Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaFU-151Gamma Knife Surgery for Hemifacial Spasm Related toCerebellopontine Angle Tumors1,2,5Chuan-Fu Huang, 1,2,4 Cheng-Siu Chang, 1,4 Hsien-Tang Tu, 1,3,4 Wen-Shan Liu1Gamma Knife Center2Department of Neurosurgery3Department of Radiation Oncology4Chung-Shan Medical University Hospital, Taichung, Taiwan5China Medical University Hospital, Taichung, TaiwanObjective: Most of tumor-related hemifacial spasm (HFS) reported was treated by open surgery. Wereport the effect of GKS on benign tumor-related HFS at a follow-up of 84 months.Methods: From 2000 to 2011, a total of 6 patients with cerebellopontine tumors (4 meningiomas, and2 schwannomas) with HFS underwent GKS as a primary treatment. These patients had tumors withinthe radiosurgical target area. For meningiomas, the mean radiosurgical treatment volume was 5.3 ml(range 1.2-9.2 ml), and the mean radiosurgical tumor margin dose was 14.1Gy (range 12-18 Gy); for 2schwannomas, the volume was 2.5 ml and 11.2 ml, and the marginal dose was 12 Gy. Five patients werefemale and one male. The mean duration of HFS was 15.5 months (range 3-36 months). The mean ageat the time of radiosurgery was 52.7 years (range, 45-60 years).Results: The mean follow-up period was 84 months (range 40 to 110 months). Overall, 4 of 6 patients(66 %) experienced complete HFS relief without medication after GKS and one patient had a goodoutcome. The mean time of the improvement was 7 months (range 2 to 18 months). Only one patienthad failed relief of HFS and coincidentally this tumor size was not shrunk. For all 6 patients (100%),there was tumor growth control at a mean follow-up of 56 months after GKS, four of them had tumorsize decreased and two were not changed. Two patients with facial numbness reported improvementafter tumor shrinkage.Conclusions: GKS appears to be an effective tool to treat benign tumor related HFS and control tumorgrowth. Reduction of tumor volume is related to spasInm improvement.26
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaFU-196Comparison reports: Thalamotomy, GK thalamotomy,DBS for Parkinsonian tremor patientsMooseong KimInje University Busan Paik Hospital, Busan, KoreaObjective: Tremor, either essential tremor or Parkinsonian tremor, has been effectively and safely treatedby GKS or RF lesioning or DBS the ventral intermediate(Vim) nucleus of the thalamus with or withoutmicroelectrode recording. The authors evaluate the treatment outcome of sixteen tremor patients whohad been treated with thalamotomy without microelectrode, five parkinson’s disease with Gamma Knife,five parkinson’s disease with DBS.Methods: Between September, 2001, and December, 2011, sixteen tremor patients were treated withthalamotomy without microelectrode recording. Twelve patients suffered from Parkinsonian tremor andfour patients were essential tremor patients. The male to female ratio was 1.6 to 1 with median age of59.6 years (range; 39-74 years). Under local anesthesia, a 3mm hole was made using a hand-held twistdrill, and the dura mater was penetrated with a 1.2mm sharp drill beat. Radiofrequency(RF) electrodewas placed in the Vim nucleus of thalamus. With intraoperative macrostimulation, RF lesion was made.Five parkinson’s disease tremor patients were operated with bilateral Vim-DBS. Five parkinson’s diseasetremor patients were operated with unilateral Vim-GK thalamotomy. A radiation dose of 120 Gy wasdelivered to nucleus using a single 4 mm collimator plug pattern following classic anatomical landmarks.Preoperative and postoperative tremor was evaluated with simple tremor severity scale, UnitedParkinson’s disease Rating Scale tremor score(UPDRS) and the development of complications relatedwith the procedure was closely reviewed at the immediate postoperative period and the last follow-up.Results: RF thalamotomy produces immediate relief in up to 98.4% of the patients. There were nodevelopment of complications related with procedure, all patients discharged one or two days aftersurgery. In DBS surgery patients ,Tremor was completely abolished in 40 % in patients, almost abolishedin 60 %. There was no complications. GK thalamotomy patients produced an excellent improvement oftremor in four patients, mild improvement in one patient.Conclusions: Vim thalamotomy without microelectrode recording is a safe and effective procedure tocontrol the tremor with minimal morbidity. DBS is very beneficial in treating bilateral intractable tremorpatients.Intraoperative macroelectrode stimulation safely localizes the Vim nucleus target of the thalamus for thetreatment of patients with tremor. GK thalamotomy is for intractable unilateral tremor patients withmedical disease, severe old age, coagulopathy,etc. Unilateral Vim GK thalamotomy is very effective forintractable tremor patients and contralateral side treated with Vim-DBS27
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Author IndexAAhluwalia Manmeet 49,
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RRadatz Matthias 12, 16Radatz Matth
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Plenary Oral Presentations - Macquarie University Hospital

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