第38回日本小児神経外科学会
The 38th Annual Meeting of the Japanese Society for Pediatric Neurosurgery

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第1日目、6月4日(金)A 会場(3階 メインホール)9:40〜10:40

特別企画 1: JSPN - KSPN joint session: 2. Management of craniopharyngioma

Chairperson: Kyu-Chang Wang, Takayuki Inagaki

SP1-2-3

Gamma Knife Radiosurgery for Craniopharyngiomas in Children: Asan Medical Center Experience

Young-Shin Ra 1, Do Hoon Kwon 2, Do Hee Lee 3

Division of Pediatric Neurosurgery 1, Asan Medical Center Children’s Hospital, Department of Neurosurgery 2, Gamma Knife Center 3, University of Ulsan, Seoul, Korea

Objectives: Gamma Knife Radiosurgery (GKRS) is an appealing alternative treatment for primary or recurrent craniopharyngiomas. More than 35 years after the first case treated by Backlund, it still has not been clear to determine indication, optimal radiation dose, long term results, and complications of stereotactic radiosurgery. Authors analyzed long term results of GKRS for residual or recurrent craniopharyngiomas to evaluate its efficacy in pediatric age.
Material and Methods: Among total 34 patients with craniopharyngioma treated at Asan Medical Center, Gamma Knife Center, 36 GKRS procedures have been performed in 25 children with 27 recurrent and 9 residual craniopharyngiomas from 1990 to 2008. Mean age of patients at GKRS was 10.5 years (range 3 - 19). All of them underwent subtotal or gross total resection of tumor prior to GKRS. The mean volumes of tumors were 1,955 mm3 ml and mean marginal doses of radiation was 13.9 Gy (8 - 35). The mean follow-up time was 76.4 months.
Results: The long-term control of tumor was achieved in 16 (64%) patients and failed in 9 patients (36%). Regarding each target control by GKRS, 14 complete remissions (66.7%), 9 partial remissions (25%) and 3 recurrences (8.3%) were noted. Despite high target control rate (91.7%), the reason why overall tumor control in patient decreased is tumor recurrence at the distant location from GKRS target. Recurrent tumor was controlled by craniotomy (5) & TSA (1), GKRS (9) and conventional radiation therapy (1). No further deterioration of vision or endocrine function developed after underwent radiosurgery in any patient.
Conclusions: It is inferred that stereotactic radiosurgery is an effective tool to treat residual and recurrent craniopharyngiomas in children without further injury to optic apparatus and hypothalamic pituitary region. There is a high chance of recurrence if tumor description is obscure because of anatomic complexity and postoperative change. The most important factor to control craniopharyngioma by stereotactic radiosurgery can be precise tumor description and avoidance of critical anatomical structures.

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