Symposium for Patients & Caregivers. GAMMA KNIFE RADIOSURGERY FOR HYPOTHALAMIC HAMARTOMA. Andrew G. Shetter M.D. Barrow Neurological Institute Phoenix, AZ. Definition of Radiosurgery.
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AndrewG. Shetter M.D.
Barrow Neurological Institute
“ The delivery of a single, high dose of irradiation to a small and critically located intracranial volume through the intact skull ”.
1949 :Lars Leksell
A single dose of ionizing radiation given with millimeter accuracy to a small volume of tissue
Stereotactic frame applied using pin fixation
Age <6 yrs - generalAge >12yrs - local + sedationAge 6-12yrs - either, depending on child
Regis et al, 2006
Regis et al, 2006
BNI Experience, Abla et al, 2010
All 3 patients with baseline STM loss experienced resolution
Improved quality of life :
9 of 10
p = 0.5
GK - 37% seizure free, 21% with >90% reduction, ≥ 3 yr follow up (Regis et al)
Endo - 49% seizure free, 21% with >90% reduction, ≥ 1 yr follow up (Ng et al) - 36% seizure free, ≥ 1 yr follow up (Drees et al)
Laser - Good initial success rate in small number of pts, no long term results available
GK - No permanent neurologic deficits, rare transient poikilothermia (Regis et al, BNI)
Endo - Permanent short term memory loss 8%, transient hemiparesis 11% (Ng et al) - Persistent deficits = stroke 5%, hormonal disturbance 24%, wt gain 59%, 1 death (Drees et al)
Laser - No permanent neurologic deficits reported, but number of pts treated is small. Similar stereotactic procedures have 2-3% incidence of intracranial hemorrhage
GK - Requires 1-3 yrs to see full effect. Some pts may experience temporary increase in seizures 6-12mo. post GK
Endo - Immediate effect if successful, but some pts may experience recurrent seizures after being seizure free for 6-24mo. post op
Laser - Immediate effect if successful. No data regarding long- term recurrence rate
Kerrigan et al, 2012
GKforHH - CONCLUSIONS