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Michael S. B. Edwards, William M. Wara, Raul C. Urtasun, Michael Prados, Victor A. Levin, Dorcas Fulton, Charles B. Wilson, John Hannigan and Pamela Silver

great clarity. In 1969 he wrote, “To our knowledge, X-ray therapy has never cured a brain stem glioma. … Indeed, should any patient with a clinical diagnosis of brain stem glioma still be alive as long as 18 months after diagnosis, with or without X-ray treatment, reinvestigation and probably surgical exploration is indicated as some other lesion is probably present.” Despite this dismal assessment, in recent years various authors have reported that radiation therapy may control tumor growth and may reverse neurological dysfunction caused by brain-stem glioma in 75

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Joseph Petronio, Michael S. B. Edwards, Michael Prados, Sarah Freyberger, Jane Rabbitt, Pamela Silver and Victor A. Levin

reduces or controls tumor bulk, 2, 21, 34, 48, 49 reverses the diencephalic syndrome of Russell, 10 and in some patients stabilizes or improves vision. 11 Because of the long-term survival of many children with chiasmal/hypothalamic gliomas and the well-known deleterious effects of external beam irradiation on the maturing brain, 4, 9, 13, 22, 38 an alternative means of primary therapy designed to reduce or control tumor bulk and preserve or restore optimal visual and endocrine function seems desirable. Recently, conservative management of chiasmal