Emerging Indications for Fractionated Gamma Knife Radiosurgery. Issue 2 (13th January 2017)

• Record Type: Journal Article
• Authors: McTyre, Emory; Helis, Corbin A.; Farris, Michael; Wilkins, Lisa; Sloan, Darrell; Hinson, William H.; Bourland, J. Daniel; Dezarn, William A.; Munley, Michael T.; Watabe, Kounosuke; Xing, Fei; Laxton, Adrian W.; Tatter, Stephen B.; Chan, Michael D.
• Is Part Of: Neurosurgery. Volume 80:Issue 2(2017)
• Page Start: 210
• Page End: 216
• Publication Date: 2017-01-13
• Subjects: Gamma Knife radiosurgery -- Meningioma -- Pituitary adenoma -- Radiosurgery -- Vestibular schwannoma; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000001227
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Gamma Knife radiosurgery (GKRS) allows for the treatment of intracranial tumors with a high degree of dose conformality and precision. There are, however, certain situations wherein the dose conformality of GKRS is desired, but single-session treatment is contraindicated. In these situations, a traditional pin-based GKRS head frame cannot be used, because it precludes fractionated treatment. OBJECTIVE: To report our experience in treating patients with fractionated GKRS using a relocatable, noninvasive immobilization system. METHODS: Patients were considered candidates for fractionated GKRS if they had 1 or more of the following indications: a benign tumor >10 cc in volume or abutting the optic pathway, a vestibular schwannoma with the intent of hearing preservation, or a tumor previously irradiated with single-fraction GKRS. The immobilization device used for all patients was the Extend system (Leksell Gamma Knife Perfexion, Elekta, Kungstensgatan, Stockholm). RESULTS: We identified 34 patients treated with fractionated GKRS between August 2013 and February 2015. There were a total of 37 tumors treated including 15 meningiomas, 11 pituitary adenomas, 6 brain metastases, 4 vestibular schwannomas, and 1 hemangioma. At last follow-up, all 21 patients treated for perioptic tumors had stable or improved vision and all 4 patients treated for vestibular schwannoma maintained serviceable hearing. No severe adverse events were reported. CONCLUSION: Fractionated GKRS was well tolerated in the treatment of large meningiomas, perioptic tumors, vestibular schwannomas with intent of hearing preservation, and reirradiation of previously treated tumors.