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.

 Gamma Knife Radiosurgery for Recurrent Posterior Fossa Hemangioblastoma

This 47 year old 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 one month.  On clinical examination middle aged lady  has decreased vision & ataxia. MRI brain with contrast dated March 09, 2022 shows abnormal signal intensity enhancing mass lesion  in posterior fossa, involving the cerebellar vermis & shows  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. 

                                         PRE-GKSRS                                   POST-GKSRS

Follow-up Comparative Study after One year (February 07, 2023):

Patient visited the gamma knife center for second follow up presented with recent MRI brain with contrast dated  February 07, 2023  shows significant regression in the targeted hemangioblastoma from 27.9cc to 2.8 cc when compared with previous MRI brain with contrast dated March 09, 2022 consistent with good lesion control.