Article

Role of Gamma Knife Radiosurgery in Multimodality Management of Craniopharyngioma.

M Abid Saleem, A Sattar M Hashim, Azher Rashid, Muhammed Ali

Department of Neurosurgery, Pakistan Gamma Knife and Stereotactic Radiosurgery Center, NeuroSpinal and Medical Institute, 100/1 Mansfield Street, M.A. Jinnah Road, Sadder, Karachi, 74400, Pakistan, .

Acta neurochirurgica. Supplement 01/2013; 116:55-60. DOI:10.1007/978-3-7091-1376-9_9

Source: PubMed

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ABSTRACT Objective: This retrospective study evaluated the efficacy and safety of the use of Gamma Knife Radiosurgery (GKS) along with other surgical procedures in the management of craniopharyngioma. Methods: Thirty-five patients (17 children and 18 adults) with craniopharyngioma were treated with GKS between May 2008 and August 2011. The age of the patients ranged from 2 to 53 years (mean 20 years). There were 26 males and 9 females. Craniopharyngiomas were solid in 7 patients, cystic in 4, and mixed in 24. Tumor size ranged from 1 to 33.3 cm(3) (mean 12 cm(3)). The prescription dose ranged from 8 to 14 Gy (mean 11.5 Gy). Maximum dose ranged from 16 to 28 Gy (mean 23 Gy). Before GKS 11 patients underwent subtotal resection of the neoplasm, 2 - neuroendocopic fenestration of the large cystic component, and 10 - stereotactic aspiration of the neoplastic cyst content. Results: The length of follow-up period varied from 6 to 36 months (mean 22 months). The tumor response rate and control rate were 77.1 % and 88.5 %, respectively. Clinical outcome was considered excellent in 10 cases, good in 17, fair in 4, and poor in 4. No one patient with normal pituitary function before GKS developed hypopituitarism thereafter. Deterioration of the visual function after treatment was noted in one patient. Conclusion: After GKS tumor control can be achieved in significant proportion of patients with craniopharyngioma. Treatment-related neurological morbidity in such cases is rare. Therefore, radiosurgery may be considered useful for management of these tumors.

Multisession stereotactic radiosurgery for large benign brain tumors of >3cm-early clinical outcomes.

Article: Multisession stereotactic radiosurgery for large benign brain tumors of >3cm-early clinical outcomes

Azhar Rashid, MBBS, FCPS Radiotherapy (PAK, Msc Oncology (UK, Muhammad Ali Memon, MCPS, Usman Ahmed, M.Phil Physics, Muhammad Abid Saleem, FCPS Neurosurgery (PAK,Amer Iqtidar Bhatti, MD in Radiology (PAK, Naveed Ahmed, FCPS Radiology (PAK, FRCR, Abdul Sattar M. Hashim, M.D, Ph.D

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ABSTRACT: Objective: To evaluate the clinical outcome of linear accelerator based multisession stereotactic radiosurgery (SRS) for large benign brain tumors of >3cm. Methods: Between June 2009 and May 2011, 35 patients having large benign brain tumors of >3cm (≥15 cm3) were treated by multisession stereotactic radiosurgery. This retrospective study was carried out at Neurospinal & Medical Institute Karachi. There were 17 (48.6 %) males and 18(51.4 %) females. Median age was 36 years (range: 13-65 years). Median target volume was 49.4 cm3 (range: 15-184 cm3). The median marginal dose was 25 Gy (range: 20–27.5Gy) prescribed to a median 75% isodose line (range: 65-100 %). Median number of 5 fractions were used ranging 3-5 fractions. Results: All the patients tolerated treatment very well. 21 (58.3%) patients had remarkable clinical improvement of neurological symptoms, 14 (38.9%) patients had stable symptoms, and only one patient had transient worsening of symptoms. No permanent neurological damage or radiation injury was seen. Radiologically, 9 (25.7%) patients achieved reduction in size of the tumor, 26(74.3 %) patients were having stable disease, and overall control rate was found to be 100 %. Median follow-up time from the end of SRS was 6.4 months (range: 1-22.5months). Conclusion: Linear accelerator based multisession stereotactic radiosurgery for large benign brain tumors of >3cm is effective and well tolerated. Key Words: Stereotactic radiosurgery (SRS), multi session SRS, brain tumors, linear accelerator, benign brain tumors, radiation injury.

