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Chun Po Yen, Jason Sheehan, Greg Patterson, and Ladislau Steiner

involved the third ventricle. Two patients developed a new lesion in a location different from that of the previously treated lesion 2.5 and 4 years following GKS, and they underwent a second GKS. On MR images, all tumors were isointense to gray matter of the brain. The enhancement was variable including eight with mild to moderate enhancement and one without enhancement. The tumor volume at the time of GKS ranged from 1.4 to 19.8 cm 3 (mean 6 cm 3 ). Gamma Knife Surgery Technique The procedure has been detailed elsewhere. 31 Briefly, a stereotactic frame was

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Mooseong Kim, Sunghwa Paeng, Seyoung Pyo, Yeonggyun Jeong, Sunil Lee, and Yongtae Jung

control, endocrinological improvement, and minimal complications. In invasive pituitary macroadenomas, complete resection is difficult without causing complications. Gamma Knife surgery for pituitary tumor achieves good treatment outcomes in terms of both tumor control and hormone control. Authors of several reports showed a tumor control rate between 64.7 and 94%, a hormone control rate between 81.8 and 100%, and a complication rate between 4.7 and 20%. Comparably, the fractionated radiotherapy group showed a tumor control rate between 76 and 97%, a hormone control

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Jason Sheehan, Chun Po Yen, Yasser Arkha, David Schlesinger, and Ladislau Steiner

neurosurgeon is associated with a high risk of complications and tumor recurrence. Gamma Knife surgery affords a favorable risk-to-benefit profile for the treatment of small to moderately sized trigeminal schwannomas. Larger studies with open-ended follow up are needed to determine the optimal radiation dose as well as the long-term results and complication rates of GKS for trigeminal neuralgia. References 1 Akiyama T , Ikeda E , Kawase T , Yoshida K : Pseudocapsule formation after gamma knife radiosurgery for trigeminal neurinoma—case report . Neurol Med

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Dibyendu Kumar Ray, Chun Po Yen, Mary Lee Vance, Edward R. Laws, Beatriz Lopes, and Jason P. Sheehan

. Follow-up to assess for clinical recurrence and delayed hypopituitarism must be performed. At our center, delayed hypopituitarism after radiosurgery has been observed in ~ 20–30% of patients with pituitary adenoma; hypopituitarism typically occurs within the first 5 years following radiosurgery. 14 Conclusions Gamma Knife surgery may be a viable treatment option for patients with lymphocytic hypophysitis in whom surgical or medical management has failed. Experience with a larger number of such patients will provide more information on this method of treatment

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Toru Serizawa, Masaaki Yamamoto, Osamu Nagano, Yoshinori Higuchi, Shinji Matsuda, Junichi Ono, Yasuo Iwadate, and Naokatsu Saeki

major institutes according to the same local treatment strategies for metastases without prophylactic WBRT, as we previously reported. 4–8 This 2-institute study demonstrated no significant institutional differences in any of the treatment result items. Similarly, there were no major differences in patients. These results indicate that differences in dose planning for metastases do not affect either overall or neurological survival. Gamma Knife surgery alone for brain metastases, without prophylactic WBRT, is more widely applied in Japan than in the rest of the

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Yanhe Li, Desheng Xu, Zhiyuan Zhang, Yipei Zhang, Dong Liu, Xiaomin Liu, Guokai Wang, and Yiguang Lin

T he incidence of brain metastases is increasing as survival of patients with cancer becomes more prolonged due to advanced cancer therapy. Brain metastases are the most common intracranial tumor; however, brainstem metastases are relatively uncommon, and account for only 3% to 7% of all brain metastases. Open surgery for brainstem metastases is difficult because of the risk of neurological damage. Gamma Knife surgery has been reported to provide benefits to patients with brain metastases; however, few data are available to evaluate the effectiveness of

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Shoji Yomo, Yasser Arkha, Anne Donnet, and Jean Régis

morbidity or death after microsurgical procedures is uncommon but never negligible, even in modern surgical practice. 8 , 25 , 38 Gamma Knife surgery has become established as a minimally invasive treatment for TN over the last 2 decades. 11 , 15 , 23 , 24 , 31 , 37 It would appear reasonable to apply this less invasive solution to GPN, the pathophysiology of which appears to be similar to that of TN. We have found only 1 other case in the literature of GPN treated using GKS, 34 and therefore the role of GKS in the treatment of refractory GPN remains unclear. Case

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Chun Po Yen, Jason Sheehan, Melita Steiner, Greg Patterson, and Ladislau Steiner

. There was no enhancement at all in the other 13 tumors. The mean tumor volume at the time of GKS was 2.5 cm 3 (range 0.4–9.7 cm 3 ). Gamma Knife Surgery Technique The GKS procedure has been detailed elsewhere. 47 In pediatric patients, the placement of the stereotactic frame and the entire treatment procedure were performed after induction of general anesthesia. In adult patients, a local anesthetic supplemented with intravenous sedation was used only during the placement of the frame. Before 1990, CT scanning was the only imaging modality available for

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Bengt Karlsson, Wan-Yuo Guo, Teo Kejia, Nivedh Dinesh, David Hung-Chi Pan, Hidefumi Jokura, Jun Kawagishi, Albertus T. C. J. van Eck, Gerhard A. Horstmann, Tseng Tsai Yeo, and Masaaki Yamamoto

, Chougule P , Zheng Z , Epstein MH , : Gamma knife surgery for treatment of central neurocytomas. Report of four cases . J Neurosurg 94 : 327 – 330 , 2001 5 Emami B , Lyman J , Brown A , Coia L , Goitein M , Munzenrider JE , : Tolerance of normal tissue to therapeutic irradiation . Int J Radiat Oncol Biol Phys 21 : 109 – 122 , 1991 6 Genc A , Bozkurt SU , Karabagli P , Seker A , Bayri Y , Konya D , : Gamma knife radiosurgery for cranial neurocytomas . J Neurooncol 105 : 647 – 657 , 2011 7 Hara M , Aoyagi

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Jay Jagannathan, Jason P. Sheehan, Nader Pouratian, Edward R. Laws, Ladislau Steiner, and Mary Lee Vance

dose to the cranial nerves, which leads us to favor bilateral adrenalectomy over repeated GKS after failed treatment. Conclusions Gamma Knife surgery is a safe and effective treatment for patients with ACTH-secreting pituitary adenomas. We observed endocrine remission in 54% and control of tumor growth in 96% of patients with Cushing's disease. Ongoing surveillance for tumor growth, disease recurrence, the development of new hormone deficiencies, and damage to the optic pathways and brain remains necessary. References 1 Arnott RD , Pestell RG