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Safety and Efficacy of Primary Hypofractionated Gamma Knife Radiosurgery for Giant Hypothalamic Hamartoma

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To describe the feasibility, safety, efficacy, and complication profile of primary hypofractionated gamma knife radiosurgery (GKRS), and practical nuances of performing the same in pediatric patients.

Methods

Three pediatric patients (age range 17–65 mo) underwent primary hypofractionated GKRS in 2–3 consecutive days with interfraction interval of 24 h. All patients had precocious puberty and were on GnRH analogue. Frame based GKRS done with 8.1–9.2 Gy radiation per fraction at 50% isodose in 2–3 fractions targeting the entire hamartoma volume. The mean target volume was 5.67 cc (4.45–7.39 cc). The authors followed these patients for clinical and endocrinological assessment at every 6 mo interval while the repeat MRI done at 6 mo and then annually. The seizure outcome analysis was done using Engel scale.

Results

At a mean follow up of 27 mo (24–30 mo), 2 patients became Engel class 3 while one achieved Engel class 1 control. 2 patients showed halted pubertal growth with no additional hormonal aberration. 2 patients showed significant volumetric reduction (48% and 32%) and patchy necrosis inside the hypothalamic hamartoma (HH). There was no deficit in visual function, memory and cognition. One patient showed reduction in aggressiveness.

Conclusion

Giant HH are exceptionally difficult neurological diseases. Primary hypofractionated GKRS may be an alternative approach as mono/multitherapy with promising results and minimal complication.

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Authors and Affiliations

  1. Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Manjul Tripathi, Prasant Maskara, Parwinder Kaur, Rupinder Kaur, Aman Batish & Sandeep Mohindra

  2. National Institute of Health Research (NIHR) Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK

    Manjul Tripathi

  3. Department of Pediatric Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Naveen Sankhyan, Jitendra Kumar Sahu & Rakesh Kumar

  4. Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Narendra Kumar

  5. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Chirag K. Ahuja

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  1. Manjul Tripathi
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  4. Jitendra Kumar Sahu
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Contributions

MT and PM: Concept, patient management, radiosurgery, manuscript writing, review, critical evaluation, submission; NS and JKS: Patient management, critical evaluation of manuscript; RK: Patient management, critical evaluation of manuscript, endocrinological management; NK: Radiotherapy, patient management; CKA: Radiology support, patient management; PK, RK and AB: Patient management, literature review; SM: Literature review and administration support. NS will act as guarantor for this paper.

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Correspondence to Manjul Tripathi.

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Equal first authorship to Manjul Tripathi and Prashant Maskara

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Tripathi, M., Maskara, P., Sankhyan, N. et al. Safety and Efficacy of Primary Hypofractionated Gamma Knife Radiosurgery for Giant Hypothalamic Hamartoma. Indian J Pediatr 88, 1086–1091 (2021). https://doi.org/10.1007/s12098-020-03637-w

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  • DOI: https://doi.org/10.1007/s12098-020-03637-w

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