Introduction

Gangliogliomas (GG) are considered WHO grade I rare tumors. While they commonly manifest as temporal lobe epilepsy, they can be located anywhere in the brain. Primary treatment is complete microsurgical resection. Remnant or recurrent GG can benefit from radiation therapy. Here, we present a series of GG who received Gamma Knife radiosurgery (GKR) after initial microsurgery.

Methods

Between October 2009 and February 2020, four patients benefitted from such approach. The median age at surgery was 16 years (mean 17, 11–25) and at the time of GKR was 22.5 years (mean 23, 19–28). Initial clinical symptom was epilepsy in 3 cases and incidental in one. Biopsy was firstly performed in one case. One patient had stereotactic electroencephalography. The respective anatomical locations were right parieto-occipital, sylvian, left paraventricular and left inferior parietal.

Results

Gamma Knife radiosurgery was performed after a median time of 3.5 years after initial gross total microsurgical resection (GTR). The median follow-up after GKR was 54 months (mean 58.5, 6–120). The median marginal dose was 18 Gy (mean 17.5, 16–18). The median target volume was 0.5 mL (mean 0.904, 0.228–2.3). The median prescription isodose volume was 0.6 mL (mean 0.9, 0.3–2.4). At last follow-up, GG majorly decreased in 3 patients, remained stable in one.

Conclusion

Gamma Knife radiosurgery is safe and effective for remnant GG after GTR. Primary treatment remains microsurgical resection, especially in cases with symptomatic mass effect or with epilepsy. Single fraction GKR can be a valuable option for remnant or recurrent tumors after initial resection.

中文翻译：

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伽玛刀放射外科手术作为初始显微手术切除后神经节胶质瘤的抢救疗法

介绍

神经节胶质瘤 (GG) 被认为是 WHO I 级罕见肿瘤。虽然它们通常表现为颞叶癫痫，但它们可以位于大脑的任何地方。主要治疗是完全显微手术切除。残留或复发的 GG 可以从放射治疗中受益。在这里，我们介绍了一系列在初始显微手术后接受伽玛刀放射外科 (GKR) 的 GG。

方法

2009 年 10 月至 2020 年 2 月期间，四名患者受益于这种方法。手术时的中位年龄为 16 岁（平均 17、11-25），GKR 时为 22.5 岁（平均 23、19-28）。临床首发症状为癫痫3例，偶发1例。在一个病例中首先进行了活检。一名患者进行了立体定向脑电图检查。各自的解剖位置是右顶枕叶、外侧裂、左室旁和左下顶叶。

结果

伽玛刀放射外科手术是在初次全显微手术切除 (GTR) 后的中位时间为 3.5 年之后进行的。GKR 后的中位随访时间为 54 个月（平均 58.5、6-120）。中位边缘剂量为 18 Gy（平均 17.5、16-18）。中位目标体积为 0.5 mL（平均 0.904、0.228-2.3）。中位处方等剂量体积为 0.6 mL（平均 0.9、0.3-2.4）。末次随访时GG显着下降3例，稳定1例。

结论

伽玛刀放射外科手术治疗 GTR 后残留的 GG 是安全有效的。主要治疗仍然是显微手术切除，特别是在有症状的占位效应或癫痫的情况下。单次 GKR 可能是初始切除后残留或复发肿瘤的有价值的选择。