Gamma knife radiosurgery for central neurocytomas: A long-term follow-up study

Hidefumi Jokura, MD1, Jun Kawagishi2, Kazuyuki Sugai2, Kou Takahashi2, Teiji Tominaga3

1Jiro Suzuki Memorial Gamma House, Furukawa Seiryo hospital 2Jiro Suzuki Memorial Gamma House, Furukawa seiryo Hospital 3Department of Neurosurgery Tohoku University School of Medicine

Keywords: brain tumor, glioma, gamma knife, outcome, anticoagulation

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     It is widely acknowledged that surgical total removal is the golden standard for the treatment of central neurocytoma, but sometimes it can be difficult with acceptable risk. 
     We evaluated the efficacy and safety of gamma knife radiosurgery (GKRS) as an adjuvant therapy for central neurocytoma.
     Consecutive eight patients with central neurocytoma treated by GKRS between May 1996 and April 2009 are included in this study. All but one patient had undergone partial to gross total removal. In one case, GKRS was the first treatment and diagnosis was based on MRI.
      GKRS was performed for recurrence or regrowth of residual tumor in 5 cases and for residual tumor in 2 cases. The mean interval between surgical removal and gamma knife was 31.8 months. The volume of tumor at the time of GKRS was 1.6-7.6 cm3 (mean 4.8 cm3). The median prescribed marginal dose was 15Gy (12-22Gy). Follow-up MRI and clinical information was available in all patients. The mean period between GKRS and the last follow-up MRI was 104 months (ranging from 27 to 169 months) and in 4 patients the period exceeded 10 years.
     The tumors within the target volume shrunk or almost disappeared in all cases at the last MRI follow-up. In one patient, the tumor recurred outside of the target volume together with unilateral hydrocephalus and needed second GKRS 54 months after the first GKRS. In this patient, regression of both tumor and hydrocephalus were confirmed 4 moths after second GKRS. In one patient, ventriculo-peritoneal shunt had been placed 3 months after GKRS for hydrocephalus that had existed at the time of GKRS. No radiation-induced complication was noted in any of the patients during the follow-up period. The KPS scores at the last follow-up was maintained or improved in all patients.
     This was a retrospective study.
     GKRS for central neurocytoma is a powerful and safe adjuvant therapy when complete surgical removal with acceptable risk is difficult.
     Radiosurgery should be considered an effective treatment for neurocytoma.


Project Roles:

H. Jokura (), J. Kawagishi (), K. Sugai (), K. Takahashi (), T. Tominaga ()