Stereotactic irradiation for treatment of acoustic neuromas

Stereotactic cerebral irradiation is a radiotherapeutic technique for precise delivery of ionizing irradiation to an intracranial target with simultaneous sparing of adjacent parenchyma. Treatment can be administered by a multi-source cobalt-60 device (gamma knife) or a dedicated linear accelerator.The target dose can be delivered in a large, single fraction (stereotactic radiosurgery SRS) or in multiple, daily increments (stereotactic radiotherapy SRT). The latter approach combines the physical dose localization advantages of SRS with the radiobiologic benefits of dose fractionation. This literature review will present the rationale and clinical results of SRS and SRT for the treatment of acoustic neuromas. Emphasis will be placed on tumor control, imaging outcome and cranial nerve preservation. The findings demonstrate that SRS and SRT represent reasonable therapeutic options for patients with acoustic neuromas.

SMART: Stroke-Like Migraine Attacks After Radiation Therapy

We describe two adults with stroke-like migraine attacks after radiation therapy (SMART syndrome), propose revised diagnostic criteria, and review the previously reported patients. ‘SMART’ is an acronym for a newly recognized syndrome which occurs as a delayed consequence of cerebral irradiation and consists of prolonged, unilateral, migrainous neurological symptoms with transient, dramatic cortical gadolinium enhancement of the affected cerebral hemisphere and is sometimes punctuated by generalized seizures and ipsilateral EEG slowing. Although the neurological symptoms can last for weeks, full recovery occurs. An appropriate evaluation should exclude alternative explanations.