Journal of Radiosurgery and SBRT Vol. 2 2012. 04/2012; vol.2(2012):29-40.

Gamma Knife Thalamotomy for Parkinson Disease and Essential Tremor: A Prospective Multicenter Study.

Ohye, Chihiro MD, DMSc; Higuchi, Yoshinori MD, PhD; Shibazaki, Toru MD; Hashimoto, Takao MD, PhD;  

Neurosurgery 70:3:526–536, 2012. doi: 10.1227/NEU.0b013e3182350893

BACKGROUND: No prospective study of gamma knife thalamotomy for intractable tremor has previously been reported.

OBJECTIVE: To clarify the safety and optimally effective conditions for performing unilateral gamma knife (GK) thalamotomy for tremors of Parkinson disease (PD) and essential tremor (ET), a systematic postirradiation 24-month follow-up study was conducted at 6 institutions. We present the results of this multicenter collaborative trial.

METHODS: In total, 72 patients (PD characterized by tremor, n = 59; ET, n = 13) were registered at 6 Japanese institutions. Following our selective thalamotomy procedure, the lateral part of the ventralis intermedius nucleus, 45% of the thalamic length from the anterior tip, was selected as the GK isocenter. A single 130-Gy shot was applied using a 4-mm collimator. Evaluation included neurological examination, magnetic resonance imaging and/or computerized tomography, the unified Parkinson's disease rating scale (UPDRS), electromyography, medication change, and video observations.

RESULTS: Final clinical effects were favorable. Of 53 patients who completed 24 months of follow-up, 43 were evaluated as having excellent or good results (81.1%). UPDRS scores showed tremor improvement (parts II and III). Thalamic lesion size fluctuated but converged to either an almost spherical shape (65.6%), a sphere with streaking (23.4%), or an extended high-signal zone (10.9%). No permanent clinical complications were observed.

CONCLUSION: GK thalamotomy is an alternative treatment for intractable tremors of PD as well as for ET. Less invasive intervention may be beneficial to patients.

Stereotactic Radiosurgery as the Primary Treatment for New and Recurrent Paragangliomas: Is Open Surgical Resection Still the Treatment of Choice?

Stereotactic Radiosurgery as the Primary Treatment for New and Recurrent Paragangliomas: Is Open Surgical Resection Still the Treatment of Choice?

Pineal region Tumor. Update at 2 years follow up.

This is a young man of 26 years  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. Now at 2 years follow Pt. is fine with consistent resolution.

Resolution at 6 Month.

Resolution at 6 Month.

Further Resolution at one year F.up.

Further Resolution at one year F.up.

Consistent Resolution at 2 years follow up.

Gamma knife Radiosurgery for Glomus Jugulare Tumor.

This 24 years old lady presented with h/o vertigo since 10 years, bilateral tinnitus more on right side since 2 years, headache since one year. She had loss of right gag and palatal reflexes, atrophied tongue on right side with fasciculation and right deviation.

.Patient was treated with marginal dose of 14 Gy with 43% isodose line was prescribed for the target volume 20.3 cc; multiple iso centers with 18, 14 and 8 mm collimators were used in APS and trunnion mode.

Pre Gamma Knife radiosurgery.
Glomus jugulare Tumor.
Volume 20.3 cc.

Follow up CT images Obtained  18 months after GKRS, showing tumor volume 5.2 cm3.

There is remarkable clinical improvement especially in tinnitus and hoarseness.

Gamma Knife Radiosurgery in Low Grade Glioma, decrease in T2 High Signal Volume

This, 35 years old man  has presented with  tonic clonic fits with loss of consciousness and sphincter control since five years, responded well to anti-epileptic medicines for three years. Progression in intensity and frequency of the tonic clonic fits observed in last two years, worst since one month. He also presented weakness of left lower limb since one month.Clinical examination has revealed left lower limb monoparesis grade 4/5.

MRI brain with contrast revealed  non enhancing mass in the right parietal para falcine region over motor strip with high T2 signals.  MR Spectroscopy revealed neoplastic activity within the lesion. He had Gamma Knife Radiosurgery with following prescription.

Target	Location	Prescription	Volume
A	Right parietal Glioma	12 Gy @ 50%	17.4 cm³

Low Grade Glioma: Follow up at 3 months shows about 25 % decrease in T2 high signal volume.
Pt. is clinically in static condition with fits controlled on medicine.