Current Treatment Strategy of Gamma Knife<sup>&amp;reg;</sup>Surgery for Vestibular Schwannoma: Image-Guided and Robotized Microradiosurgery

Hayashi, Motohiro; Tamura, Noriko; Maruyama, Takashi; Nakaya, Kotaro; Ochiai, Taku; Chernov, Mikhail; Yomo, Shoji; Anami, Hidenori; Izawa, Masahiro; Ono, Yuko; Okada, Yoshikazu; Hori, Tomokatsu; Takakura, Kintomo

doi:10.1159/000288729

Cited by 7 publications

(18 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14,18) This observation is in concordance with experimental results, which showed that presence of a``hot spot'' within the lesion is more likely provide the desired radiobiological outcome for GKS. 36) At the same time, the risk of complications is not increased, unless treatment is insufficiently selective and high-dose irradiation extends over the adjacent normal tissue.…”

Section: Radiosurgery For Cavernous Sinus Tumorssupporting

confidence: 87%

“…15) On the other hand, cranial neuropathy in patients with schwannomas was seemingly caused by transient enlargement of the lesion, which is rather common after radiosurgery for this type of tumors and probably relates to inflammatory changes after irradiation. 6,11,18,34) Meanwhile, transient abducens nerve palsy in one patient with cisternocavernous abducens nerve schwannoma fully resolved but re-appeared 2 years after radiosurgery due to formation of the intratumoral cyst, which showed spontaneous regression during the longer follow-up period.…”

Section: Resultsmentioning

confidence: 96%

“…Availability of this device permitted us to create an original concept of robotic gamma knife microradiosurgery, which application in clinical practice during the last decade has provided effective and safe radiosurgical management of various brain tumors. [13][14][15][16]18,22) The present study evaluated the results of our microradiosurgical treatment strategy in a large series of patients with benign cavernous sinus neoplasms, with particular emphasis on the tumor shrinkage rate and risk of treatment-associated complications.…”

Section: Introductionmentioning

confidence: 99%

“…59) Wide 80% prescription isodose area was created within the neoplasm to attain not just control of growth, but shrinkage, which might depend on the amount of the delivered radiation energy, reflected by an original parameter, designated as unit energy (mJ/cm 3 ). 14,18) For evaluation of the high-dose area within the target, the so-called homogeneity index (HI) was calculated as:…”

mentioning

confidence: 99%

See 3 more Smart Citations

Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Treatment Concept and Outcomes in 120 Cases

Hayashi

Chernov

Tamura

et al. 2012

Neurol. Med. Chir.(Tokyo)

Self Cite

View full text Add to dashboard Cite

Availability of modern computer-aided robotized devices, such as the Automatic Positioning System (APS TM ; Elekta Instruments AB, Stockholm, Sweden) and Perfexion TM (Elekta Instruments AB), allowed us to develop the original concept of robotic gamma knife microradiosurgery, which is based on the very precise irradiation of the lesion with regard to conformity and selectivity; intentional avoidance of the excessive irradiation of functionally-important anatomical structures, particularly cranial nerves, located both within and in the vicinity of the target; and delivery of sufficient irradiation energy to the tumor with the intention to attain lesion shrinkage, while keeping the marginal dose sufficiently low for prevention of possible complications. The results of such treatment strategy were evaluated retrospectively in 120 patients with benign cavernous sinus neoplasms (pituitary adenomas, meningiomas, schwannomas, and hemangiomas), who were followed up from 24 to 78 months (mean 47 months) after radiosurgery. Tumor growth control and shrinkage rates were 98% and 68%, respectively. More than 50% volume reduction was noted in 25% of lesions. The most prominent volumetric tumor response was observed in hemangiomas, followed by schwannomas, pituitary adenomas, and meningiomas. Treatment-related complications were marked in 7% of cases, and were mainly related to transient isolated cranial neuropathy appearing within several months after radiosurgery. Major morbidity was limited to one patient (0.8%). Application of microradiosurgical treatment principles provides effective and safe management of benign cavernous sinus tumors and is associated with high probability of lesion shrinkage and minimal risk of complications.

