Abstract
A 25-year-old female presented asymptomatic, but with old, post-previous surgery, persistent minimal chocking, mild dysphagia, and repeated mild aspirations. She had history of surgery for brain stem glioma 3 years ago. The patient was treated with upfront (primary); Linac-based SRS for post-surgery residual, medullary pilocytic astrocytoma (WHO Grade I). The target volume of 6.0 cc received a marginal dose of 10.0 Gy normalized to 80% isodose line. The maximum dose to brain stem was 13.1 Gy. At 7 months post-SRS, follow-up MRI showed unchanged tumor size and contrast enhancement, and a de novo tumor-related cyst formation within the medulla. At 32 months post-SRS, follow-up MRI showed a mild decrease in tumor size and contrast enhancement and increased size of medullary cyst. Serial follow-up MRIs demonstrated stationary tumor size and contrast enhancement and a marked decrease in size of de novo tumor-related medullary cyst. At last follow-up (96 months post-SRS), the patient was neurologically intact and had sustainable improvement of chocking, dysphagia, and recurrent aspirations.
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Further Reading
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Abdelaziz, O.S., De Salles, A.A.F. (2023). Medullary Glioma. In: NeuroRadiosurgery: Case Review Atlas. Springer, Cham. https://doi.org/10.1007/978-3-031-16199-5_52
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DOI: https://doi.org/10.1007/978-3-031-16199-5_52
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