gms | German Medical Science

Objective: Microsurgical resection is the treatment of choice for intracranial tumors. But in certain cases there is a high risk of neurological deficits where a strategy with stereotactic biopsy and radiosurgery (RS) or stereotactic radiotherapy (SRT) can offer an alternative treatment option.

Methods: Between 05/2000 and 05/2008 42 patients with intracranial tumors were treated with RS or SRT after a stereotactic biopsy, of which 17 were low grade gliomas and 16 metastases. 18 patients with a cystic tumor (8 metastases, 5 low grade gliomas and 5 recurrent craniopharyngeomas) had a stereotactic cyst aspiration before RS or SRT.

Results: This combined stereotactically guided treatment was well tolerated in all patients. After cyst aspiration, neurological deficits decreased and the tumor volume shrank more than 50%. This resulted in a better condition of the patient for the RS or SRT.

Up until now 4 tumor progressions were observed in the 17 paramedian gliomas or those located in the brainstem. 10 metastases showed a regression. The other 6 patients had only a temporary response, a second cyst aspiration was necessary and they died after 9–14 months. The 5 craniopharyngeomas and 4 other tumors showed no progression till now.

Conclusions: As a low risk and effective treatment option for tumor control, RS or SRT after a stereotactic biopsy can be recommended in case of intracranial tumors which are unsuitable for resection. An interdisciplinary decision is very important for each patient.

Stereotactic cyst aspiration followed by SRT is an effective minimal invasive treatment for recurrent cystic craniopharyngeomas and centrally located cystic tumors and as well as a palliative treatment option for cystic brain metastases.