Purpose: To assess clinical and imaging out- comes in patients treated with Gamma Knife stereotactic radiosurgery (SRS) for brainstem metastases. Materials and methods: We reviewed all patients with brain metas- tases treated with SRS at the University of California, San Francisco from 1991-2005 to identify patients who had SRS to a brainstem metastasis. Survival time and freedom from progression (FFP) were calculated from date of SRS using the Kaplan-Meier method. Prognostic factors were evaluated using the log-rank test and Cox proportional hazards model. Results: From 1991 through 2005, 42 consecutive patients with brainstem metastases had SRS to 44 lesions (seven midbrain, 31 pontine, and six medullary) in 42 sessions. Primary diagnoses included 14 cases of lung cancer (one small-cell), 10 melanoma, 12 breast cancer, five renal cell, and one unknown. The median age was 55 years (range, 25-79). The median survival time was 9 months after SRS. Longer survival time was associated with single metastasis, non-melanoma histology, and extracranial disease control. The median target volume was 0.26 ml (0.015-2.8 ml) and the median prescribed dose was 16.0 Gy (10.0-19.8 Gy). Brainstem lesion FFP was 90% at 6 months and 77% at 1 year. Four patients had brainstem complications following treatment. Poor brain- stem outcome was associated with melanoma and renal cell histology as well as brainstem lesion volume ‡1 ml. Con- clusions: In this series, SRS using a median dose of 16 Gy provided excellent local control with relatively low mor- bidity in patients with brainstem metastases less than 1 ml or non-melanoma, non-renal cell histology.

Gamma Knife radiosurgery for brainstem metastases: the UCSF experience

Object Most intrinsic infiltrative brainstem lesions diagnosed in children are gliomas, and these carry a very bad prognosis. Although the utility and risk of stereotactically guided biopsy procedures in intrinsic infiltrative brainstem lesions have been widely questioned, the neuroimaging diagnosis may be inaccurate in approximately 25% of cases, and the consequences of empirical therapy should not be underestimated. Stereotactic biopsy sampling is still performed in many centers, but the reported diagnostic yield ranges from 83 to 96%. The authors integrated positron emission tomography (PET) images into the planning for stereotactic biopsy procedures to direct the biopsy needle's trajectory to hypermetabolic foci of intrinsic infiltrative brainstem lesions. Their aim was to assess the benefit of the technique in terms of target selection and diagnostic yield. Methods Twenty children with newly diagnosed intrinsic infiltrative brainstem lesions underwent a PET-guided stereotactic biopsy procedure. The P...

Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors

Benign central neurocytoma (CN) is a rare neuronal tumour of the central nervous system recognised since the early eighties. More than 300 articles have been published in the literature, mostly comprising of case reports and short series from individual specialties. These tumours, though normally benign, are more often likely to recur after surgery than previously thought. A multi-modality team involvement, therefore, has become increasingly necessary for their optimum management. In this article, the authors from various neurosciences sub-specialties, with a specific interest and experience in managing CN, review the epidemiology, clinical features, pathological findings, radiological characteristics and surgical treatment, with an emphasis on the latest developments in their histology, molecular biology and adjuvant treatment modalities for recurrent or residual disease.

Central neurocytoma: a multi-disciplinary review.

Central neurocytoma: A clinical, radiological and pathological study of nine cases

Background Treatment of tumors metastatic to the brainstem with stereotactic radiosurgery (SRS) has not been widely studied. Objective To identify the effects of SRS on patients with brainstem metastases by assessing duration of local progression-free survival (LPFS) and overall survival. Methods We retrospectively reviewed clinical data collected from 60 patients undergoing linear accelerator-based SRS for tumors metastatic to the brainstem between August 1994 and December 2007. The LPFS and overall survival were calculated with the Kaplan-Meier method. Prognostic factors were evaluated with the log-rank test and Cox proportional hazards model. Results The median age of patients was 61 years (range, 39-85 years); the median treated lesion volume was 1.0 mL (range, 0.1-8.7 mL); and the median SRS dose was 15 Gy (range, 8-18 Gy). The median overall survival interval after SRS was 4 months (95% confidence interval, 3.4-4.9 months); crude local tumor control was 76%; and median LPFS was 5.7 months (95% confidence interval, 3.0-8.4 months). Shorter overall survival was associated with a pretreatment tumor volume ≥4 mL (P 5 (P = .003) were significantly associated with longer survival. Twelve patients (20%) developed SRS-related complications. Conclusion Stereotactic radiosurgery provides noninvasive treatment and favorable local tumor control for patients with brainstem metastases.

