title: Gamma Knife radiosurgery for low-grade tectal gliomas.
abstract: BACKGROUND
  Tectal gliomas are present in a critical location that makes their surgical treatment difficult. Stereotactic radiosurgery presents an attractive noninvasive treatment option. However, tectal gliomas are also commonly associated with aqueductal obstruction and consequently hydrocephalus. This necessitates some form of CSF diversion procedure before radiosurgery. The aim of the study was to assess the efficacy and safety of Gamma Knife radiosurgery for tectal gliomas.
  
  
  METHODS
  Between October 2002 and May 2011, 11 patients with tectal gliomas were treated with Gamma Knife radiosurgery. Five patients had pilocytic astrocytomas and six nonpilocytic astrocytomas. Ten patients presented with hydrocephalus and underwent a CSF diversion procedure [7 V-P shunt and 3 endoscopic third ventriculostomy (ETV)]. The tumor volume ranged between 1.2-14.7 cc (median 4.5 cc). The prescription dose was 11-14 Gy (median 12 Gy).
  
  
  RESULTS
  Patients were followed for a median of 40 months (13-114 months). Tumor control after radiosurgery was seen in all cases. In 6/11 cases, the tumors eventually disappeared after treatment. Peritumoral edema developed in 5/11 cases at an onset of 3-6 months after treatment. Transient tumor swelling was observed in four cases. Four patients developed cysts after treatment. One of these cases required aspiration and eventually disappeared, one became smaller spontaneously, and two remained stable.
  
  
  CONCLUSIONS
  Gamma Knife radiosurgery is an effective and safe technique for treatment of tectal gliomas. Tumor shrinkage or disappearance after Gamma Knife radiosurgery may preclude the need for a shunt later on.
authors.affiliation: Gamma Knife Center Cairo, Cairo, Egypt, amrelshehaby@yahoo.com.
authors.forename: Amr Mohamed Nageeb
authors.initials: AM
authors.lastname: El-Shehaby
authors.forename: Wael Abdel Halim
authors.initials: WA
authors.lastname: Reda
authors.forename: Khaled Mohamed
authors.initials: KM
authors.lastname: Abdel Karim
authors.forename: Reem Mohamed
authors.initials: RM
authors.lastname: Emad Eldin
authors.forename: Ignatius Ngene
authors.initials: IN
authors.lastname: Esene
mesh_terms: D000293:Adolescent; D000328:Adult; D001254:Astrocytoma / Q000473:pathology / Q000601:surgery; D020295:Brain Stem Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D016634:Radiosurgery / Q000379:methods*; D003336:Tectum Mesencephali / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden; D014696:Ventriculostomy; D055815:Young Adult