scholarly journals 3D WrapTM Ultra-Widefield Reconstruction in Stereotactic Radiosurgery for Choroidal Melanoma

2019 ◽  
Vol 6 (1) ◽  
pp. 20-24
Author(s):  
Maria Vittoria Cicinelli ◽  
Alessandro Marchese ◽  
Francesco Bandello ◽  
Giulio Maria Modorati
Keyword(s):  
Side Effects ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Three Dimensional ◽  
Choroidal Melanoma ◽  
Ocular Complications ◽  
Virtual Reconstruction ◽  
Radiation Induced ◽  
Imaging Instrument

Choroidal melanoma (CM) is the most commonly diagnosed primary intraocular malignancy in adults. Gamma knife radiosurgery (GKR) has demonstrated reliable results in the treatment of CM, but it is limited by the risk of radiation-induced ocular complications. To optimize the dose of radiation focused on the tumor, and limit side effects, the eye should be properly immobilized before treatment. A recently released ultra-widefield imaging instrument (Optomap California; Optos, Dunfermline, Scotland, UK) allows for an interactive three-dimensional (3D) virtual reconstruction of the globe, called 3D WrapTM. The authors share their experience with this rapid, reliable, and relatively easy support in planning globe positioning before GKR treatment.

scholarly journals Gamma Knife Radiosurgery for Acromegaly

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
John D. Rolston ◽  
Lewis S. Blevins
Keyword(s):  
Side Effects ◽  
Medical Treatment ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cranial Nerve ◽  
Remission Rate ◽  
Gamma Knife Radiosurgery ◽  
Substantial Proportion ◽  
Disease Remission ◽  
Cranial Nerve Palsies

Acromegaly is debilitating disease occasionally refractory to surgical and medical treatment. Stereotactic radiosurgery, and in particular Gamma Knife surgery (GKS), has proven to be an effective noninvasive adjunct to traditional treatments, leading to disease remission in a substantial proportion of patients. Such remission holds the promise of eliminating the need for expensive medications, along with side effects, as well as sparing patients the damaging sequelae of uncontrolled acromegaly. Numerous studies of radiosurgical treatments for acromegaly have been carried out. These illustrate an overall remission rate over 40%. Morbidity from radiosurgery is infrequent but can include cranial nerve palsies and hypopituitarism. Overall, stereotactic radiosurgery is a promising therapy for patients with acromegaly and deserves further study to refine its role in the treatment of affected patients.

scholarly journals Gamma Knife Radiosurgery for Uveal Melanoma: A Retrospective Review of Clinical Complications in a Tertiary Referral Center

2019 ◽  
Vol 6 (2) ◽  
pp. 115-122 ◽  
Author(s):  
Giulio Maria Modorati ◽  
Roi Dagan ◽  
Lauge Hjorth Mikkelsen ◽  
Simon Andreasen ◽  
Alfio Ferlito ◽  
...  
Keyword(s):  
Side Effects ◽  
Gamma Knife ◽  
Uveal Melanoma ◽  
Optic Neuropathy ◽  
Gamma Knife Radiosurgery ◽  
Vitreous Hemorrhage ◽  
Neovascular Glaucoma ◽  
Ophthalmological Examination ◽  
Department Of Ophthalmology ◽  
Radiation Induced

Introduction: Gamma knife radiosurgery (GKR) has shown promising results in the treatment of intraocular uveal melanoma (UM) in terms of local tumor control. However, GKR is not free from potentially sight-threatening side effects, including cataract, dry eye disease, vitreous hemorrhage, radiation retinopathy (RR), radiation maculopathy (RM), optic neuropathy, and neovascular glaucoma. The aim of this paper is to report our 20-year experience in UM management with GKR focusing on the rate of clinical treatment-induced complications. Methods: Single-center, retrospective, observational study, including all patients with UM treated at the Ocular Oncology and Uveitis Service, in the Department of Ophthalmology of the San Raffaele Scientific Institute, Milan from September 1993 to September 2018. Clinical charts comprised complete ophthalmological examination with measurement of best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, gonioscopy, and indirect ophthalmoscopy at each visit. B-scan ultrasound (Aviso S, 10 MHz probe; Paris, France), optical coherence tomography (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), retinography, and fundus fluorescein angiography (standard or ultra-widefield [UWF; California, Optos, Dunfermline, Scotland, UK]) were performed aiding in the diagnosis of complications. Results: Overall, 194 patients (100 males, 51.6%) were reviewed. The median age at the time of the treatment was 65 years (range 27–89) and all participants were Caucasian. In 185 eyes (95.4%), the tumor was primarily located at the choroid. The median follow-up was 57.6 months; radiation-induced complications were found in 145 eyes (74.7%). Radiation-induced cataract and RR were the most frequent events, with a relative incidence of 41.2 and 34.5%, respectively, followed by neovascular glaucoma (27.3%), optic neuropathy (18.6%), RM (11.4%), vitreous hemorrhage (14.4%), phthisis bulbi (7.7%), hyphema (0.5%), and corneal melting (0.5%). The shorter onset of side effects involved the optic nerve (median 14.9 months) and the macula (median 13.7 months). Conclusion: Despite modern and advanced strategies introduced to limit GKR side effects, cataract and RR still represent a serious limitation of this treatment. Incidence of RR was higher in our cohort compared to other reports, probably due to increased diagnosis rate permitted by UWF retinal imaging.

scholarly journals Carbon fiducials for large choroidal melanoma treated with gamma knife radiosurgery

