title: Gamma Knife treatment of low-grade gliomas in children.
abstract: BACKGROUND
  Low-grade gliomas have good overall survival rates in pediatric patients compared to adults. There are some case series that reported the effectiveness and safety of Gamma Knife radiosurgery, yet they are limited in number of patients. We aimed to review the relevant literature for pediatric low-grade glial tumors treated with stereotactic radiosurgery, specifically Gamma Knife radiosurgery, and to present an exemplary case.
  
  
  METHODS
  A 6-year-old boy was admitted to clinic due to head trauma. He was alert, cooperative, and had no obvious motor or sensorial deficit. A head CT scan depicted a hypodense zone at the right caudate nucleus. The brain magnetic resonance imaging (MRI) depicted a mass lesion at the same location. A stereotactic biopsy was performed. Histopathological diagnosis was low-grade astrocytoma (grade II, World Health Organization (WHO) classification, 2007). Gamma Knife radiosurgery was applied to the tumor bed. Tumor volume was 21.85 cm(3). Fourteen gray was given to 50% isodose segment of the lesion (maximal dose of 28 Gy). The tumor has disappeared totally in 4 months, and the patient was tumor-free 21 months after the initial treatment.
  
  
  CONCLUSIONS
  The presented literature review represents mostly single-center experiences with different patient and treatment characteristics. Accordingly, a mean/median margin dose of 11.3-15 Gy with Gamma Knife radiosurgery (GKRS) is successful in treatment of pediatric and adult low-grade glial tumor patients. However, prospective studies with a large cohort of pediatric patients should be conducted to make a more comprehensive conclusion for effectiveness and safety of GKRS in pediatric low-grade glial tumors.
authors.affiliation: Department of Orthopaedic Surgery-Spine Center, University of California at San Francisco, 500 Parnassus Avenue MU320 West, San Francisco, CA, 94143-0728, USA. muratsakireksi@gmail.com.
authors.forename: Murat Şakir
authors.initials: MŞ
authors.lastname: Ekşi
authors.affiliation: Department of Neurosurgery, Bahçeşehir University Medical School, İstanbul, Turkey.
authors.forename: Baran
authors.initials: B
authors.lastname: Yılmaz
authors.affiliation: Department of Neurosurgery, Bahçeşehir University Medical School, İstanbul, Turkey.
authors.forename: Akın
authors.initials: A
authors.lastname: Akakın
authors.affiliation: Department of Neurosurgery, Bahçeşehir University Medical School, İstanbul, Turkey.
authors.forename: Zafer Orkun
authors.initials: ZO
authors.lastname: Toktaş
authors.affiliation: Department of Pathology, Medical Park Göztepe Hospital, İstanbul, Turkey.
authors.forename: Ahmet Cemil
authors.initials: AC
authors.lastname: Kaur
authors.affiliation: Department of Radiology, Bahçeşehir University Medical School, İstanbul, Turkey.
authors.forename: Mustafa Kemal
authors.initials: MK
authors.lastname: Demir
authors.affiliation: Department of Neurosurgery, Bahçeşehir University Medical School, İstanbul, Turkey.
authors.forename: Türker
authors.initials: T
authors.lastname: Kılıç
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D005910:Glioma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016634:Radiosurgery / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Caudate nucleus; Gamma Knife radiosurgery; Low-grade glioma; Radiotherapy