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Группа авторов. Leksell Radiosurgery
Progress in Neurological Surgery
Leksell Radiosurgery
Contents
Preface
The Origins and Development of Radiosurgery and the Leksell Gamma Knife
Abstract
The Early Years
X-Rays and Protons
The Gamma Knife
Spreading the Gospel against Disbelief
The Turning Point
Gamma Knife Statistics and Education
Personal Reflections
References
The First North American Clinical Gamma Knife Center
Abstract
First Look
A Year in Sweden
The Two-Part Plan. The Dedicated Stereotactic Operating Room
A Gamma Knife in Pittsburgh
NMR Centers
Regulatory Authorities
Creation of the Team and the First Patients
The B Unit
The 4C Unit
Perfexion
ICON
Thirty Years, and Where We Are Now
A Word about Reimbursement
References
Frame versus Frameless Leksell Stereotactic Radiosurgery
Abstract
The ICON Technology
Frame-Based Stereotactic Radiosurgery Procedures
Advantages
Disadvantages
Frameless Fixation
Advantages
Disadvantages
Mask to Frame and Frame to Mask Conversion
Future Evolution of the ICON System
References
Imaging Techniques for Leksell Radiosurgery
Abstract
MRI Alone for Radiosurgery Planning
MRI Clinical Protocols
Intravenous Contrast
Stereotactic CT Imaging
Advantages of Stereotactic Cone Beam CT with the LGK Icon
Stereotactic Angiography
Quality Assurance of Images
Role of Additional Physiologic and Metabolic Imaging
MR Spectroscopy
MR Diffusion and Diffusion Tensor Imaging
Metabolic PET Imaging
Magnetoencephalography
Conclusion
References
Quality Improvement Radiosurgery Registry
Abstract
The Task Force
Requirements for the New Database
Rationale for Nomenclature and Regulatory Oversight Requirement
Registry Design
Registry Security
Workflow and Data Entry
QI Registry versus Clinical Trials
The Role of a Patient Registry
Query Functions
The Value of the Registry
Challenges and Limitations
Conclusions
References
Medical Physics for Leksell Radiosurgery
Abstract
Radiation Protection
The Gamma Knife Unit
Acceptance and Commissioning
Radiation Profiles
The Radiologic Focal Point
Absolute Dose Calibration
Relative Output Factors
Stereotactic Cone-Beam Computed Tomography
High-Definition Motion Management
Quality Assurance
Treatment Planning
References
Patient Preparation and Nursing Management for Leksell Radiosurgery
Abstract
Stage 1: Pre-Radiosurgery Nursing Evaluation
Gamma Knife Procedure Instructions
Stage 2: Nursing Care on the Day of Radiosurgery
Frame-Based Radiosurgery
Mask-Based Radiosurgery
Imaging
Stage 3: Patient Care after Stereotactic Radiosurgery
Stage 4: Discharge and Follow-Up Counselling
Anesthesia Considerations during Leksell Radiosurgery
Abstract
Patient Selection
Mask-Based Technique
Frame-Based Technique
General Anesthesia for Pediatric Patients
Facilities and Personnel
Preanesthetic Assessment
Risks and Challenges in Caring for Sedated Children
Preanesthetic Evaluation and Preparation
Monitoring
Types of Pharmacologic Agents Used for Sedation. Intravenous Agents
Inhalational (General) Anesthetics
Other Drugs
Recovery
References
Gamma Knife Radiation Safety and Regulatory Requirements
Abstract
Regulatory Agencies
Radioactive Materials License
Historical Development of Gamma Knife Regulations
Training and Experience Requirements for an Authorized User, Authorized Medical Physicist, and Radiation Safety Officer
Radiation Surveys
Radiation Safety Requirements
Physical Presence Requirements