2016 ◽  
Vol 94 (8) ◽  
pp. e806-e807 ◽  
Author(s):  
Margaret M. Reynolds ◽  
Thomas J. Whitaker ◽  
Ian F. Parney ◽  
Timothy F. Kozelsky ◽  
Yolanda I. Garces ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Choroidal Melanoma

scholarly journals MLTI-15. A CASE SERIES OF PRE-OPERATIVE GAMMA-KNIFE RADIOSURGERY FOR RESECTABLE BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i17-i17
Author(s):  
Tatsuya Takezaki ◽  
Haruaki Yamamoto ◽  
Naoki Shinojima ◽  
Jun-ichiro Kuroda ◽  
Shigeo Yamashiro ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Systemic Treatment ◽  
Radiation Necrosis ◽  
Gamma Knife Radiosurgery ◽  
Case Series ◽  
Phase 3 ◽  
Optimal Sequence ◽  
Median Margin

Abstract Recent advances in the systemic treatment of various cancers have resulted in longer survival and higher incidence of brain metastases. Phase 3 trials in north America and in Japan have demonstrated that stereotactic radiosurgery will be a standard adjuvant modality following surgery for resectable brain metastases. However, we don’t know the optimal sequence of this combination therapy. We hypothesized that pre-operative stereotactic radiosurgery for resectable brain metastases provides favorable rates of local control, overall survival, leptomeningeal dissemination and symptomatic radiation necrosis. We have experienced 4 cases of resected brain metastases within 1–7 days after Gamma-knife surgery (median margin dose:22Gy) and have been following their clinical course. We will show the repressive cases.

scholarly journals Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium

2020 ◽  
Vol 132 (1) ◽  
pp. 114-121 ◽  
Author(s):  
Robert M. Starke ◽  
David J. McCarthy ◽  
Ching-Jen Chen ◽  
Hideyuki Kano ◽  
Brendan McShane ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Predictors Of Outcome ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Radiation Induced ◽  
Venous Ectasia ◽  
Grading Scales

OBJECTIVEIn this multicenter study, the authors reviewed the results obtained in patients who underwent Gamma Knife radiosurgery (GKRS) for dural arteriovenous fistulas (dAVFs) and determined predictors of outcome.METHODSData from a cohort of 114 patients who underwent GKRS for cerebral dAVFs were compiled from the International Gamma Knife Research Foundation. Favorable outcome was defined as dAVF obliteration and no posttreatment hemorrhage or permanent symptomatic radiation-induced complications. Patient and dAVF characteristics were assessed to determine predictors of outcome in a multivariate logistic regression analysis; dAVF-free obliteration was calculated in a competing-risk survival analysis; and Youden indices were used to determine optimal radiosurgical dose.RESULTSA mean margin dose of 21.8 Gy was delivered. The mean follow-up duration was 4 years (range 0.5–18 years). The overall obliteration rate was 68.4%. The postradiosurgery actuarial rates of obliteration at 3, 5, 7, and 10 years were 41.3%, 61.1%, 70.1%, and 82.0%, respectively. Post-GRKS hemorrhage occurred in 4 patients (annual risk of 0.9%). Radiation-induced imaging changes occurred in 10.4% of patients; 5.2% were symptomatic, and 3.5% had permanent deficits. Favorable outcome was achieved in 63.2% of patients. Patients with middle fossa and tentorial dAVFs (OR 2.4, p = 0.048) and those receiving a margin dose greater than 23 Gy (OR 2.6, p = 0.030) were less likely to achieve a favorable outcome. Commonly used grading scales (e.g., Borden and Cognard) were not predictive of outcome. Female sex (OR 1.7, p = 0.03), absent venous ectasia (OR 3.4, p < 0.001), and cavernous carotid location (OR 2.1, p = 0.019) were predictors of GKRS-induced dAVF obliteration.CONCLUSIONSGKRS for cerebral dAVFs achieved obliteration and avoided permanent complications in the majority of patients. Those with cavernous carotid location and no venous ectasia were more likely to have fistula obliteration following radiosurgery. Commonly used grading scales were not reliable predictors of outcome following radiosurgery.

Multivoxel proton MRS for differentiation of radiation-induced necrosis and tumor recurrence after gamma knife radiosurgery for brain metastases

2006 ◽  
Vol 23 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Mikhail F. Chernov ◽  
Motohiro Hayashi ◽  
Masahiro Izawa ◽  
Masao Usukura ◽  
Shimetoshi Yoshida ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Tumor Recurrence ◽  
Gamma Knife Radiosurgery ◽  
Proton Mrs ◽  
Radiation Induced

scholarly journals Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients

2019 ◽  
Vol 130 (6) ◽  
pp. 1799-1808 ◽  
Author(s):  
Kyung-Jae Park ◽  
Hideyuki Kano ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
Daniel A. Tonetti ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Cavernous Sinus Meningioma ◽  
Long Term Study

OBJECTIVEThe authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM).METHODSThe authors retrospectively assessed treatment outcomes 5–18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22–83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm3 (range 0.1–37.3 cm3), and the median margin dose was 13.0 Gy (range 10–20 Gy).RESULTSTumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8–120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438–12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041–0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3–85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm3) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026–12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS.CONCLUSIONSThis long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.

scholarly journals The Role and Limitations of Gamma Knife Radiosurgery(Stereotactic Radiosurgery Past, Present and Future)

2008 ◽  
Vol 17 (6) ◽  
pp. 455-460
Author(s):  
Keisuke Maruyama ◽  
Tomoyuki Koga ◽  
Masahiro Shin ◽  
Nobuhito Saito
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery
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