scholarly journals Gamma Knife Stereotactic Radiosurgery (GKS) for the treatment of meningiomas – a study of 550 cases

2015 ◽  
Vol 62 (2) ◽  
pp. 130-134
Author(s):  
Radu Perin ◽  
◽  
Rodica Stempurszki ◽  
Vasile Ciubotaru ◽  
Ligia Tataranu ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Daily Practice ◽  
University Hospital ◽  
Response To Treatment ◽  
Benign Tumors ◽  
Long Time ◽  
Remnant Tumor ◽  
Gamma Knife Stereotactic Radiosurgery ◽  
The Impact

Introduction. Meningiomas are benign tumors which originate from the cells of the arachnoid granules. Meningiomas represent a special pathologic entity for neurosurgeons due to the fact that they can grow silently for a long time, and can affect important neural structures when they become symptomatic. The total resection of meningiomas is curative. For the meningiomas which are not surgically accessible and for reoccurrence. Gamma Knife radiosurgery (GKS) is a very efficient solution. Materials and methods. The study below presents the experience of the authors regarding the use of GKS for the treatment of meningiomas. The authors focus on a population of 550 patients diagnosed and treated for meningiomas over a period of 10 years at the „Bagdasar-Arseni“ University Hospital in Bucharest. This study compares the impact of GKS when performed alone or in association with open microneurosurgery. The authors assessed patients with tumors ranging between 1 and 42 cm3 in volume. GKS is used successfully to treat meningiomas, both independently and in association with open microsurgery. Results. The major complications of the treatment are represented by lack of response to treatment (7% of patients) and transient cerebral edema (22% of patients). A disturbing phenomenon happens in a few meningiomas of the convexity, with malignant edema (<1%). Conclusion. Given the multiple advantages it has, GKS is right now the tip of the spear regarding the therapeutical methods available for meningiomas. These tumors usually are benign in nature; however, a small percentage are malignant. Often, meningiomas cause no symptoms and require no immediate treatment. But the growth of benign meningiomas can cause serious problems. In some cases, such growth can be fatal. Typically, symptomatic meningiomas are treated with either radiosurgery or conventional surgery. When the tumors met in daily practice are larger than the therapeutical resources of the devices used for GKS, an open microsurgical approach may be attempted followed by stereotactic irradiation of the remnant tumor.

scholarly journals Gamma Knife Stereotactic Radiosurgery (GKS) for the treatment of Vestibular Schwannomas (VS)

2015 ◽  
Vol 10 (2) ◽  
pp. 143-147
Author(s):  
R. PERIN ◽  
◽  
A. MOHAN ◽  
H. MOISA ◽  
A.V. CIUREA ◽  
...  
Keyword(s):  
Nervous System ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Vestibular Schwannomas ◽  
Response To Treatment ◽  
Benign Tumors ◽  
Acoustic Neuromas ◽  
The Impact

Introduction. Vestibular schwannomas (VS) or acoustic neuromas (AN) (as they are known to neurosurgeons) are benign tumors which originate at the junction between central nervous system myelin and peripheral nervous system myelin – an area known as the Obersteiner-Redlich area. Acoustic neuromas represent a special pathologic entity for neurosurgeons due to their important symptoms which need to be adressed as soon as possible and due to the secondary disfunctions which may appear if the tumors are not treated appropriately. Materials and methods. The study below presents the experience of the authors regarding the use of stereotactic radiosurgery for the treatment of acoustic neuromas. The authors focus on a population of 231 patients diagnosed and treated for VS over a period of 10 years at the „Bagdasar-Arseni“ University Hospital in Bucharest. This study compares the impact of Gamma Knife Surgery when performed alone or in association with open microneurosurgery. The authors assessed patients with tumors ranging between 0.25 and 14 cm3 in volume. Gamma Knife Surgery is used successfully to treat VS, both independantly or in association with open microsurgery. Results. The major complications of the treatment are represented by lack of response to treatment (less than 1% of patients) and cerebral edema (16.4% of patients). Conclusions. Given its multiple advantages, stereotactic radiosurgery is right now the tip of the spear regarding the therapeutical means available for VS. When the tumors met in daily practice are larger than the therapeutical resources of the devices used for Gamma Knife Surgery an open microsurgical approach may be attempted followed by stereotactic iradiation of the remnant tumor. Given the large number of successes reported in the literature and the small number of complications but also the ever progressing technology used to improve Gamma Knife devices, the authors consider stereotactic radiosurgery to be a very good solution for the treatment of VS. Furthermore, the improvement potential this technique has grants it the potential to improve standard of treatment for acoustic neuromas and the quality of life in patients with this disease.