Medical Event Criteria and Notification Reporting Requirements
Radioactive Source Security
References
Leksell Radiosurgery for Vestibular Schwannomas
Abstract
Background
Treatment Considerations
Tumor Control Outcomes. Sporadic VS Control
Neurofibromatosis Type II VS Control
Volumetric Outcomes and Predictors
Fractionated Gamma Knife Stereotactic Radiosurgery
Repeat Gamma Knife Stereotactic Radiosurgery
Functional Outcomes. Serviceable Hearing
Facial Nerve Function
Trigeminal Neuropathy
Induced Malignancy
Microsurgery and Gamma Knife Stereotactic Radiosurgery
Conclusion
References
Gamma Knife Radiosurgery for Meningioma
Abstract
Indications for Gamma Knife in Intracranial Meningioma
Treatment Planning and Radiobiology of Gamma Knife for Meningioma
Overview of Meningioma Outcomes following Gamma Knife
Subgroup Analysis. Convexity Meningiomas
Parasagittal/Parafalcine
Skull Base Meningiomas: An Overview
Parasellar/Cavernous Sinus/Petroclival Region Meningiomas
Atypical and Malignant Meningiomas
Management of Meningioma Recurrence Post-Gamma Knife
The Role of Hypofractionated Radiosurgery for Larger Meningiomas
Treatment of Complications. Peri-Tumoral Oedema
Vascular Complications after Radiosurgery for Meningiomas
Risk of Radiation-Induced Tumours
Conclusions
References
Guidelines for Multiple Brain Metastases Radiosurgery
Abstract
Survey of Clinical Practice
Reasons to Avoid Whole-Brain Radiation Therapy
Advantages of Stereotactic Radiosurgery
Myth 1: Stereotactic Radiosurgery Should Not Be Used for More than 10 Tumors. Reality
Cumulative Tumor Volume versus Number of Tumors
Myth 2: Whole-Brain Radiation Therapy Treats Micro-Metastases and Significantly Reduces the Rate of Neurologic Death. Reality
Myth 3: Stereotactic Radiosurgery for >10 Tumors Is Associated with a High Total Mean and Integral Dose to the Brain. Reality
UPMC Center of Image-Guided Neurosurgery Guidelines
Conclusion
References
Stereotactic Radiosurgery for Patients with 10 or More Brain Metastases
Abstract
Achievement in SRS for ≥10 Brain Metastases over the Last 2 Decades. Treatment Results
Is Concurrent Whole-Brain Radiotherapy Necessary?
Is Stereotactic Radiosurgery for Multiple Brain Metastases Safe?
Mito Experiences of Stereotactic Radiosurgery for ≥10 Brain Metastases. Patient Population
Clinical Outcomes
Statistical Analysis
Results
Comparison between Groups A and B
Factors Impacting on Longer Survival Periods in Patients with ≥10 Brain Metastases
Discussion
Disclosure Statement
References
Targeted Therapies for Brain Metastases
Abstract
Opportunities and Challenges in Brain Metastasis Research
Targeted Therapies for Brain Metastases from Lung Cancer
Targeted Therapies for Brain Metastases from Breast Cancer
Targeted Therapies for Brain Metastases from Melanoma
Targeted Treatment for CTLA-4 Immune Checkpoint Molecule
Targeted Treatment for BRAF-Mutant Melanoma
Conclusion
References
Adverse Radiation Effects
Abstract
Epidemiology of Radiation Necrosis
Pathophysiology of Radiation Necrosis
Risk Factors for the Development of Radiation Necrosis
Diagnosis of Radiation Necrosis
Magnetic Resonance Imaging. Lesional Morphology
Diffusion-Weighted Imaging
T1/T2 Mismatch
MR Spectroscopy and MR Perfusion
Nuclear Medicine Imaging. FDG-PET
Amino Acid PET
Thallium-201 SPECT
Management of Radiation Necrosis
Medical Treatments
Surgical Intervention
Conclusion
References
Pituitary Tumor Radiosurgery
Abstract
History of Radiosurgery for Pituitary Tumors
Patient Selection
