scholarly journals Photon Radiosurgery: A Clinical Review

1992 ◽  
Vol 19 (2) ◽  
pp. 212-221 ◽  
Author(s):  
Michael R. McKenzie ◽  
Luis Souhami ◽  
Ervin B. Podgorsak ◽  
André Olivier ◽  
Jean-Louis Caron ◽  
...  
Keyword(s):  
Linear Accelerator ◽  
Arteriovenous Malformations ◽  
Clinical Results ◽  
Operating Costs ◽  
Linear Accelerators ◽  
Dose Distributions ◽  
Acoustic Neurinomas ◽  
Malignant Lesions ◽  
High Doses ◽  
Established Role

ABSTRACT:The term radiosurgery has been used to describe a variety of radiotherapy techniques which deliver high doses of radiation to small, stereotactically defined intracranial targets in such a way that the dose fall-off outside the targeted volume is very sharp. Proton, charged particle, gamma unit, and linear accelerator-based techniques appear to be equivalent from the standpoint of accuracy, dose distributions, and clinical results. However, capital and operating costs associated with the use of linear accelerators in general clinical use are much lower. Radiosurgery has an established role in the treatment of arteriovenous malformations and acoustic neurinomas. Interest in these techniques is increasing in neurosurgical and radiation oncological communities, as radiosurgery is rapidly assuming a place in the management of several other conditions, including craniopharyngiomas, meningiomas, and selected malignant lesions.

scholarly journals Current Status of Radiosurgery for Arteriovenous Malformations

1991 ◽  
Vol 18 (4) ◽  
pp. 499-502 ◽  
Author(s):  
Michael Schwartz ◽  
Peter O'Brien ◽  
Phillip Davey ◽  
Charlene Young ◽  
Robert Willinsky ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Linear Accelerator ◽  
Arteriovenous Malformations ◽  
Current Status ◽  
Recent Experience ◽  
Linear Accelerators ◽  
Centre Of Rotation ◽  
Risk Of Hemorrhage ◽  
The Cost ◽  
Annual Risk

ABSTRACT:Cerebral arteriovenous malformations (AVM), regardless of the mode of discovery, have an annual risk of hemorrhage of approximately 4 percent. A progressive obliterative vasculitis culminating in the occlusion of an AVM may be induced by the administration of radiation doses of approximately 20 Gy given in a single fraction. The process takes about two years and occlusion occurs in approximately 80% of patients so treated. Such a dose may be accurately administered to AVMs up to 3 cm in diameter with very little radiation imparted to the adjacent brain by means of multiple highly collimated radially arranged cobalt sources (the Gamma Knife) or by means of a modified linear accelerator turned through an arc or arcs with the target AVM as the centre of rotation. The Gamma Knife and the modified linear accelerator have nearly equal accuracy. Recent experience with modified linear accelerators indicates efficacy equal to the Gamma Knife. Both devices are effective treatment for small AVMs but the cost of modifying a pre-existing linear accelerator is only a few percent of the acquisition and installation costs of the Gamma Knife.

Stereotactic radiosurgery: a review and comparison of methods.

1994 ◽  
Vol 12 (5) ◽  
pp. 1085-1099 ◽  
Author(s):  
M H Phillips ◽  
K J Stelzer ◽  
T W Griffin ◽  
M R Mayberg ◽  
H R Winn
Keyword(s):  
Charged Particle ◽  
Gamma Radiation ◽  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Medical Physics ◽  
Clinical Results ◽  
Particle Methods ◽  
Benign Tumors ◽  
Dose Distributions ◽  
Clinical Series

PURPOSE Stereotactic radiosurgery (SRS) is an evolving modality for treating well-circumscribed intracranial lesions. Different physical methods have been developed to deliver highly localized dose distributions accurately. We review the different methods and the documented clinical results to present a coherent view of radiosurgery, and to aid physicians and physicists in the appropriate use of this modality. DESIGN A review of the medical physics and clinical literature was conducted. The physical aspects of the different methods and their impact on treatment were summarized. Results were compiled from those individual clinical series with adequate follow-up data to compare the various modalities with respect to treatment outcome for benign tumors, metastases, and vascular malformations. RESULTS The physical accuracy was comparable between radiosurgical methods. Differences between gamma radiation and linear accelerator methods had little effect on the dose distribution for single isocenter treatments. Charged particle methods could produce better dose localization for large lesions (> 25 cm3) than was possible with photon methods. Clinical results indicate similar lesion control rates between all radiosurgical methods. There was a progressive increase in the median size of treated lesions for gamma radiation, linear accelerator, and charged particle methods. CONCLUSION For small lesions (< 5 cm3), physical dose distributions are similar for the photon methods, but linear accelerator methods offer more flexibility for the treatment of intermediate-sized (5 to 25 cm3) lesions in applying future technical developments. More clinical results are needed before firm conclusions can be drawn on the type of lesions to be treated, and the dose-volume parameters to be used.

