radiation. Patient is sitting on wheel chair & has 3/5 power in right limbs. MRI brain with contrast dated December 01, 2023 shows ill-defined signal intensity with linear nodular enhancement noted in left hemi pons extending into mid brain, thalamus & internal capsule could be brain deposit. PET CT scan dated December 05, 2023 shows negative post treatment FDG PET CT scan study with symmetrical normal FDG avidly bilateral cerebral hemisphere. Histopathology dated April 19, 2023 shows diffuse high grade large B Cell Lymphoma. Risks of GKSRS have been explained Written and valid consent obtained to proceed.

Follow up Comparative Study I February,2024:

Patient visited the gamma knife center for the first routine follow up presented with recent MRI brain with contrast dated January 29, 2024 shows complete resolution of the targeted lesion , no new lesion seen when compared with previous MRI brain with contrast dated December 01, 2023 consistent with good ongoing control of tumor.

 

Gamma Knife Radiosurgery for Recurrent Left Frontal Astrocytoma WHO G-III.

Case Summary:

40 years male, underwent biopsy of SOL in March 16, 2019 & March 28, 2013 presented with complaints of fits since 2012. Patient received in 33 fractions of RT in 2019  & 6 cycles of Temozolamid in November 2019. On clinical examination middle age man is sitting on chair has no obvious deficit. MRI brain with contrast dated March 03, 2023 shows interval increase in nodular signal & enhancement in left fronto temporo parietal region with heterogeneously enhancing mass in left fronto parietal surgical bed with drop met lesion in left temporal lobe. Histopathology dated March 29, 2023 shows Anaplastic Astrocytoma.G-111. Risks of GKSRS have been explained. Written and valid consent obtained to proceed.

Follow up Comparative Study July 04,2023:

Patient consulted the gamma knife center for the first follow up presented with recent MRI Brain with contrast Dated June 15,2023 shows sizeable reduction in overall bulk of target and peri lesional edema when compared with previous MRI Brain with contrast dated March 03,2023 , consistent with good ongoing control of tumor.