Acoustic Schwannoma Treatment.

Ependymoma,complete resolution.

Case summary:

This, 26 years nice man from Karachi had undergone insertion of VP shunt on right side on November 22, 2010 on radio diagnosis of heterogeneous enhancing solid cum cystic mass in posterior fossa in fourth ventricle causing hydrocephalus. This was diagnosed when patient had presented with severe headache on and off associated with vomiting worst since last month and blurred vision since one month.

On referral, he had presented some improvement in headache and vomiting and significant improvement in blurring of vision. Clinical examination had revealed no obvious neurologic deficit. MRI brain spectroscopy had revealed markedly elevated Choline levels up to 399. Patient has referred us for the management with GKSRS.  Risk of GKSRS explained all in Urdu along with requirement of strict follow up. These agreed upon wished to proceed. He had treatment with following prescription,

Target	Location	Prescription	Volume
A	Ependymoma.	12Gy @ 50%	18.6 cm³

Multiple isocenters with 18, 14 & 8 mm collimator used in APS mode. He had discharged on tapering doses of Dexamethasone and advised follow up after 3 months

Follow up at 3 months showed almost complete resolution of the tumor.

Oligodendroglioma, Anaplastic, WHO grade III. Good Control.

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This 45 years old Lady had undergone left frontal Craniotomy in November 2009 on diagnosis of left frontoparietal  tumor,. On histopathology it was Anaplastic Oligodendroglioma, WHO grade III. She had tonic clonic fits and right hemiparesis. she had received Radiotherapy to left hemisphere using left lateral and posterior fields on 6Mv X-ray beam.  Total dose of 60 Gy in Multiple fractions of 200 cGy had received until March 1, 2010. Temozolamide as conjoined chemotherapy used for 6 weeks during radiotherapy and 3 cycles after one month of radiotherapy.  

On referral, for She had presented progressive recurrence of right hemiparesis and fits since first week of April 2010. On Clinical examination, she had House Brackmann right facial palsy grade I-II and right hemiplegia. MRI brain with contrast had revealed multiple heterogeneous rim enhancing mass in the left parietal region with significant perilesional edema.  Patient referred us for management with GKSRS. Risk of GKSRS explained. These agreed upon wished to proceed. She had treatment with following prescription.

Target	Location	Prescription	Volume
A	Left parietal Glioma	12.0 Gy @ 50%	33.6 cm³
B	Left parietal Glioma lateral part	12.0 Gy @ 40%	3.5 cm³

Multiple isocenters with 18 & 8 mm collimator used in APS mode. She discharged on tapering doses of Dexamethasone and advised follow up after 3 months.

Target

                             Location

                   Prescription

       Volume

A

Left parietal Glioma

  12.0 Gy @ 50%

33.6 cm³

B

Left parietal Glioma lateral part

  12.0 Gy @ 40%

 3.5 cm³

Follow up at 4 months significant necrosis and shrinkage of the tumor mass.

Follow up at 9 months further decrease in enhancment.

Meningioma (Lt.Parietal Recurrent).80% reduction in 2 yrs.

She is 54 yrs old Lady with recurrent left Parietal convexity Meningioma.She was treated with marginal dose of 12.0 Gy with 50% isodose line was prescribed for the target volume 29.2 cc. 

Meningioma reduced to 7.1 cu. cm from 29.2 cu.cm
in two years time.

Acoustic Schwannoma 2yrs. Follow Up. after GKRS.

This 32 years old gentleman from Lahore was a diagnosed case of left Acoustic Schwannoma.He presented with progressive left hearing loss since 10^th June 09, left hemi facial numbness, mild headache , loss of taste and occasional imbalance since 20 days. Clinical examination revealed left hemi facial hypoesthesia and poor corneal reflex. MRI shows heterogeneously enhancing mass in left CPA. He was treated with marginal dose of 12.5 Gy at 50% isodose line to the target volume of 9.0 cc. Multiple isocenters with 14,  8 and 4 mm collimators were used in APS mode. He was discharged on tapering doses of Dexamethasone and advised for follow up images after 6 months.

F.up at one year shows 80% reduction in Tumor.

F.Up at 2 yrs. Shows 90 % reduction in tumor.