Outcomes and prognostic factors for patients with brainstem metastases undergoing stereotactic radiosurgery.

Object The authors review imaging and clinical outcomes in patients with metastatic brainstem tumors treated using Gamma Knife surgery (GKS). Methods Between March 1989 and March 2005, 53 patients (24 men and 29 women) with metastatic brainstem lesions underwent GKS. The metastatic deposits were located in the midbrain in eight patients, the pons in 42, and the medulla oblongata in three. Lung cancer was the most common primary malignancy, followed by breast cancer, melanoma, and renal cell carcinoma. The mean volume of the metastatic deposits at the time of treatment was 2.8 cm3 (range 0.05–21 cm3). The prescription doses varied from 9 to 25 Gy (mean 17.6 Gy). Imaging follow-up studies were not completed in 16 patients, because of the short-term survival in 11 and patient refusal in five. Of the remaining 37 patients, who underwent an imaging follow-up evaluation at a mean of 9.8 months (range 1–25 months), the tumors disappeared in seven, shrank in 22, remained unchanged in three, and grew in five. All ...

Gamma knife surgery for metastatic brainstem tumors.

Object. Focal tumors, a distinct subgroup of which is composed of brainstem gliomas, may have an indolent clinical course. In the past, their management involved monitoring of open-ended imaging studies and shunt placement if cerebrospinal fluid diversion was required. Nonetheless, their treatment remains a significant challenge for neurosurgeons. Gamma Knife surgery (GKS) has recently been tried as an alternative to surgical extirpation. In the present study the authors assess clinical and imaging results in 20 patients who harbored focal brainstem gliomas treated with GKS between 1990 and 2001. Methods. There were 10 male and 10 female patients with a mean age of 19.1 years. Sixteen tumors were located in the midbrain, three in the pons, and one in the medulla oblongata. The mean tumor volume at the time of GKS was 2.5 cm 3 . In 10 cases a tumor specimen was obtained either by open surgery or stereotactic biopsy, securing the diagnosis of pilocytic astrocytoma in five patients and nonpilocytic astrocytoma in five others. In the remaining 10 cases, the diagnosis was based on clinical and neuroimaging findings. The prescription Gamma Knife dose varied between 10 and 18 Gy, except in three patients who were receiving a boost to a site in which external-beam radiation was previously delivered. An average of four isocenters were utilized per GKS. Patients were followed up for a mean of 78.0 months. The tumors disappeared in four patients and shrank in 12 patients. Of these patients, one experienced transitory extrapyramidal symptoms and fluctuating impairment of consciousness (from somnolence to coma) for 6 months. Another patient whose tumor disappeared 3 years following GKS died of stroke 8 years postoperatively. The rest of the patients either remained stable or improved clinically. Tumor progression occurred in four patients; of these four, one patient developed hydrocephalus requiring a ventriculoperitoneal shunt, two showed neurological deterioration, and one 4-year-old boy died of tumor progression. Conclusions. Gamma Knife surgery may be an effective primary treatment or adjunct to open surgery for focal brainstem gliomas.

Gamma Knife surgery for focal brainstem gliomas

Object Although considered benign tumors, neurocytomas have various biological behaviors, histological patterns, and clinical courses. In the last 15 years, fractionated radiotherapy and radiosurgery in addition to microsurgery have been used in their management. In this study, the authors present their experience using Gamma Knife surgery (GKS) in the treatment of these tumors. Methods Between 1989 and 2004, the authors performed GKS in seven patients with a total of nine neurocytomas. Three patients harbored five recurrent tumors after a gross-total resection, three had progression of previous partially resected tumors, and one had undergone a tumor biopsy only. The mean tumor volume at the time of GKS ranged from 1.4 to 19.8 cm3 (mean 6.0 cm3). A mean peripheral dose of 16 Gy was prescribed to the tumor margin with the median isodose configuration of 32.5%. Results After a mean follow-up period of 60 months, four of the nine tumors treated disappeared and four shrank significantly. Because of secondary...

Gamma knife surgery for neurocytoma.

Diffusivity Metrics Three Months After Upfront Gamma Knife Radiosurgery for Trigeminal Neuralgia May Be Correlated with Pain Relief.

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Gamma knife surgery for metastatic brainstem tumors.

Gamma Knife surgery for focal brainstem gliomas

Gamma knife surgery for neurocytoma.

Diffusivity Metrics Three Months After Upfront Gamma Knife Radiosurgery for Trigeminal Neuralgia May Be Correlated with Pain Relief.