Gamma Knife Radiosurgery for Orbital Lesions

Young-Joo Choi; Jung-Il Lee; Yoon-Duck Kim

doi:10.3341/jkos.2008.49.4.555

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Choi, Lee, and Kim: Gamma Knife Radiosurgery for Orbital Lesions

Original Article

J Korean Ophthalmol Soc 2008;49(4):555-561.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.4.555

Gamma Knife Radiosurgery for Orbital Lesions

Young-Joo Choi, M.D.¹, Jung-Il Lee, M.D.², Yoon-Duck Kim, M.D.³

¹Department of Ophthalmology, Ulsan University Hospital, Ulsan University School of Medicine, Ulsan, Korea

²Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

³Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Yoon-Duck Kim, M.D. Department of Ophthalmology, Samsung Medical Center, School of Medicine Sungkyunkwan University #50, Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3568, Fax: 82-2-3410-0074, E-mail: ydkimoph@skku.edu

Received 30 May 2007 Accepted 28 October 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effectiveness and safety of treating orbital lesions with gamma knife radiosurgery (GKS).

Methods

Between April 2004 and January 2006, ten patients who had orbital tumors or vascular lesions and who underwent GKS were included in this retrospective study.

Results

Ten patients with orbital lesions were treated with GKS. The group of orbital lesions consisted of 5 meningiomas, 2 schwannomas, 1 cavernous hemangioma, 1 arteriovenous fistula, and 1 adenoidcystic carcinoma of the lacrimal gland. The most common symptom was proptosis. The tumors were located at the orbital apex in eight patients, and five of these patients were treated with fractionated stereotactic radiosurgery. The mean cumulative marginal dose was 17.0 Gy (12-20 Gy), and the mean cumulative maximal dose was 30.8 Gy (16.2–40.4 Gy). The follow-up period ranged from 3 to 25 months (mean 13.9 months). During the follow-up period, magnetic resonance imaging revealed a decrease of tumor volume in 3 patients with symptomatic improvement. In two patients, tumor volume increased. No radiation-induced optic neuropathy, retinopathy, or cataract was observed in any of the 10 patients during the follow-up period.

Conclusions

Gamma knife radiosurgery is an effective and relatively safe treatment when orbital lesions have a high risk of neurosurgical deficits with surgery, when they recur after incomplete resection, or when complete removal of tumor is impossible.

Keywords: Gamma knife radiosurgery, Orbital tumor

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Figure 1.

T1-weighted axial magnetic resonance image (A) and sagittal images (B) before radiosurgery in case 6 with cavernous hemangioma in the left orbital apex. Eighteen months after radiosurgery (C, D) the tumor volume is reduced.

Figure 2.

Optic nerve sheath meningioma in a 34-year-old woman (case 1) presenting with decreased visual acuity in her left eye for 2 months. Before gamma knife surgery axial T1 contrast MR image (A) reveals a well-circumscribed retrobulbar mass in the left orbit and 7 months after fractionated gamma knife surgery (B) central necrotic lesion is shown. (C) Visual field examination of the left eye before radiosurgery showed extensive field loss. The visual acuity of her left eye decreased to 0.1. (D) Seven months after radiosurgery the visual field improved except small paracentral scotoma and visual acuity improved to 0.7.

Table 1.

Radiosurgical feature of lesions treated with gamma knife radiosurgery

No. of patients	Pathologic diagnosis	Location	Maximal Dose (Gy)	Marginal dose (Gy)	No. of fraction
1	Meningioma	Optic n.	10.2	5	3
2	Meningioma	Optic n. cavernous sinus	10.1	5	4
3	Meningioma	Orbital apex	25.5	12	
4	Meningioma	Frontal & sphenoid bone	8.0	4	4
5	AVF^*	Ophthalmic a.	16.2	13	
6	Cavernous hemangioma	Orbital apex	31.5	15	
7	Adenocystic ca.	Lacrimal gland	26.2	13	
8	Schwannoma	Orbital apex	28.5	14	
9	Meningioma	Optic n,	10	5	4
10	Schwannoma	Orbital apex	9.1	5	4

^* AVF = arteriovenous fistula.

Table 2.

Summary of results after radiosurgery

No. of patients	Pathologic diagnosis	(months) Follow up	Lesion Vol. (mm³)		Radiosurgical	Visual Acuity
No. of patients	Pathologic diagnosis	(months) Follow up	Before GKS^*	After GKS^*	response	Before GKS^*	After GKS^*
1	Meningioma	17	886.4	817.8	Necrosis	0.1	0.7
2	Meningioma	25	6800	4700	Shrunken	LP^†(+)	CF^‡
3	Meningioma	13	2400	2074	Static	0.03	0.01
4	Meningioma	21	3100	8100	Aggravated	0.1	LP (−)
5	AVF^*	16	32	25	Static	1.0	0.9
6	Cavernous hemangioma	18	2000	1400	Shrunken	LP (−)	LP (−)
7	Adenocystic ca.	3	2996.2	3879	Aggravated	1.0	Exenteration
8	Schwannoma	5	5000	4500	Static	LP (+)	LP (+)
9	Meningioma	9	736.6	733	Static	1.0	1.0
10	Schwannoma	12	1700	428	Shrunken	0.4	1.0

^* GKS = gamma knife radiosurgery

^† LP= light perception

^‡ CF= counting fingers.

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