Gamma Knife Radiosurgical Technique
Stereotactic Frame and Mask Placement
Radiographic Imaging
Radiosurgical Planning
Radiosurgical Dose Selection
Clinical Outcomes following Radiosurgery. Prolactinomas
Non-Functioning Pituitary Adenomas
Growth Hormone-Secreting Adenomas
Adrenocorticotropin Hormone-Secreting Adenomas
Radiosurgical Complications
Hypopituitarism and Hypothalamic Dysfunction
Cranial Neuropathy
Late Adverse Radiation Effect
Conclusion
Disclosure Statement
References
Non-Vestibular Schwannoma Radiosurgery
Abstract
Olfactory Nerve Schwannomas
Oculomotor Nerve Schwannomas
Trochlear Nerve Schwannomas
Trigeminal Nerve Schwannomas
Abducens Nerve Schwannomas
Facial Nerve Schwannomas
Jugular Foramen Schwannomas
Hypoglossal Schwannomas
Conclusion
References
The Role of Leksell Radiosurgery in the Management of Craniopharyngiomas
Abstract
UPMC Experience
Review of Other Craniopharyngioma Radiosurgery Series
Technical Considerations
The Challenge of Craniopharyngiomas
Conclusion
References
Stereotactic Radiosurgery for Pineal Region Tumors
Abstract
Germ Cell Tumors
Pineal Parenchymal Tumors
Papillary Tumors of the Pineal Region
Miscellaneous Tumors
Discussion
Conclusion
References
Stereotactic Radiosurgery for Low-Grade Gliomas
Abstract
The Role of Radiosurgery
Pilocytic Astrocytoma
Grade 2 Astrocytoma
Conclusion
References
Salvage Leksell Stereotactic Radiosurgery for Malignant Gliomas
Abstract
The Role of Radiosurgery
Anaplastic (Grade 3) Gliomas
Glioblastoma Multiforme
The UPMC Leksell SRS Experience
Radiosurgery in Combination with Bevacizumab
Technical Considerations in Malignant Glioma Patients Undergoing Leksell Salvage Stereotactic Radiosurgery
Conclusion
References
Leksell Radiosurgery for Ependymomas and Oligodendrogliomas
Abstract
Ependymoma Radiosurgery. Epidemiology of Ependymoma
Pathology of Ependymoma
Treatment for Ependymomas
Stereotactic Radiosurgery for Ependymomas
Summary
Oligodendroglioma Radiosurgery. Epidemiology of Oligodendroglioma
Pathology of Oligodendroglioma
Treatment for Oligodendrogliomas
Stereotactic Radiosurgery for Oligodendrogliomas
Summary
References
Radiosurgery for Chordoma and Chondrosarcoma
Abstract
Chordoma Radiosurgery
Treatment for Chordomas
Stereotactic Radiosurgery for Chordomas
Summary
Chondrosarcoma Radiosurgery
Treatment for Chondrosarcomas
Stereotactic Radiosurgery for Chondrosarcomas
Summary
References
Radiosurgery for Glomus Tumors
Abstract
Radiosurgery Technique. Patient Selection
Treatment Planning
Dose Selection
Follow-Up
The Clinical and Image Outcomes
Complications
The Special Consideration for Radiosurgery Plan and Dose Prescription
Conclusion
References
Leksell Radiosurgery for the 3 H Tumors: Hemangiomas, Hemangioblastomas, and Hemangiopericytomas
Abstract
Hemangiomas
Technical Considerations
Early Results
Multicenter Experience of the International Gamma Knife Research Foundation
Hemangioblastoma
Role for Surgical Resection
Fractionated Radiation Therapy
Stereotactic Radiosurgery
Multicenter Retrospective Trial
Hemangiopericytoma
Role for Surgical Resection
Radiation Therapy
Stereotactic Radiosurgery
Multicenter Retrospective Trial
References
Radiosurgery for Central Neurocytoma
Abstract
UPMC Experience
Discussion
Conclusion
References
Gamma Knife Radiosurgery of Arteriovenous Malformations: Long-Term Outcomes and Late Effects
Abstract
Patient Selection
Technique and Follow-Up
Outcomes after Gamma Knife Radiosurgery