show abstract

Section: Radiosurgery For Cavernous Sinus Tumorssupporting

confidence: 87%

Section: Resultsmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Treatment Concept and Outcomes in 120 Cases

Hayashi

Chernov

Tamura

et al. 2012

Neurol. Med. Chir.(Tokyo)

Self Cite

View full text Add to dashboard Cite

show abstract

“…Advances in the gamma knife radiosurgery unit-including the automatic positioning system, gamma plan, and (more recently) the new Perfexion system-provide higher accuracy and improved patient convenience and comfort. Hayashi et al (Hayashi et al, 2006) introduced the concept of robotic micro-radiosurgery and demonstrated high accuracy in the planning of gamma knife radiosurgery.…”

Section: Conformitymentioning

confidence: 99%

Gamma Knife Radiosurgery for the Vestibular Schwannomas, Technical Considerations and Hydrocephalus as a Complication

Hwang¹,

Park²,

Lee³

et al. 2011

Gamma Knife Radiosurgery

View full text Add to dashboard Cite

Concept of Robotic Gamma Knife Microradiosurgery and Results of Its Clinical Application in Benign Skull Base Tumors

Hayashi

Chernov

Tamura

et al. 2012

Acta Neurochirurgica Supplement

View full text Add to dashboard Cite

The availability of advanced computer-aided robotized devices for the Gamma Knife (i.e., an automatic positioning system and PerfeXion) resulted in significant changes in radiosurgical treatment strategy. The possibility of applying irradiation precisely and the significantly improved software for treatment planning led to the development of the original concept of robotic Gamma Knife microradiosurgery, which is comprised of the following: (1) precise irradiation of the lesion with regard to conformity and selectivity; (2) intentional avoidance of excessive irradiation of functionally important anatomical structures, particularly cranial nerves, located both within the target and in its vicinity; (3) delivery of sufficient radiation energy to the tumor with a goal of shrinking it while keeping the dose at the margins low enough to prevent complications. Realization of such treatment principles requires detailed evaluation of the microanatomy of the target area, which is achieved with an advanced neuroimaging protocol. From 2003, we applied the described microradiosurgical concept in our clinic for patients with benign skull base tumors. Overall, 75 % of neoplasms demonstrated shrinkage, and 47 % showed ≥50 % and more volume reduction. Treatment-related complications were encountered in only 6 % of patients and were mainly related to transient cranial nerve palsy. Just 2 % of neoplasms showed regrowth after irradiation. In conclusion, applying the microradiosurgical principles based on advanced neuroimaging and highly precise treatment planning is beneficial for patients, providing a high rate of tumor shrinkage and a low morbidity rate.

show abstract

Current Treatment Strategy of Gamma Knife^®Surgery for Vestibular Schwannoma: Image-Guided and Robotized Microradiosurgery

Cited by 7 publications

References 16 publications

Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Treatment Concept and Outcomes in 120 Cases

Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Treatment Concept and Outcomes in 120 Cases

Gamma Knife Radiosurgery for the Vestibular Schwannomas, Technical Considerations and Hydrocephalus as a Complication

Concept of Robotic Gamma Knife Microradiosurgery and Results of Its Clinical Application in Benign Skull Base Tumors

Contact Info

Product

Resources

About

Current Treatment Strategy of Gamma Knife&reg;Surgery for Vestibular Schwannoma: Image-Guided and Robotized Microradiosurgery

Cited by 7 publications

References 16 publications

Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Treatment Concept and Outcomes in 120 Cases

Gamma Knife Radiosurgery for Benign Cavernous Sinus Tumors: Treatment Concept and Outcomes in 120 Cases

Gamma Knife Radiosurgery for the Vestibular Schwannomas, Technical Considerations and Hydrocephalus as a Complication

Concept of Robotic Gamma Knife Microradiosurgery and Results of Its Clinical Application in Benign Skull Base Tumors

Contact Info

Product

Resources

About

Current Treatment Strategy of Gamma Knife^®Surgery for Vestibular Schwannoma: Image-Guided and Robotized Microradiosurgery