Gamma Knife surgery for subependymal giant cell astrocytomas

Clinical article

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Object

The authors report their experience of using Gamma Knife surgery (GKS) in patients with subependymal giant cell astrocytoma (SEGA).

Methods

Over a 20-year period, the authors identified 6 patients with SEGAs who were eligible for GKS. The median patient age was 16.5 years (range 7–55 years). In 4 patients, GKS was used as a primary management therapy. One patient underwent radiosurgery for recurrent tumors after prior resection, and in 1 patient GKS was used as an adjunct after subtotal resection. The median tumor volume at GKS was 2.75 cm3 (range 0.7–5.9 cm3). A median radiation dose of 14 Gy (range 11–20 Gy) was delivered to the tumor margin.

Results

The median follow-up duration was 73 months (range 42–90 months). Overall local tumor control was achieved in 4 tumors (67%) with progression-free periods of 24, 42, 57, and 66 months. Three tumors regressed and one remained unchanged. In 2 patients the tumors progressed, and in 1 of these patients the lesion was managed by repeated GKS with subsequent tumor regression. The other relatively large tumor (5.9 cm3) was excised 9 months after GKS. The progression-free period for all GKS-managed tumors varied from 9 to 66 months. There were no cases of hydrocephalus or GKS-related morbidity.

Conclusions

Gamma Knife surgery may be an additional minimally invasive management option for SEGA in a patient who harbors a small but progressively enlarging tumor when complete resection is not safely achievable. It may also benefit patients with a residual or recurrent tumor that has progressed after surgery.

Abbreviations used in this paper: GKS = Gamma Knife surgery; SEGA = subependymal giant cell astrocytoma; SRS = stereotactic radiosurgery.

Article Information

Address correspondence to: Douglas Kondziolka, M.D., Department of Neurological Surgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213. email: kondziolkads@upmc.edu.

Please include this information when citing this paper: published online October 15, 2010; DOI: 10.3171/2010.9.JNS10816.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Cases 1–3, respectively. A–C: Gadolinium-enhanced MR images obtained in the patients with tuberous sclerosis, demonstrating a well-enhanced mass in the frontal horn of the lateral ventricle near the foramen of Monro.

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    Case 5. A: Axial Gd-enhanced MR image of a SEGA obtained before radiosurgery. B: Dose planning at GKS. C: Follow-up image 42 months after GKS showing a decrease in size of the tumor.

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    Case 6. A: Axial Gd-enhanced MR image acquired before GKS for a SEGA. B: Dose planning at second GKS for the tumor with cystic enlargement. C: Axial Gd-enhanced MR image obtained 43 months after second GKS demonstrating regression of the cyst with a stable solid component.

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