Linear Accelerator as a Neurosurgical Tool for Stereotactic Radiosurgery

Neurosurgery ◽  
1988 ◽  
Vol 22 (3) ◽  
pp. 454-464 ◽  
Author(s):  
Ken R. Winston ◽  
Wendell Lutz
Keyword(s):  
Computed Tomography ◽  
Cerebral Angiography ◽  
Linear Accelerator ◽  
Photon Radiation ◽  
Entire System ◽  
High Doses ◽  
Design And Testing ◽  
Stereotactic Apparatus ◽  
The Brain ◽  
New System

Abstract A new system has been developed for stereotactically delivering prescribed high doses of radiation to precisely located volumes of approximately 0.6 to 10.0 ml within the brain. A Brown-Roberts-Wells stereotactic apparatus and a 6-MeV linear accelerator equipped with a special collimator (12.5 to 30 mm in diameter) have been adapted. The 20-mm collimator allows treatment of a nearly spherical volume of 2.1 ml. Outside the treatment field, the dosage declines to 80% of the dose prescribed for the periphery of the lesion over a distance of 1.8 mm and to 50% over the next 3.4 mm. Localization can be accomplished via computed tomography or cerebral angiography. Treatment is accomplished with an arcing beam of photon radiation with the turntable (couch) in each of four positions. The entire system has been extensively tested for accuracy in alignment and distribution of radiation. Errors have been measured for the alignment of the apparatus and for the process of localization. Safety of operation was emphasized throughout the design and testing phase. (Neurosurgery 22:454-464, 1988)

Repeat linear accelerator radiosurgery for cerebral arteriovenous malformations

2003 ◽  
Vol 56 (2) ◽  
pp. 529-536 ◽  
Author(s):  
Michel Schlienger ◽  
Dimitri Lefkopoulos ◽  
François Nataf ◽  
Hammid Mammar ◽  
Odile Missir ◽  
...  
Keyword(s):  
Linear Accelerator ◽  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations

Linear Accelerator Stereotactic Radiosurgery in the Management of Intracranial Arteriovenous Malformations: Long-Term Outcome

2014 ◽  
Vol 37 (5) ◽  
pp. 342-349 ◽  
Author(s):  
Yu-Chi Wang ◽  
Yin-Cheng Huang ◽  
Hsien-Chih Chen ◽  
Kuo-Cheng Wei ◽  
Cheng-Nen Chang ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Palliative Embolisation of Brain Arteriovenous Malformations Presenting with Progressive Neurological Deficit

2000 ◽  
Vol 6 (3) ◽  
pp. 177-183 ◽  
Author(s):  
M. Al-Yamany ◽  
K. G. terBrugge ◽  
R. Willinsky ◽  
W. Montanera ◽  
M. Tymianski ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Clinical Results ◽  
Neurological Deficits ◽  
Therapeutic Modality ◽  
High Morbidity ◽  
Progressive Neurological Deficit ◽  
Permanent Morbidity ◽  
Brain Avms

Large arteriovenous malformations (AVMs) located in eloquent areas of the brain are generally considered incurable because of the high morbidity and mortality associated with their treatment. When these patients develop a progressive neurological deficit they in time often become severely disabled. This report presents the results of palliative embolisation in this subgroup of patients. Analysis of our data-base of 714 patients with known brain AVMs revealed 17 patients who presented with progressive neurological deficit and who underwent palliative embolisation as the therapeutic modality of choice for management of their AVM. One patient was excluded due to lack of follow-up and two were excluded because they later received radiation therapy. Following embolisation 43% had improvement of their neurological deficit, 50% stabilized and 7% continued to deteriorate and these clinical results persisted for an average of more than 2 years follow-up. Transient neurological morbidity associated with embolisation treatment was 7% and there was no permanent morbidity and no mortality. Palliative embolisation of brain AVMs presenting with progressive neurological deficits arrested deterioration in more than 90% of patients and was associated with low morbidity and no mortality.

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