Current concepts in stereotactic radiosurgery - a neurosurgical and radiooncological point of view

Abstract

Stereotactic radiosurgery is related to the history of "radiotherapy" and "stereotactic neurosurgery". The concepts for neurosurgeons and radiooncologists have been changed during the last decade and have also transformed neurosurgery. The gamma knife and the stereotactically modified linear accelerator (LINAC) are radiosurgical equipments to treat predetermined intracranial targets through the intact skull without damaging the surrounding normal brain tissue. These technical developments allow a more precise intracranial lesion control and offer even more conformal dose plans for irregularly shaped lesions. Histological determination by stereotactic biopsy remains the basis for any otherwise undefined intracranial lesion. As a minimal approach, it allows functional preservation, low risk and high sensitivity. Long-term results have been published for various indications. The impact of radiosurgery is presented for the management of gliomas, metastases, brain stem lesions, benign tumours and vascular malformations and selected functional disorders such as trigeminal neuralgia. In AVM's it can be performed as part of a multimodality strategy including resection or endovascular embolisation. Finally, the technological advances in radiation oncology as well as stereotactic neurosurgery have led to significant improvements in radiosurgical treatment opportunities. Novel indications are currently under investigation. The combination of both, the neurosurgical and the radiooncological expertise, will help to minimize the risk for the patient while achieving a greater treatment success.

Features of Individual-Typological Variability of the Pterygomaxillary Fissure

“…Данное обстоятель-ство обеспечивает необходимую теоретиче-скую базу для разработки и оптимизации сте-реотаксических вмешательств при патологи-ческих процессах различного происхождения [6,8,11,15].…”

“…Однако, в доступной нам литературе сведения об индивидуально-типологической изменчивости труднодоступных структур че-репа, таких как, например, крыловидно-верхнечелюстной щели (КВЩ) и ее взаимо-связях с тотальными размерами и формами черепа встречались чрезвычайно редко [9]. Так как комплексное изучение морфологии глубинных элементов черепа представляет большой интерес, для последующего исполь-зования результатов в эндоскопической хи-рургии, рентгеновской, компьютерной и маг-нитно-резонансной томографии [5,8,11,15], мы решили более подробно изучить индиви-дуально-типологическую изменчивость КВЩ.…”

Combining Brain Diagnosis and Therapy in a Single Strategy: The Safety, Reliability, and Cost Implications Using Same-Day versus Separate-Day Stereotactic Procedures

“…During these same 30 years, SRS has found an increasing role as a primary treatment for brain tumors that have definable tumor borders or as adjuvant therapy within a paradigm of multimodality management in patients with infiltrative tumor borders [15][16][17] . For patients who have surgically unresectable neoplasms confirmed by stereotactic biopsy, radiosurgery may be an initial treatment option [17][18][19] .…”

“…For patients who have surgically unresectable neoplasms confirmed by stereotactic biopsy, radiosurgery may be an initial treatment option [17][18][19] .…”

Radiosurgery for recurrent glioblastoma: a review article

“…Improved spatial target localization by virtue of advanced neuroimaging techniques allows for precisely focused delivery of high effective target doses with optimal normal tissue sparing through steep dose gradients achieved via robust stereotactic localization and intensity-modulated computerized treatment planning for accurate radiosurgery applications [53,54].…”