Outcome Predictors After Gamma Knife Radiosurgery for Recurrent Trigeminal Neuralgia

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1637-1645 ◽  
Author(s):  
Hideyuki Kano ◽  
Douglas Kondziolka ◽  
Huai-Che Yang ◽  
Oscar Zorro ◽  
Javier Lobato-Polo ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
Surgical Procedure ◽  
Gamma Knife Radiosurgery ◽  
Sensory Loss ◽  
Failed Surgery ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract BACKGROUND: Trigeminal neuralgia (TN) that recurs after surgery can be difficult to manage. OBJECTIVE: To define management outcomes in patients who underwent gamma knife stereotactic radiosurgery (GKSR) after failing 1 or more previous surgical procedures. METHODS: We retrospectively reviewed outcomes after GKSR in 193 patients with TN after failed surgery. The median patient age was 70 years (range, 26-93 years). Seventy-five patients had a single operation (microvascular decompression, n = 40; glycerol rhizotomy, n = 24; radiofrequency rhizotomy, n = 11). One hundred eighteen patients underwent multiple operations before GKSR. Patients were evaluated up to 14 years after GKSR. RESULTS: After GKSR, 85% of patients achieved pain relief or improvement (Barrow Neurological Institute grade I-IIIb). Pain recurrence was observed in 73 of 168 patients 6 to 144 months after GKSR (median, 6 years). Factors associated with better long-term pain relief included no relief from the surgical procedure preceding GKSR, pain in a single branch, typical TN, and a single previous failed surgical procedure. Eighteen patients (9.3%) developed new or increased trigeminal sensory dysfunction, and 1 developed deafferentation pain. Patients who developed sensory loss after GKSR had better long-term pain control (Barrow Neurological Institute grade I-IIIb: 86% at 5 years). CONCLUSION: GKSR proved to be safe and moderately effective in the management of TN that recurs after surgery. Development of sensory loss may predict better long-term pain control. The best candidates for GKSR were patients with recurrence after a single failed previous operation and those with typical TN in a single trigeminal nerve distribution.

CYBERKNIFE RADIOSURGERY FOR TRIGEMINAL SCHWANNOMAS

Neurosurgery ◽  
2009 ◽  
Vol 64 (suppl_2) ◽  
pp. A14-A18 ◽  
Author(s):  
Gordon T. Sakamoto ◽  
D. John Borchers ◽  
Furen Xiao ◽  
Hee-Jin Yang ◽  
Steven D. Chang ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Benign Tumors ◽  
Tumor Control ◽  
Modest Improvement ◽  
Facial Numbness ◽  
The Mean

Abstract OBJECTIVE Trigeminal schwannomas (TS) are benign tumors that are managed by surgical resection and/or stereotactic radiosurgery. Most radiosurgical series report results using the gamma knife. The CyberKnife (Accuray, Inc., Sunnyvale, CA) is a frameless, robotic stereotactic radiosurgical system. In this series, we report our experience using the CyberKnife in the treatment of TS. METHODS We retrospectively reviewed the medical records and diagnostic imaging in 13 consecutive patients with TS who were treated with the CyberKnife from 2003 to 2007. Seven patients had a previous surgical resection. The mean tumor volume was 6.3 mL (range, 0.39–19.98 mL), and the mean marginal dose was 18.5 Gy. Six of the tumors were treated in a single session. The mean clinical follow-up period was 21.8 months (range, 7–53 months). RESULTS In this series, the tumor control rate was 100%. The average reduction in tumor volume was 45% (range, 14–98%). A modest improvement in facial pain was noted in 4 of the 6 patients who presented with this symptom. One patient had improvement in facial numbness, and another had improvement in pretreatment headaches. One patient developed jaw weakness and facial dysesthesia, and another patient developed asymptomatic radiation necrosis. CONCLUSION Although the length of follow-up is limited, we report our initial experience with CyberKnife treatment of TS. Our results demonstrate tumor control rates and clinical outcomes that parallel those of previous reports using gamma knife radiosurgery; however, long-term follow-up studies are needed.

