Dose—response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery

Leber, K.; Berglöff, J.; Pendl, G.

doi:10.3171/jns.1998.88.1.0043

Cited by 482 publications

(201 citation statements)

References 42 publications

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“…Reports from retrospective trials of SRS specifically addressing pituitary macroadenoma show similar results 20,21 , although in one series, macroadenomas tended to have worse local control. Local failures were also more common in cases in which the tumour extended into the cavernous sinus 20 .…”

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confidence: 52%

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

et al. 2008

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BackgroundThe use of fractionated stereotactic radiotherapy (FSRT) has evolved with technical advances in noninvasive immobilization, radiation delivery, and image guidance. The application of FSRT to pituitary tumours is aimed at reducing toxicity through improved dose conformality and reduced treatment margins. The aim of the present paper is to report our own experience and to review the published data on FSRT for pituitary macroadenomas. MethodsBetween September 2000 and October 2005, 13 patients with pituitary macroadenoma underwent FSRT at our institution. In 12 patients, radiotherapy treatment followed surgical resection (transsphenoidal resection in 8, frontal craniotomy in 3, and multiple transsphenoidal resections followed by craniotomy in 1). In 4 patients, the tumours were functional (2 adrenocorticotropic hormone-secreting, 1 prolactinoma, and 1 growth hormone-secreting); the tumours in the remaining patients were clinically non-secretory. Before radiation, 3 patients had panhypopituitarism, and 6 patients had visual field defects. All patients were treated with FSRT using non-coplanar micro-multileaf collimation portals. A median dose of 50.4 Gy (range: 45-60 Gy) was prescribed to the 76.9%-95.2% isodose surface and delivered in 1.8-Gy fractions. The median planning target volume (gross tumour plus 3 mm) was 33.5 cm 3 (range: 3.2-75 cm 3 ). ResultsAfter a median follow-up of 24 months (range: 6-60 months), local control was 100%. One patient achieved clinical complete response. Treatment was well tolerated acutely for all patients. Neither radiation-induced optic neuropathy nor any radiation-related endocrine dysfunction was observed in our patients. ConclusionsIn accordance with published series, we found FSRT to be safe and effective in the management of large pituitary macroadenomas.

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confidence: 52%

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

et al. 2008

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“…We ensured that the optic nerves or brainstem received no more than 8-10 Gy of radiation. 1,5,8,13) Recent advances of MR angiography have provided less-invasive methods for the identification of AVFs, but cavernous sinus and inferior petrosal sinus flow signals may cause false-positive findings in patients without symptoms or signs of CCF. 3) However, MR angiography is useful for following up patients treated for dural CCF.…”

Section: Discussionmentioning

confidence: 99%

Gamma Knife Surgery for the Treatment of Spontaneous Dural Carotid-Cavernous Fistulas

Onizuka

Mori

Takahashi

et al. 2003

Neurol. Med. Chir.(Tokyo)

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Endovascular treatment for a spontaneous dural carotid-cavernous fistula (CCF) is an established treatment, but stereotactic radiosurgery might provide a less-invasive alternative in selected cases. Four women aged 67 to 79 years (mean 72.0 years) with spontaneous dural CCFs presented with chemosis or bruit. Angiography revealed arteriovenous fistulas in the cavernous portion. Three cases were Barrow type D and one was type B converted from type D. Stereotactic gamma knife surgery was performed with a marginal dose of 13-15 Gy and a maximum dose of 26-30 Gy with a volume from 824 to 1755 mm 3 . The target point of radiosurgery for type D CCFs was the compartment of the cavernous sinus supplied by multiple feeders from the external carotid artery. All patients responded favorably to the treatment, with improvement of symptoms beginning after 1 to 3 months. Angiography confirmed the complete disappearance of the CCFs in all patients. There were no recurrences, and the follow-up period was 14 to 32 months (mean 24 months). No significant side effects were observed. Stereotactic radiosurgery is a useful method to treat CCFs and is indicated for elderly patients, low-flow CCFs, and cases in which endovascular treatment has failed.

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“…1 However, some studies have shown that injury to the optic nerve or chiasm may occur if Ͼ 8-10 Gy is delivered in a single fraction to a segment of the optic apparatus, 13,32 while in another study craniopharyngiomas were successfully treated with a limit of 13 Gy to the optic apparatus. 29 In general, however, radiosurgery is contraindicated if the distance between the tumor and optic apparatus is Ͻ 3 mm because the visual pathways would typically receive Ͼ 10 Gy is these situations.…”

Section: Discussionmentioning

confidence: 99%

Radiation therapy and CyberKnife radiosurgery in the management of craniopharyngiomas

Lee¹,

Kalani²,

Cheshier³

et al. 2008

FOC

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Object Many benign intracranial tumors are amenable to radiotherapy treatment including meningiomas, schwannomas, pituitary tumors, and craniopharyngiomas. The authors present their experience in the treatment of craniopharyngiomas in 16 patients using frameless CyberKnife stereotactic radiosurgery (SRS). The authors discuss the role of radiation therapy in the management of these tumors, and more specifically, the role of CyberKnife SRS. Methods Sixteen patients were treated for residual or recurrent craniopharyngioma between 2000 and 2007 with CyberKnife SRS at Stanford University Medical Center. All patients underwent magnetic resonance imaging and visual and neuroendocrine evaluations before and at regular intervals after SRS. A multisession treatment regimen and a nonisocentric treatment plan for each patient were used with a mean marginal dose of 21.6 Gy and a mean maximal dose of 29.9 Gy. Results There were adequate clinical data to assess outcomes in 11 of 16 patients. Evaluation of patients between 13 and 71 years of age (mean 34.5 years) with a mean follow-up period of 15.4 months revealed no deterioration in visual or neuroendocrine function. Tumor shrinkage was achieved in 7 of these 11 patients, and tumor control in another 3. One patient had cystic enlargement of the residual tumor. Conclusions The authors' early experience with the application of CyberKnife SRS to residual or recurrent craniopharyngiomas has been positive; control or shrinkage of the tumor was achieved in 91% of patients, with no visual or neuroendocrine complications. Longer-term follow-up with a larger group of patients is required to fully evaluate the safety and effectiveness of this treatment modality.

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Dose—response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery

Cited by 482 publications

References 42 publications

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

Gamma Knife Surgery for the Treatment of Spontaneous Dural Carotid-Cavernous Fistulas

Radiation therapy and CyberKnife radiosurgery in the management of craniopharyngiomas

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