Safety and Efficacy of Primary Hypofractionated Gamma Knife Radiosurgery for Giant Hypothalamic Hamartoma

Objective To describe the feasibility, safety, efficacy, and complication profile of primary hypofractionated gamma knife radiosurgery (GKRS), and practical nuances of performing the same in pediatric patients. Methods Three pediatric patients (age range 17–65 mo) underwent primary hypofractionated...

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Published in:Indian journal of pediatrics 2021-11, Vol.88 (11), p.1086-1091
Main Authors: Tripathi, Manjul, Maskara, Prasant, Sankhyan, Naveen, Sahu, Jitendra Kumar, Kumar, Rakesh, Kumar, Narendra, Ahuja, Chirag K., Kaur, Parwinder, Kaur, Rupinder, Batish, Aman, Mohindra, Sandeep
Format: Article
Language:English
Subjects:
Child
Child, Preschool
Follow-Up Studies
Gynecology
Hamartoma - radiotherapy
Humans
Hypothalamic Diseases - radiotherapy
Infant
Medicine
Medicine & Public Health
Original Article
Pediatrics
Radiosurgery - adverse effects
Treatment Outcome
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Summary:Objective To describe the feasibility, safety, efficacy, and complication profile of primary hypofractionated gamma knife radiosurgery (GKRS), and practical nuances of performing the same in pediatric patients. Methods Three pediatric patients (age range 17–65 mo) underwent primary hypofractionated GKRS in 2–3 consecutive days with interfraction interval of 24 h. All patients had precocious puberty and were on GnRH analogue. Frame based GKRS done with 8.1–9.2 Gy radiation per fraction at 50% isodose in 2–3 fractions targeting the entire hamartoma volume. The mean target volume was 5.67 cc (4.45–7.39 cc). The authors followed these patients for clinical and endocrinological assessment at every 6 mo interval while the repeat MRI done at 6 mo and then annually. The seizure outcome analysis was done using Engel scale. Results At a mean follow up of 27 mo (24–30 mo), 2 patients became Engel class 3 while one achieved Engel class 1 control. 2 patients showed halted pubertal growth with no additional hormonal aberration. 2 patients showed significant volumetric reduction (48% and 32%) and patchy necrosis inside the hypothalamic hamartoma (HH). There was no deficit in visual function, memory and cognition. One patient showed reduction in aggressiveness. Conclusion Giant HH are exceptionally difficult neurological diseases. Primary hypofractionated GKRS may be an alternative approach as mono/multitherapy with promising results and minimal complication.
ISSN:0019-5456
0973-7693
DOI:10.1007/s12098-020-03637-w