title: Primary central nervous system lymphoma of the brain stem responding favorably to radiosurgery: a case report and literature review.
abstract: OBJECTIVE
  To explore various therapeutic alternatives and evaluate the clinical results of patients with primary central nervous system lymphoma (PCNSL). We report a case of PCNSL with involvement of the brain stem managed with radiosurgery using the Leksell gamma knife as the treatment modality.
  
  
  METHODS
  A 55-year-old white woman presented with complaints of weakness on the left side of her body and double vision associated with a frontal headache. Nervous system examination revealed right-sided oculomotor palsy and left-sided motor paresis, grade 2/5, in both upper and lower limbs. Her Karnofsky performance score was 50. A contrast-enhanced magnetic resonance imaging scan of the brain revealed an irregular space-occupying lesion in the pons that enhanced uniformly with gadolinium. A frame-based stereotactic biopsy was performed revealing a B-cell malignant lymphoma. Subsequently, stereotactic radiosurgery using the Leksell gamma knife was performed. A dose of 11 Gy was delivered to the tumor margin. A follow-up magnetic resonance imaging scan after 2 months revealed a 50% reduction in the size of the enhancing lesion.
  
  
  CONCLUSIONS
  Our own results and limited evidence from the literature suggest stereotactic radiosurgery as a potentially safe and effective treatment option in patients with PCNSL.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71130-3932, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Campbell
authors.forename: Ajay
authors.initials: A
authors.lastname: Jawahar
authors.forename: Marjorie R
authors.initials: MR
authors.lastname: Fowler
authors.forename: Allyson
authors.initials: A
authors.lastname: Delaune
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
mesh_terms: D020295:Brain Stem Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D016393:Lymphoma, B-Cell / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome