XXXX and symptom resolution following Gamma Knife surgery for brain @entity3 2 cm or smaller in relation to eloquent cortices.

@entity1 @entity5 @entity75 @entity16 @entity1269 @entity51 @entity3
OBJECT: Reports on resection of @entity5 in or near eloquent cortices have noted @entity16 in up to 30% of @entity1 . This paper contains an analysis of symptom resolution and @entity16 following 20-Gy Gamma Knife surgery (GKS) for supratentorial brain @entity3 < or = 2 cm in greatest diameter. METHODS: The authors performed a retrospective analysis of 98 consecutively treated adults (33 @entity1 and 65 @entity1 with a median age of 61.4 years at the time of GKS) with Karnofsky Performance Scale score > or = 60, who underwent GKS for supratentorial brain @entity3 < or = 2 cm in diameter. Lesion location was classified as noneloquent (Grade I), near eloquent (Grade II), or eloquent (Grade III), in accordance with the grading system developed by the group at M. D. Anderson @entity5 Center. Following treatment, the @entity1 underwent MR imaging and clinical examinations at 6 weeks and every 3 months thereafter. RESULTS: Ninety-eight @entity1 underwent 20-Gy GKS for 131 @entity3 at initial presentation and 31 @entity1 underwent salvage 20-Gy GKS for 76 new lesions, for a total of 207 lesions (mean lesion volume 0.44 cm3). Lesions were classified as follows: Grade I, 96 (46.4%); Grade II, 51 (24.6%); and Grade III, 60 (29%). Fifteen @entity1 (2 with Grade II and 13 with @entity75 ) presented with deficits referable to their lesions, yielding pre-GKS deficit rates of 7.2% per lesion and 15.3% per @entity1 . The pre-GKS deficits improved or resolved in 10 @entity1 (66.7%) at a median time of 2.8 months and remained stable in 3 @entity1 (20%). Two @entity1 (13.3%) experienced worsened @entity51 . One @entity1 who was neurologically intact prior to treatment developed a new @entity1269 (1 of 83 @entity1 [1.2%]). The rates of permanent @entity16 following GKS for Grades I, II, and III lesions were 0% (0 of 96 @entity5 ), 2% (1 of 51), and 3.3% (2 of 60), respectively. The pre-GKS @entity51 and larger lesions were the most significant risk factors for post-GKS @entity16 . CONCLUSIONS: Gamma Knife surgery performed using a 20-Gy dose provides amelioration of @entity51 from brain @entity3 that are < or = 2 cm in diameter and located in or near eloquent cortices in nearly two-thirds of @entity1 with a low incidence of morbidity. Consistent with the surgical literature, higher rates of @entity16 were observed as proximity to eloquent regions and lesion size increased. There was no @entity16 in @entity1 harboring @entity3 in noneloquent areas.
