Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaVA-56Gamma Knife Surgery for the Management of IntrinsicBrainstem Tumors and Vascular LesionsDavid Hung-Chi PanTaipei Veterans General HospitalObjective: We present a retrospective study of 111 patients with intrinsic brainstem lesions treated byGamma Knife surgery (GKS) between 1993-2009.Methods: These lesions include 26 gliomas, 49 cavernous malformations, 20 AVMs and 16 metastatictumors. Criteria of patients’ selection for GKS are based on thorough clinical and imaging studies toshow a well-demarcated lesion in the brain stem which is difficult to treat with conventional surgeryor radiotherapy. During GKS, varied radiosurgical doses to the lesion margin were prescribed basedon the lesion size and nature: AVMs 15-22Gy, gliomas and cavernous malformations 10.5-12Gy, andmetastasis 11.5-20Gy. After radiosurgery, all patients underwent regular imaging follow-ups every2-6 months to assess treatment results. For AVMs, a final angiogram was performed 2-4 years posttreatmentto verify complete obliteration.Results: In 20 AVMs, 15 have shown angiographically confirmed complete obliteration. The obliterationrate was 75%. Complications included 1 (5%) radiation-induced edema, 1 (5%) mild rebleeding and2 (10%) focal infarction with hemiparesis. There was no mortality. In 49 cavernous malformations,the annual hemorrhagic rate significantly reduced from 28.2% of the pre-GKS status to 3.33% within2 years post-GKS, and further reduced to 1.74% over 2 years after radiosurgery. In 26 gliomas, thefollow-up time ranged from 6-181 months (median 37 months). Post-GKS MRI revealed tumorregression in 8 (30%), stable in 9 (35%), and enlarged in 9 (35%). Five (19%) glioma patients dieddue to tumor progression, others (81%) were clinically stable after GKS. In 16 patients with metastatictumors, a prolonged survival over 12 months with initial shrinkage of tumors was observed in 10patients.Conclusions: Our data suggest that GKS is effective for the treatment of selected brainstem neoplasm orvascular lesions with acceptably low risks. Careful selection of patients before treatment is necessary.72
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaVA-69Long-Term Follow-Up Results of Two-Stage Gamma KnifeRadiosurgery with a ≥3 Year Interval for >10 ccArteriovenous Malformations1Masaaki Tamamoto , 2 Atsuya Akabane, 3 Yuji Matsumaru,1Bierta E. Barfod, 4 Hidetoshi Kasuya, 1 Yoichi Urakawa1Katsuta Hospital Mito GammaHouse2Departments of Neurosurgery, Kanto Medical Center NTT EC3Departments of Neurosurgery, Toranomon Hospital4Departments of Neurosurgery,Tokyo Womenâ€s Medical University Medical Center EastObjective: Little information is available on staged gamma knife radiosurgery (GKRS) with an intervalof ≥3 years for relatively large arteriovenous malformations (AVMs).Methods: Among our 250 AVM patients treated with GKRS during a 16-year period (1988-2004),the courses of 31 (15 females, 16 males, mean age; 29 [range; 10-63] years) were selected for study.The median nidus volume was 14.0 (maximum; 55.8) cc, respectively. In all 31 patients, relatively lowdoses (12-16 Gy at the lesion periphery) were intentionally employed for the first GKRS. The secondGKRS was scheduled for at least 36 months later.Results: Complete nidus obliteration was attained after the first GKRS in one patient. To date, 26patients have undergone a second procedure with a post-GKRS mean interval of 41 (range 24 to 83)months, while two patients refused the second GKRS and no further treatment was not applicablebecause of severely morbid and death due to bleeding in one each. Among the 26 patients, threerefused follow-up DSA, two died due to bleeding and follow-up DSA is awaited in one. The remaining20 paients have undergone follow-up DSA. Complete nidus obliteration was confirmed in 13 (65.0%),remarkable shrinkage in the other seven (35.0%). In the two of the seven patients, a third GKRSachieved complete nidus obliteration. Therefore, the cumulative complete obliteration rate in thisseries was 76.2% (16[1+13+2]/21 eligible patients). Seven patients (22.6%) experienced bleeding; sixbefore and one after GKRS. Mild symptomatic GKRS-related complications occurred in two patients(6.5%).Conclusions: Although a final conclusion awaits further studies and patient follow-up, these resultssuggest two-stage GKRS to have certain benefits even for relatively large AVMs.73
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Page 83 and 84: Author IndexAAhluwalia Manmeet 49,
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Plenary Oral Presentations - Macquarie University Hospital

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