The role of gamma knife radiosurgery in children.
OBJECTIVE
Despite advances in microneurosurgery, the surgical management of deep-seated lesions is still associated with a high risk. Gamma knife radiosurgery (GKRS), however, has improved the outcome of cerebral tumors and arteriovenous malformations (AVMs) in delicate areas.


METHODS
Between March 1992 and June 1998, 50 children (age 1-16 years) with intracranial lesions were treated with GKRS. There were 12 low-grade gliomas, 12 high-grade gliomas, 7 craniopharyngiomas, 3 hamartomas, 2 meningiomas of the skull base, 2 vestibular schwannomas, 1 pituitary adenoma, 1 choroid plexus papilloma, and 10 AVMs. The mean size of the pathologies was 4.6 cm3 (range: 0.21-25.5 cm3). A mean marginal dose of 16 Gy (8-25 Gy) was applied to a mean isodose surface of 50% (35-90%). Clinical and neuroradiological follow-up were analyzed for outcome. Follow-up periods of 45 of these patients ranged from 8 to 79 months (mean 36 months); 5 patients were lost to follow-up. Neoplasms decreased in size in 15 cases (41%), remained unchanged in 13 patients (35%), and increased in 9 cases (24%). AVMs obliterated in 3 children (38%) within 24 months. Neurological follow-up demonstrated improved clinical status in 7 patients (15.5%), stable neurological status in 31 cases (69%) and clinical deterioration in 7 patients (15.5%). The treatment was well tolerated and no complications occurred.


CONCLUSIONS
GKRS represents a safe and effective treatment option for benign neoplasms or AVMs in pediatric patients and may extend survival times of children with malignant lesions.
Eder
H G
HG
Department of Neurosurgery, Karl-Franzens University, Auenbruggerplatz 29, 8036 Graz, Austria. hans.eder@kfunigraz.ac.at
Leber
K A
KA
Eustacchio
S
S
Pendl
G
G
D000293:Adolescent; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis; D016634:Radiosurgery