scholarly journals Gamma Knife Stereotactic Radiosurgery for Grade 2 Meningiomas

2017 ◽  
Vol 78 (04) ◽  
pp. 288-294 ◽  
Author(s):  
Tamer Refaat ◽  
Michelle Gentile ◽  
Sean Sachdev ◽  
Prarthana Dalal ◽  
Anish Butala ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Gamma Knife ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Institutional Review ◽  
Effective Treatment Modality ◽  
Gamma Knife Stereotactic Radiosurgery

Purpose This study aims to report long-term clinical outcomes after Gamma Knife radiosurgery (GKRS) for intracranial grade 2 meningiomas. Methods In this Institutional Review Board approved study, we reviewed records of all patients with grade 2 meningiomas treated with GKRS between 1998 and 2014. Results A total of 97 postoperative histopathologically confirmed grade 2 meningiomas in 75 patients were treated and are included in this study. After a mean follow-up of 41 months, 28 meningiomas had local recurrence (29.79%). Median time to local recurrence was 89 months (mean: 69, range: 47–168). The 3- and 5-year actuarial local control (LC) rates were 68.9 and 55.7%, respectively. The 3- and 5-year overall survival rates were 88.6 and 81.1%, respectively. There was a trend toward worse LC with tumors treated with radiation doses ≤ 13 versus > 13 Gy. There was no radiation necrosis or second malignant tumors noted in our series. Conclusion This report, one of the largest GKRS series for grade 2 meningiomas, demonstrates that GKRS is a safe and effective treatment modality for patients with grade 2 meningiomas with durable tumor control and minimal toxicity. Adjuvant GKRS could be considered as a reasonable treatment approach for patients with grade 2 meningiomas.

Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

2010 ◽  
Vol 113 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Jason P. Sheehan ◽  
Dibyendu Kumar Ray ◽  
Stephen Monteith ◽  
Chun Po Yen ◽  
James Lesnick ◽  
...  
Keyword(s):  
Pain Relief ◽  
Mr Imaging ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Vascular Compression ◽  
Pain Intensity Score ◽  
The Impact

Object Trigeminal neuralgia is believed to be related to vascular compression of the affected nerve. Radiosurgery has been shown to be reasonably effective for treatment of medically refractory trigeminal neuralgia. This study explores the rate of occurrence of MR imaging–demonstrated vascular impingement of the affected nerve and the extent to which vascular impingement affects pain relief in a population of trigeminal neuralgia patients undergoing Gamma Knife radiosurgery (GKRS). Methods The authors performed a retrospective analysis of 106 cases involving patients treated for typical trigeminal neuralgia using GKRS. Patients with or without single-vessel impingement on CISS MR imaging sequences and with no previous surgery were included in the study. Pain relief was assessed according to the Barrow Neurological Institute (BNI) pain intensity score at the last follow-up. Degree of impingement, nerve diameter preand post-impingement, isocenter placement, and dose to the point of maximum impingement were evaluated in relation to the improvement of BNI score. Results The overall median follow-up period was 31 months. Overall, a BNI pain score of 1 was achieved in 59.4% of patients at last follow-up. Vessel impingement was seen in 63 patients (59%). There was no significant difference in pain relief between those with and without vascular impingement following GKRS (p > 0.05). In those with vascular impingement on MR imaging, the median fraction of vessel impingement was 0.3 (range 0.04–0.59). The median dose to the site of maximum impingement was 42 Gy (range 2.9–79 Gy). Increased dose (p = 0.019) and closer proximity of the isocenter to the site of maximum vessel impingement (p = 0.012) correlated in a statistically significant fashion with improved BNI scores in those demonstrating vascular impingement on the GKRS planning MR imaging Conclusions Vascular impingement of the affected nerve was seen in the majority of patients with trigeminal neuralgia. Overall pain relief following GKRS was comparable in those with and without evidence of vascular compression on MR imaging. In subgroup analysis of those with MR imaging evidence of vessel impingement of the affected trigeminal nerve, pain relief correlated with a higher dose to the point of contact between the impinging vessel and the trigeminal nerve. Such a finding may point to vascular changes affording at least some degree of relief following GKRS for trigeminal neuralgia.

