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Gamma Knife treatment of low-grade gliomas in children

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Abstract

Background

Low-grade gliomas have good overall survival rates in pediatric patients compared to adults. There are some case series that reported the effectiveness and safety of Gamma Knife radiosurgery, yet they are limited in number of patients. We aimed to review the relevant literature for pediatric low-grade glial tumors treated with stereotactic radiosurgery, specifically Gamma Knife radiosurgery, and to present an exemplary case.

Case description

A 6-year-old boy was admitted to clinic due to head trauma. He was alert, cooperative, and had no obvious motor or sensorial deficit. A head CT scan depicted a hypodense zone at the right caudate nucleus. The brain magnetic resonance imaging (MRI) depicted a mass lesion at the same location. A stereotactic biopsy was performed. Histopathological diagnosis was low-grade astrocytoma (grade II, World Health Organization (WHO) classification, 2007). Gamma Knife radiosurgery was applied to the tumor bed. Tumor volume was 21.85 cm3. Fourteen gray was given to 50 % isodose segment of the lesion (maximal dose of 28 Gy). The tumor has disappeared totally in 4 months, and the patient was tumor-free 21 months after the initial treatment.

Discussion and conclusion

The presented literature review represents mostly single-center experiences with different patient and treatment characteristics. Accordingly, a mean/median margin dose of 11.3–15 Gy with Gamma Knife radiosurgery (GKRS) is successful in treatment of pediatric and adult low-grade glial tumor patients. However, prospective studies with a large cohort of pediatric patients should be conducted to make a more comprehensive conclusion for effectiveness and safety of GKRS in pediatric low-grade glial tumors.

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Acknowledgments

Murat Şakir Ekşi, M.D. was supported by a grant from Tubitak (The Scientific and Technological Research Council of Turkey), Grant number 1059B191400255.

Conflict of interest

All the authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery-Spine Center, University of California at San Francisco, 500 Parnassus Avenue MU320 West, San Francisco, CA, 94143-0728, USA

    Murat Şakir Ekşi

  2. Department of Neurosurgery, Bahçeşehir University Medical School, İstanbul, Turkey

    Baran Yılmaz, Akın Akakın, Zafer Orkun Toktaş & Türker Kılıç

  3. Department of Pathology, Medical Park Göztepe Hospital, İstanbul, Turkey

    Ahmet Cemil Kaur

  4. Department of Radiology, Bahçeşehir University Medical School, İstanbul, Turkey

    Mustafa Kemal Demir

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  1. Murat Şakir Ekşi
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Ekşi, M.Ş., Yılmaz, B., Akakın, A. et al. Gamma Knife treatment of low-grade gliomas in children. Childs Nerv Syst 31, 2015–2023 (2015). https://doi.org/10.1007/s00381-015-2819-y

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