Artikel
Stereotactic iodine-125 brachytherapy in a patient with a pontine ependymoma WHO grade II
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Veröffentlicht: | 2. Juni 2015 |
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Objective: We present a patient with a pontine ependymoma who has been treated by stereotactic iodine-125 brachytherapy 9 years ago with an unexpected short-time but a satisfying long-time follow-up.
Method: This 43-year-old patient presented to his oculist with a blurry vision, running eyes and headache. The prescription of glasses only improved the headaches. Further on, he stopped jogging due to an increasing instability and a hemianopia for the left side. The consulted neurologist found additionally a bradydysdiadochokinesia, a paresis of the abducens nerve on the left side and a slight hemiparesis on the right side. An MRI showed a huge inhomogenously enhancing tumor of the pons nearly without perifocal alterations in T2 weighed images.
Results: After biopsy of the lesion showing an ependymoma WHO grade II the patient was treated by a permanent seed implantation with cumulative therapeutic dose of 50 Gy. 2 weeks later he developed an incomplete peripheral facial palsy on both sides. After a short therapy with corticoids which did not really change the symptoms we opted for “wait and see” being aware of the half-life of 125Iodine of 60 days. Improvement was very slowly but 6 months later there was only a slight remnant of the paresis of the abducens nerve and of the hemiparesis. MRI showed a nice reduction of tumor volume. The patient was reintegrated in his professional life. Actually, 9 years later he is in very good condition and there is no sign of recurrence or seeding into other areas of the central nervous system.
Conclusions: In case of a circumscribed lesion of the brain stem the treatment via stereotactic iodine-125 brachytherapy should be taken into consideration.