Cavernous sinus hemangioma, total resolution at 6 months.

Twenty five year old lady with restricted Rt.eye movements towards nasal side,

Drooping of rt. eyelid and mid dilated pupil.

MRI showed 2.7+2.9+3.4 cm homogenously enhancing solid mass just above

 rt. Cavernous sinus in right side of supra sellar cistern abutting anteromedial

Surface of rt. Temporal lobe, undersurface of thalamus and anterior portion of

right temporal lobe, undersurface of thalamus and anterior portion of rt. half of

midbrain, encasing more than 70% of circumference of top of basilar artery,

causing mild mass effect on pituitary stalk and optic chiasm on rt. Side.

6 month post GKRS

12 Gy at 50 % isodose line.

No Ptosis

Still has devation of rt. eyeball.

Craniopharyngioma, complete resolution at one year follow up.

This 32 years old male is a diagnosed case of Craniopharyngioma with the diminished vision more on left side, headache and  a single episode of generalized fit since 2 and half years. Under went right frontal craniotomy on 2nd July 2007. MRI scan and CT scans showed residual/recurrent Craniopharyngioma. Patient was treated with 12 GY at 50% isodose line,  for the target volume 7.1 cc, multiple isocenters with 4 and 8mm collimators were used in APS mode.

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F.up images after one year showing complete resolution of 

craniopharyngioma, clinically patient has normal vision and has no defecits.

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Left Parietal AVM, complete obliteration at 2 years.

This  8 yrs old girl with Rt hemiparesis, had Left parietal AVM. She was treated with 16 Gy at 50% isodose line for a vol. of 15.1cc. At 2 years there is complete obliteration of AVM and child has no neurodefecits.

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Pineal Region Tumor, resolution with excellent clinical improvement,F.up at 6m and one year.

This is a young man of 26 years who came to us from Afghanistan with c/o headache vomiting and blurred vision.

MR imaging showed an enhancing mass in the pineal region and obstructive hydrocephalus.MR Specrtroscopy revealed alow NAA and high choline.

V.P shunt was placed and he was treated with Gamma Knife.It was a single day treatment as usual and patient was discharged next day.

At 6 months he is back to his normal life style and the Follow up MRI shows 90% resolution of the said tumor.

  

90% resolution at 6 month Follow up.

At 6 months

Further Resolution at one year F.up.

One year

One year

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.