Summary
From August 1992 until December 1999 Gamma Knife radiosurgery (GKRS) was applied to 21 patients (male to female ratio 14:7) with brainstem gliomas. Patient’s median age was 23 years (8–56 years). All tumours were histologically confirmed by biopsy or open surgery: 12 low-grade gliomas and 9 malignant growths. Two lesions were located primarily in the medulla, 12 in the pons and 7 in the midbrain. A median dose of 12 Gy (9–20 Gy) was applied to the tumour margin by the median isodose of 45%. Prior to radiosurgery 4 patients were treated by conventional radiotherapy, 1 had radiotherapy and chemotherapy, 1 patient underwent chemotherapy, and 1 patient was shunted due to hydrocephalus.
Neuroimaging controls (MR, CT) were obtained from 19 patients. The median interval between radiosurgery and the last neuroimaging control was 11.8 months (1–74 months). Neuroimaging depicted tumour progression in 2 patients, stable disease in 10 patients and regression in 3 cases. Follow-up periods ranged between 3 and 99 months (median 29 months). The neurological state improved in 5 patients. Microsurgical cyst fenestration was performed in 1 patient after GKRS, shunting procedure was necessary for 2 patients. Nine patients died unrelated to radiosurgery within 3 to 45 months (median 20.7 months).
GKRS is an effective treatment modality for brainstem gliomas with satisfying tumour control and functional outcome.
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References
Albright AL, Guthkelch AN, Packer RJ, Price RA, Rourke LB (1986) Prognostic factors in pediatric brain-stem gliomas. J Neurosurg 65: 751–755
Alvisi C, Cerisoli M, Maccheroni ME (1985) Long-term results of surgically treated brainstem gliomas. Acta Neurochir (Wien) 76: 12–17
Barcia JA, Barcia-Salorio JL, Ferrer C, Ferrer E, Algas R, Hernandez G (1994) Stereotactic radiosurgery of deeply seated low grade gliomas. Acta Neurochir (Wien) [Suppl] 62: 58–61
Chang WH, Kak VK, Banerjee AK, Rajwanshi A (1990) Stereotaxic biopsy of brain-stem tumours in children. Childs Nerv Syst 6: 409–411
Cloughesi TF, Black KL (1994) Diagnosis and management of brainstem gliomas. Neurosurg Q 4: 174–186
Epstein F, Farmer JP (1993) Brain-stem glioma growth patterns. J Neurosurg 78: 408–412
Grabb PA, Lunsford LD, Albright AL, Kondziolka D, Flickinger JC (1996) Stereotactic radiosurgery for glial neoplasms of childhood. Neurosurgery 38: 696–701
Grigsby PW, Garcia DM, Simpson JR, Fineberg BB, Schwartz HG (1989) Prognostic factors and results of therapy for adult thalamic and brainstem tumors. Cancer 63: 2124–2129
Heffez DS, Zinreich SJ, Long DM (1990) Surgical resection of intrinsic brain stem lesions: an overview. Neurosurgery 27: 789–798
Hirato M, Nakamura M, Inoue HK, Ohye C, Hirato J, Shibazaki T, Andou Y (1995) Gamma knife radiosurgery for the treatment of brainstem tumors. Stereotact Funct Neurosurg 64 [Suppl] 1: 32–41
Huang CF, Kondziolka D, Flickinger JC, Lunsford LD (1999) Stereotactic radiosurgery of brainstem metastases. J Neurosurg 91: 563 568
Kaplan AM, Albright AL, Zimmerman RA, Roke LB, Li H, Boyett JM, Finlay JL, Wara WM, Packer RJ (1996) Brainstem gliomas in children. Pediatr Neurosurg 24: 185–192
Kida Y, Kobayashi T, Mori Y (2000) Gamma knife radiosurgery for low-grade astrocytomas: Results of long-term follow up. J Neurosurg [Suppl] 3 93: 42–46
Kleihues P, Cavenee WK (1997) Pathology and genetics of tumours of the nervous system. International Agency for Research on Cancer, France, pp 1–36
Kondziolka D, Flickinger JC, Bissonette DJ, Bozik M, Lunsford LD (1997) Survival benefit of stereotactic radiosurgery for patients with malignant glial neoplasms. Neurosurgery 41: 776–785
Legat J, Mokry M, Leber K, Schröttner O, Pendl G (1998) Gamma Knife radiosurgery for midline lesions. Kitakanto Med J (S1): 41–50
Masciopinto JE, Levin AB, Mehta MP, Rhode BS (1995) Stereotactic radiosurgery for glioblastoma: a final report of 31 patients. J Neurosurg 82: 530–535
Massager N, Regis J, Kondziolka D, Njee T, Leviver M (2000) Gamma knife radiosurgery for brainstem arteriovenous malformations: preliminary results. J Neurosurg [Suppl] 3 93: 102–103
Pendl G, Vorkapic P, Koniyama M (1990) Microsurgery of midbrain lesions. Neurosurgery 26: 641–648
Pendl G, Vorkapic P (1991) Microsurgery of intrinsic midbrain lesions. Acta Neurochir (Wien) [Suppl] 53: 137–143
Pool LJ (1968) Gliomas in the region of brain stem. J Neurosurg 29: 164–167
Selvapandian S, Rajshekar V, Chandy MJ (1999) Brainstem glioma: Comparative study of clinico-radiological presentation, pathology and outcome in children and adults. Acta Neurochir (Wien) 141: 721–727
Smith RR, Zimmerman RA, Packer RJ, Hackney DB, Bilaniuk LT, Sutton LN, Goldberg HI, Grossman RI, Schut L (1990) Pediatric brainstem glioma. Post-radiation clinical and MR follow-up. Neuroradiology 32: 265–271
Steck J, Friedman WA (1995) Stereotactic biopsy of brainstem mass lesions. Surg Neurol 43: 563–568
Pollack IF, Hoffman HJ, Humphreys RP, Becker L (1993) The long-term outcome after surgical treatment of dorsally exophytic brain-stem gliomas. J Neurosurg 78: 859–863
Wang C, Zhang J, Liu A, Sun B, Zhao Y (2000) Surgical treatment of primary midbrain gliomas. Surg Neurol 53: 41–51
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Fuchs, I., Kreil, W., Sutter, B., Papaethymiou, G., Pendl, G. (2002). Gamma Knife Radiosurgery of Brainstem Gliomas. In: Sutter, B., Schröttner, O. (eds) Advances in Epilepsy Surgery and Radiosurgery. Acta Neurochirurgica Supplements, vol 84. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6117-3_10
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DOI: https://doi.org/10.1007/978-3-7091-6117-3_10
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