Twenty-three years follow-up after low-dose Gamma Knife surgery of a brainstem juvenile pilocytic astrocytoma: a case report and review of the literature

  • J. Sherry Liu
  • Denise Foo
  • Tseng Tsai Yeo
  • Kee Hang Ho
  • Vincent Diong Weng NgaEmail author
  • Bengt Karlsson
Case Report


Juvenile pilocytic astrocytoma (JPA) is a World Health Organization (WHO) grade I tumor that is the commonest to occur in the 0–19 age group, with an excellent prognosis of 96% 10-year survival in pediatric patients. Complete resection is the treatment of choice for JPAs. However, this is not always feasible due to the location of certain tumors, and the management following subtotal resection is controversial. Fractionated radiotherapy, chemotherapy, radiosurgery, and observation have all been used to treat tumor remnants. We report a young patient with good tumor control 23 years following low-dose Gamma Knife surgery (GKS) of a subtotally resected brainstem JPA and recommend that GKS may be a feasible treatment option to achieve long-term tumor control when subtotal resection cannot be achieved, even if the GKS prescription dose must be significantly reduced due to large tumor volume or proximity to critical structures sensitive to radiation.


Gamma Knife surgery Pilocytic astrocytoma Low-grade glioma Tumor control 


Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Boethius J, Ulfarsson E, Rahn T, Lippitz B (2002) Gamma knife radiosurgery for pilocytic astrocytomas. J Neurosurg 97:677–680CrossRefGoogle Scholar
  2. 2.
    Buder T, Deutsch A, Klink B, Voss-Böhme A (2015) Model-based evaluation of spontaneous tumor regression in pilocytic astrocytoma. Komarova NL, ed. PLoS Comput Biol 11(12):e1004662CrossRefGoogle Scholar
  3. 3.
    Foroughi M, Hendson G, Sargent MA, Steinbok P (2011) Spontaneous regression of septum pellucidum/forniceal pilocytic astrocytomas–possible role of Cannabis inhalation. Childs Nerv Syst 27:671–679CrossRefGoogle Scholar
  4. 4.
    Gnekow A, Falkenstein F, von Hornstein S, Zwiener I, Berkefeld S, Bison B, Warmuth-Metz M, Driever P, Soerensen N, Kortmann R, Pietsch T, Faldum A (2012) Long-term follow-up of the multicenter, multidisciplinary treatment study HIT-LGG-1996 for low-grade glioma in children and adolescents of the German Speaking Society of Pediatric Oncology and Hematology. Neuro-Oncology 14:1265–1284CrossRefGoogle Scholar
  5. 5.
    Gunny R, Hayward R, Phipps K, Harding B, Saunders D (2005) Spontaneous regression of residual low-grade cerebellar pilocytic astrocytomas in children. Pediatr Radiol 35:1086–1091CrossRefGoogle Scholar
  6. 6.
    Hafez R (2007) Stereotaxic gamma knife surgery in treatment of critically located pilocytic astrocytoma: preliminary result. World J Surg Oncol 5:39CrossRefGoogle Scholar
  7. 7.
    Kano, Niranjan, Kondziolka D, Flickinger J, Pollack I, Jakacki R, Lunsford L (2009) Stereotactic radiosurgery for pilocytic astrocytomas part 2: outcomes in pediatric patients. J Neuro-Oncol 95:219–229CrossRefGoogle Scholar
  8. 8.
    Karlsson B, Lindquist C, Steiner L (1997) Prediction of obliteration after Gamma Knife surgery for cerebral arteriovenous malformations. Neurosurgery 40:425–431Google Scholar
  9. 9.
    Kernan, Horgan, Piatt, D'Agostino A (1998) Spontaneous involution of a diencephalic astrocytoma. Pediatr Neurosurg 29:149–153CrossRefGoogle Scholar
  10. 10.
    Kida, Kobayashi, Mori (2000) Gamma knife radiosurgery for low-grade astrocytomas: results of long-term follow up. J Neurosurg 93:42–46CrossRefGoogle Scholar
  11. 11.
    Kihlström L, Lindquist C, Lindqvist M, Karlsson B (1994) Stereotactic radiosurgery for tectal low-grade gliomas. Acta Neurochir 62(suppl):55–57CrossRefGoogle Scholar
  12. 12.
    Lizarraga, Gorgulho, Lee S, Rauscher G, Selch M, DeSalles A (2012) Stereotactic radiation therapy for progressive residual pilocytic astrocytomas. J Neuro-Oncol 109:129–135CrossRefGoogle Scholar
  13. 13.
    Loh J-K, Lieu A-S, Chai C-Y, Hwang SL, Kwan AL, Wang CJ, Howng SL (2013) Arrested growth and spontaneous tumor regression of partially resected low-grade cerebellar astrocytomas in children. Childs Nerv Syst 29(11):2051–2055CrossRefGoogle Scholar
  14. 14.
    Noren G, Greitz D, Hirsch A et al (1993) Gamma knife surgery in acoustic tumours. Acta Neurochir Suppl (Wien) 58:1047Google Scholar
  15. 15.
    Ogiwara H, Bowman RM, Tomita T (2012) Long-term follow-up of pediatric benign cerebellar astrocytoma. Neurosurgery 70:40–48CrossRefGoogle Scholar
  16. 16.
    Ohgaki, Kleihues (2005) Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol 64:479–489CrossRefGoogle Scholar
  17. 17.
    Ostrom, Gittleman, Fulop J, Liu M, Blanda R, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan J (2015) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro-Oncology Suppl 4:iv1–iv62CrossRefGoogle Scholar
  18. 18.
    Palma L, Celli P, Mariottini A (2004) Long-term follow-up of childhood cerebellar astrocytomas after incomplete resection with particular referenced to arrested growth or spontaneous tumour regression. Acta Neurochir 146:581–588CrossRefGoogle Scholar
  19. 19.
    Rozen W, Joseph S, Lo P (2008) Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis. Pediatr Neurosurg 44:324–328CrossRefGoogle Scholar
  20. 20.
    Simonova G, Kozubikova P, Liscak R, Novotny JJ (2016) Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results. J Neurosurg Pediatr 18:58–64CrossRefGoogle Scholar
  21. 21.
    Smoots DW, Geyer JR, Lieberman DM, Berger MS (1998) Predicting disease progression in childhood cerebellar astrocytoma. Childs Nerv Syst 14:636–648CrossRefGoogle Scholar
  22. 22.
    Steinbok P, Poskitt K, Hendson G (2006) Spontaneous regression of cerebellar astrocytoma after subtotal resection. Childs Nerv Syst 22:572–576CrossRefGoogle Scholar
  23. 23.
    Trifiletti D, Peach M, Xu Z, Kersh R, Showalter T, Sheehan J (2017) Evaluation of outcomes after stereotactic radiosurgery for pilocytic astrocytoma. J Neuro-Oncol 134:297–302CrossRefGoogle Scholar
  24. 24.
    Ulfarsson E, Lindquist C, Roberts M, Rähn T, Lindquist M, Thorén M, Lippitz B (2002) Gamma knife radiosurgery for craniopharyngiomas: long-term results in the first Swedish patients. J Neurosurg 5:613–622CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Yong Loo Lin School of MedicineSingaporeSingapore
  2. 2.Division of NeurosurgeryNational University HospitalSingaporeSingapore

Personalised recommendations