Radiosurgery for Intracranial Disorders

Seung-Yeob Yang; Dong Gyu Kim; Hyun-Tai Chung

doi:10.5124/jkma.2008.51.1.27

J Korean Med Assoc > Volume 51(1); 2008 > Article

Yang, Kim, and Chung: Radiosurgery for Intracranial Disorders

Focused Issue of This Month

Current Concepts and Clinical Application of Radiosurgery

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2008; 51(1): 27-37.

Published online: January 31, 2008

DOI: http://dx.doi.org/10.5124/jkma.2008.51.1.27

Radiosurgery for Intracranial Disorders

Seung-Yeob Yang, MD¹, Dong Gyu Kim, MD², Hyun-Tai Chung, PhD²

¹Department of Neurosurgery, Dongguk University International Hospital, Korea. soundofmusic@duih.org

²Department of Neurosurgery, Seoul National University College of Medicine, Korea. gknife@plaza.snu.ac.kr, htchung@korea.com

Abstract

Stereotactic radiosurgery offers a broad spectrum armamentarium for the safe treatment of various lesions within the central nervous system. Radiosurgery uses stereotactic targeting methods to precisely deliver highly focused, large doses of radiation to small intracranial tumors and arteriovenous malformations (AVMs). It is widely used for the treatment of metastatic brain tumors, non-resectable tumors, residual or recurrent benign and malignant tumors as well as for the treatment of AVMs, functional diseases, and pain disorders. Although radiosurgery has the potential to produce complications, the majority of patients experience clinical improvement with less morbidity and mortality than those occur in surgical resection.

Radiosurgery; Cerebral arteriovenous malformation; Meningioma; Vestibular schwannoma; Brain metastasis; Trigeminal neuralgia

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Figure 1

Cerebral arteriovenous malformation.

A) Initial and follow-up angiograms of a 30-year-old man who presented with headache and right hemiparesis as a result of an intracerebral haemorrhage. Angiogram at the time of initial gamma knife radiosurgery (GKS). The nidus volume was 29ml, and the marginal dose to the AVM was 12Gy.

B) Angiogram 37 months later at the second GKS (AVM volume, 9.8ml; marginal dose, 17Gy). Note partial obliteration in the AVM during the interval.

C) Angiogram obtained 35 months after the second GKS revealing complete obliteration of the AVM.

Figure 2

Brain metastasis.

Magnetic resonance images of brain metastasis of renal cell carcinoma before (A) and after gamma knife radiosurgery (GKS) (B~D).

A) The axial contrast-enhanced image depicts a renal cell carcinoma brain metastasis prior to GKS (tumor volume, 7.3ml; marginal dose, 15Gy).

B) Similar axial contrast-enhanced view of this region obtained 3 months following GKS is illustrated. A marked decrease in tumor size is observed (tumor volume, 2.6ml).

C) 18-month post-GKS MR image (tumor volume, 0.6ml).

D) 30-month post-GKS MR image (tumor volume, 0.5ml).

Figure 3

Vestibular schwannoma.

A) Axial T1-weighted contrast-enhanced MR-images of a 48-year-old-female with right-sided large cystic vestibular schwannoma (VS).

B) The residual tumor after subtotal removal via the retrosigmoid approach without any neurological deterioration.

C) Three months after operation, the tumor shape became suitable for GKS. Imaging revealed a VS with a 1.8-ml volume in right cerebellopontine angle. The tumor was treated with a marginal dose of 13Gy at 50% isodose level.

D) Five years after GKS, MR images showing decrease of tumor in size and the patient in good health with no new neurologic deficits.

Figure 4

Petroclival meningioma.

A) Serial contrast-enhanced T1-weighted MR images obtained in a 53-year-old woman with petroclival meningioma.The tumor has wide dural attachment at the clivus and compresses the ventral brainstem.

B) MR images after subtotal resection.

C, D) Five months after operation, the tumor shape became suitable for GKS. GKS was performed on the residual tumor (tumor volume, 4.8ml; marginal dose, 15Gy), resulting in a reduction in size 40 months post-GKS (tumor volume, 3.6ml) and the patient in good health with no new neurologic deficits.

Table 1

Summary of radiosurgery results for trigeminal neuralgia