Influence of Absorbed Dose and Field Size on the Geometry of the Radiation-Surgical Brain Leslon

Dahlin, H.; Larsson, B.; Leksell, L; Rosander, Kerstin; Sarby, B.; Steiner, Ladislau

doi:10.3109/02841867509132656

Cited by 14 publications

(2 citation statements)

References 3 publications

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“…Leksell worked for many years with Larsson, a medical physicist, to build the original Gamma Knife unit. 8 Around that same time, innovative work in the field of SRS using heavy particles from cyclotrons was conducted by Raymond Kjellberg and Jacob Fabrikant. In 1983 at a center in Buenos Aires, Argentina, Betti and Derechinsky 4,5 developed the concept of a dedicated linear accelerator for SRS.…”

Section: Interdisciplinary Collaborationmentioning

confidence: 99%

Inception of a national multidisciplinary registry for stereotactic radiosurgery

Sheehan

Kavanagh

Asher

et al. 2016

JNS

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Since its conception in 1951, the field of stereotactic radiosurgery (SRS) has demonstrated substantial growth, and it has altered treatment paradigms for patients with complex and diverse intracranial disorders. 12In the United States alone, there are more than 100 distinct SRS centers that treat thousands of patients each year. Patients are treated for diverse indications such as benign and malignant brain tumors, vascular malformations, and functional disorders.SRS is routinely delivered using several common radiosurgical devices. Despite the exponential growth of radiosurgery in the United States during the past 2 decades, the majority of the radiosurgical literature is composed of single-center retrospective studies.There are, of course, a small percentage of retrospective multicenter pooled analyses and even fewer prospective randomized clinical trials (RCTs). Some prospective multicenter SRS trials, such as ACOSOG-N0574 and the Stereotactic radiosurgery (SRS) represents a multidisciplinary approach to the delivery of ionizing high-dose radiation to treat a wide variety of disorders. Much of the radiosurgical literature is based upon retrospective single-center studies along with a few randomized controlled clinical trials. More timely and effective evidence is needed to enhance the consistency and quality of and clinical outcomes achieved with SRS. The authors summarize the creation and implementation of a national SRS registry. The American Association of Neurological Surgeons (AANS) through NeuroPoint Alliance, Inc., started a successful registry effort with its lumbar spine initiative. Following a similar approach, the AANS and NeuroPoint Alliance collaborated with corporate partners and the American Society for Radiation Oncology to devise a data dictionary for an SRS registry. Through administrative and financial support from professional societies and corporate partners, a framework for implementation of the registry was created. Initial plans were devised for a 3-year effort encompassing 30 high-volume SRS centers across the country. Device-specific web-based data-extraction platforms were built by the corporate partners. Data uploaders were then used to port the data to a common repository managed by Quintiles, a national and international health care trials company. Audits of the data for completeness and veracity will be undertaken by Quintiles to ensure data fidelity. Data governance and analysis are overseen by an SRS board comprising equal numbers of representatives from the AANS and NeuroPoint Alliance. Over time, quality outcome assessments and post hoc research can be performed to advance the field of SRS. Stereotactic radiosurgery offers a high-technology approach to treating complex intracranial disorders. Improvements in the consistency and quality of care delivered to patients who undergo SRS should be afforded by the national registry effort that is underway.

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Section: Interdisciplinary Collaborationmentioning

confidence: 99%

Inception of a national multidisciplinary registry for stereotactic radiosurgery

Sheehan

Kavanagh

Asher

et al. 2016

JNS

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“…Still no means existed to monitor intraoperative physiological feedback, however, and thus experience with functional radiosurgery began slowly. [1,4,23] There is a subgroup of patients with PD who have conditions that predispose them to the risks of invasive stereotactic neurosurgery. These are patients who are receiving a course of anticoagulant drugs, have respiratory or cardiac disease, are very elderly, or who are in general poor risks for invasive surgery.…”

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confidence: 99%

Gamma knife radiosurgery for thalamotomy in Parkinsonian tremor: a five-year experience

Duma¹,

Jacques²,

Kopyov³

et al. 1997

FOC

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Certain patients, for example elderly, high-risk surgical patients, may be unfit for radiofrequency thalamotomy to treat Parkinsonian tremor. Some patients, when given the opportunity, may choose to avoid an invasive surgical procedure. The authors retrospectively reviewed their experience using gamma knife radiosurgery for thalamotomies in this patient subpopulation. Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make 38 lesions in 24 men and 10 women (median age 73 years, range 58-87 years) over a 5-year period. A median radiation dose of 130 Gy (range 100-165 Gy) was delivered to 38 nuclei (four patients underwent bilateral thalamotomy) using a single 4-mm collimator following classic anatomical landmarks. Twenty-nine lesions were made in the left nucleus ventralis intermedius thalamus for right-sided tremor. Patients were followed for a median of 28 months (range 6-58 months). Independent neurological evaluation of tremor based on the change in the Unified Parkinson's Disease Rating Scale tremor score was correlated with subjective patient evaluation. Comparison was made between a subgroup of patients in whom “low-dose” lesions were made (range 110-135 Gy, mean 120 Gy) and those in whom “high-dose” lesions were made (range 140-165 Gy, mean 160 Gy) for purposes of dose-response information. Four thalamotomies (10.5%) failed, four (10.5%) produced mild improvement, 11 (29%) produced good improvement, and 10 (26%) produced excellent relief of tremor. In nine thalamotomies (24%) the tremor was eliminated completely. The median time to onset of improvement was 2 months (range 1 week-8 months) Concordance between an independent neurologist's evaluation and that of the patient was statistically significant (p < 0.001). Two patients who underwent unilateral thalamotomy experienced bilateral improvement of their tremor. There were no neurological complications. There was better tremor reduction in the high-dose group when compared with the low-dose group (p < 0.04). Although less effective than other stereotactic techniques, gamma knife radiosurgical thalamotomy offers tremor control with minimal risk to a patient population unsuited for open surgery.

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Gamma Knife radiosurgery for cerebral AVMs

Wowra¹

2002

Neurosurgery of Arteriovenous Malformations and Fistulas

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Influence of Absorbed Dose and Field Size on the Geometry of the Radiation-Surgical Brain Leslon

Cited by 14 publications

References 3 publications

Inception of a national multidisciplinary registry for stereotactic radiosurgery

Inception of a national multidisciplinary registry for stereotactic radiosurgery

Gamma knife radiosurgery for thalamotomy in Parkinsonian tremor: a five-year experience

Gamma Knife radiosurgery for cerebral AVMs

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