Volume-Staged Arteriovenous Malformation Radiosurgery
Radiosurgery for Unruptured Arteriovenous Malformations
Late Adverse Radiation Effects
References
Radiosurgery for Dural Arteriovenous Fistulas
Abstract
Epidemiology and Classification of Dural Arteriovenous Fistulas
Clinical Manifestations
Treatment Options
Patient Selections and Pre-Stereotactic Radiosurgery Evaluation
Radiosurgical Technique and Planning
Follow-Up Program
Image and Clinical Outcomes
Complications
Complicated Dural Arteriovenous Fistulas and the Role of Combined Sinus Recanalization for Its Treatment
References
Leksell Stereotactic Radiosurgery for Cavernous Malformations
Abstract
Natural History of Cavernous Malformations
Management Options
The Goal of Leksell Stereotactic Radiosurgery
Leksell Stereotactic Radiosurgery Technique for Cavernous Malformations
Outcomes of Leksell Stereotactic Radiosurgery for Cavernous Malformations
Projected Cost-Benefit Analysis of Leksell Stereotactic Radiosurgery
Final Thoughts about Leksell SRS for CMs
References
Re-Evaluating Clinical Outcomes for AVM Stereotactic Radiosurgery
Abstract
Arteriovenous Malformation Stereotactic Radiosurgery Outcomes
Grading Scales for Arteriovenous Malformation Radiosurgery
An Alternative Look at Stereotactic Radiosurgery Outcomes
References
Trigeminal Neuralgia and Other Facial Neuralgias
Abstract
Effectiveness of Radiosurgery for Idiopathic Trigeminal Neuralgia
Predictors of Success to Radiosurgery in Trigeminal Neuralgia
Trigeminal Sensory Dysfunction after Radiosurgery
Tumor-Associated Trigeminal Neuralgia
Radiosurgery in Multiple Sclerosis-Associated Trigeminal Neuralgia
Radiosurgery in Idiopathic Glossopharyngeal Neuralgia
Radiosurgery in Sphenopalatine Neuralgia
Radiosurgery in Cluster Headache
Conclusion
References
Leksell Radiosurgery for Movement Disorders
Abstract
Leksell Radiosurgical Thalamotomy for Tremor
Radiosurgical Considerations for Gamma Knife Thalamotomy
Results of Gamma Knife Thalamotomy. Essential Tremor
Parkinson’s Disease-Related Tremor
Multiple Sclerosis-Related Tremor
Bilateral Leksell Radiosurgical Thalamotomy
Imaging Changes after Gamma Knife Thalamotomy
Justification of Leksell Radiosurgical Thalamotomy as a Surgical Option for Tremor
Radiosurgical Pallidotomy for Parkinson’s Disease
Conclusions
References
Radiosurgery for Behavioral Disorders
Abstract
Current Concepts
Conditions Treated by Gamma Knife Radiosurgery. Obsessive-Compulsive Disorder
Depression
Anorexia Nervosa
Radiosurgical Capsulotomy
Radiosurgical Cingulotomy
Clinical Course and Procedure Outcomes
Obsessive-Compulsive Disorder
Depression
Anorexia Nervosa
Clinical Experience Regarding Gamma Knife Radiosurgery for Obsessive-Compulsive Disorder
Clinical Experience Regarding Depression, Anorexia Nervosa, and Gamma Knife Radiosurgery
Conclusion
References
Leksell Radiosurgery for Orbital, Uveal, and Choroidal Tumors
Abstract
Leksell Stereotactic Surgical Technique
Tumors of the Orbit
Primary Tumors of the Uvea
Metastatic Tumors to the Choroid
Complications of Stereotactic Radiosurgery in Treating Orbital and Uveal Lesions
Conclusion
References
Radiosurgery for Ocular Disorders: Other Indications
Abstract
Eye Fixation
Dosimetry and Treatment Planning
Ophthalmological Indications for Gamma Knife Treatment
Glaucoma
Age-Related Macular Degeneration
Retinoblastoma
Orbital and Uveal Metastases of Carcinomas
Other Conditions Suitable for Treatment
Conclusion
References
Author Index
Subject Index
