Gamma knife radiosurgery for children with orbital lesions

Dong Liu1, Guokai Wang2

1 2Gamma Knife center, Tianjin Medical University Second Hospital

Keywords: outcome, vision, gamma knife, children, orbit

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     Orbital pathology in children are challenging.
Our purpose was to evaluate the medium term results of Gamma Knife surgery (GKS) for children patients with orbital lesions.
     There are 57 patients who were treated with Leksell Gamma Knife between September 1995 and January 2010 , and 31 of them were well followed up including18 boys and 13 girls with a median age of 6 (range 2-12) years.
     GKS was performed as the primary treatment for 28 patients, while 3 patients had recurrent or residual lesions after prior surgical resection. The most common symptoms of the patients were proptosis, 25 patients with the measurement of 3 mm, and eyesight lost, one was completely blind before GKS among 28 such patients. All patients had MRI or CT examination for the exact diagnosis before the GKS treatment, while the B type ultrasound was used when the diagnosis was not very clear. The mean diameter of the lesions was 2.5 cm( ranged 0.8 to 3.5 cm). The prescribed peripheral dose varied from 13 to 20 Gy (mean 15.8 Gy) and the corresponding central dose was 26 to 40 Gy. The mean radiation dose to the optic nerve was 5.7±1.6 Gy.
     Patients underwent follow-up examination at 3 or 6 months intervals after GKS. The median follow-up periods were 32months (ranged 4 to 108 months). The lesions completely disappeared in 5(16.12?) patients, and tumor shrinkage was observed in 12 ( 38.71 %) patients , and the lesions of 14 (45.16?) patients kept stable. No further tumor enlargement was observed after GKS. 8 patients had an improvement in their symptoms, and remained stable in 18 patients, and deteriorated in 5 cases. The most common complication was conjunctival edema happened usually within 3 months and was reversible, no other serious acute adverse effects were observed.
     This was a retrospective study.
     Gamma knife radiosurgery is an effective and safe treatment for children patients with orbital lesions. 
     It provides good lesion control and visual preservation with low toxicity. GKS can become a standard treatment approach in selected children cases of orbital lesions.


Project Roles:

D. Liu (), G. Wang ()