Gamma knife radiosurgery for recurrent anaplastic ependymoma with intracranial disseminations: a case report

ABSTRACT

Intracranial ependymomas are relatively rare type of gliomas which have high recurrence rates after multimodal therapy with surgery, fractionated radiation therapy and chemotherapy. We report the case of a 15-year-old girl with recurrent anaplastic ependymoma [WHO grade III] who underwent multiple surgical excisions for a right temporoparietal tumor in 1998, followed by fractionated radiation therapy and chemotherapy. Eleven years after initial treatment, follow-up imaging of the brain demonstrated tumor recurrence with multiple intracranial dissemination. Clinically, the patient was asymptomatic. We managed her with gamma knife radiosurgery at our center. The recurrent ependymoma along with four intracranial disseminations were defined with gamma plan and a prescription dose of 16 Gy was delivered to the mean target volume of 1.56 ml [range 0.159 - 5.7 ml] with a mean isodose line of 54.3% [range 50 - 65%]. Images on post-radiosurgery follow-up at 21 months revealed complete remission of the recurrent ependymoma and significant decrease in size of all disseminations