Stagnant Venous Outflow Predicts Brain Arteriovenous Malformation Obliteration After Gamma Knife Radiosurgery Without Prior Intervention

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 338-347 ◽  
Author(s):  
Yong-Sin Hu ◽  
Cheng-Chia Lee ◽  
Hsiu-Mei Wu ◽  
Huai-Che Yang ◽  
Te-Ming Lin ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Digital Subtraction Angiography ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Magnetic Resonance Images ◽  
Venous Stasis ◽  
Digital Subtraction ◽  
Venous Outflow ◽  
Therapeutic Decisions ◽  
The Impact

Abstract BACKGROUND Gamma Knife radiosurgery (GKRS) obliterates 65% to 82% of brain arteriovenous malformations (BAVMs). OBJECTIVE To explore the impact of hemodynamics on GKRS outcomes. METHODS We retrospectively (2011-2017) included 98 patients with BAVMs who had received GKRS alone. Two evaluators, blinded to the outcomes, analyzed the pre-GKRS angiography and magnetic resonance images to obtain the morphological characteristics and quantitative digital subtraction angiography (QDSA) parameters. The venous stasis index was defined as the inflow gradient divided by the absolute value of the outflow gradient. Patients’ follow-up magnetic resonance or digital subtraction angiography images were evaluated for the presence of complete obliteration (CO). Cox regression and Kaplan–Meier analyses were conducted to determine the correlations between the parameters and outcomes. RESULTS Among the 98 patients, 63 (63.4%) achieved CO after GKRS at a median latency period of 31 mo. In multivariable analyses with adjustments for age and sex, increased BAVM volume (hazard ratio (HR) 0.949, P = .022) was an independent characteristic predictor, and venous stenosis (HR 2.595, P = .009), venous rerouting (HR 0.375, P = .022), and larger stasis index (HR 1.227, P = .025) were independent angiographic predictors of CO. BAVMs with a stasis index of &gt;1.71 had a higher 36-mo probability of CO than those with a stasis index of ≤1.71 (61.1% vs 26.7%, P &lt; .001). CONCLUSION BAVMs with a larger stasis index, indicating more stagnant venous outflow, may predict obliteration after GKRS. QDSA analysis may help in predicting BAVM treatment outcomes and making therapeutic decisions.

scholarly journals Dosimetric study between a single isocenter dynamic conformal arc therapy technique and Gamma Knife radiosurgery for multiple brain metastases treatment: impact of target volume geometrical characteristics

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Michel Chea ◽  
Karen Fezzani ◽  
Julian Jacob ◽  
Marguerite Cuttat ◽  
Mathilde Croisé ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Irradiation Time ◽  
Geometric Characteristic ◽  
Gamma Knife Radiosurgery ◽  
Major Axis ◽  
Target Volume ◽  
Gradient Index ◽  
Dynamic Conformal Arc Therapy ◽  
The Impact

Abstract Purpose To compare linac-based mono-isocentric radiosurgery with Brainlab Elements Multiple Brain Mets (MBM) SRS and the Gamma Knife using a specific statistical method and to analyze the dosimetric impact of the target volume geometric characteristics. A dose fall-off analysis allowed to evaluate the Gradient Index relevancy for the dose spillage characterization. Material and methods Treatments were planned on twenty patients with three to nine brain metastases with MBM 2.0 and GammaPlan 11.0. Ninety-five metastases ranging from 0.02 to 9.61 cc were included. Paddick Index (PI), Gradient Index (GI), dose fall-off, volume of healthy brain receiving more than 12 Gy (V12Gy) and DVH were used for the plan comparison according to target volume, major axis diameter and Sphericity Index (SI). The multivariate regression approach allowed to analyze the impact of each geometric characteristic keeping all the others unchanged. A parallel study was led to evaluate the impact of the isodose line (IDL) prescription on the MBM plan quality. Results For mono-isocentric linac-based radiosurgery, the IDL around 70–75% was the best compromise found. For both techniques, the GI and the dose fall-off decreased with the target volume. In comparison, PI was slightly improved with MBM for targets < 1 cc or SI > 0.78. GI was improved with GP for targets < 2.5 cc. The V12Gy was higher with MBM for lesions > 0.4 cc or SI < 0.84 and exceeded 10 cc for targets > 5 cc against 6.5 cc with GP. The presence of OAR close to the PTV had no impact on the dose fall off values. The dose fall-off was higher for volumes < 3.8 cc with GP which had the sharpest dose fall-off in the infero-superior direction up to 30%/mm. The mean beam-on time was 94 min with GP against 13 min with MBM. Conclusions The dose fall-off and the V12Gy were more relevant indicators than the GI for the low dose spillage assessment. Both evaluated techniques have comparable plan qualities with a slightly improved selectivity with MBM for smaller lesions but with a healthy tissues sparing slightly favorable to GP at the expense of a considerably longer irradiation time. However, a higher healthy tissue exposure must be considered for large volumes in MBM plans.

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