Gamma knife neurosurgery in the management of intracranial disorders. II

The articles in this volume cover the various radiosurgical techniques used to treat benign and malignant intracranial tumors, cavernous malformations, and functional disorders, as well as a wide array of specific details on medical physics, neuroimaging, and anesthetic support. Particular emphasis is put on the optimal combination of microneurosurgery and radiosurgery for attaining the best functional results in patients with vestibular schwannomas, craniopharyngiomas, and pituitary adenomas, and on the most effective methods of treatment planning and radiation dosimetry in cases of metastatic brain tumors. The highlighted clinical aspects include indications for radiosurgery and the prediction of patients’ prognosis, along with analysis of outcomes in comparison with results achieved by other modalities in the context of multifaceted therapeutic strategies. In addition, possible options for applying advanced treatment using such modern devices as Leksell Gamma Knife Perfexion TM and Icon TM are presented in depth. This information will interest both radiosurgical practitioners and neurosurgeons, and help them to provide optimal care and to achieve the greatest benefit of their patients. This book will serve as an excellent companion for the previous publication “Gamma Knife Neurosurgery in the Management of Intracranial Disorders” (Acta Neurochirurgica Supplement, Volume 116, Springer, 2013). Preface Contents Subtotal Resection Followed by Adjuvant Radiosurgery for Large Vestibular Schwannomas: Outcomes with Regard to the Timing and Regimen of Irradiation Introduction Patients and Methods Stereotactic Radiosurgery Follow-Up, Tumor Volumetry, and Outcome Measures Statistics Results Tumor Control and Volumetric Response to Radiosurgery Preservation of Facial Nerve Function Other Outcome Measures Discussion Conclusion References Preplanned Partial Surgical Removal Followed by Low-Dose Gamma Knife Radiosurgery for Large Vestibular Schwannomas Introduction Patients and Methods Surgical Technique Radiosurgical Technique Follow-Up Results Preservation of Facial Nerve Function Preservation of Hearing Salvage Surgery Complications Discussion Partial Surgical Removal of a Vestibular Schwannoma Before Radiosurgery Timing of Radiosurgery After Partial Surgical Removal of a Vestibular Schwannoma Outcome After Combined Treatment Salvage Surgery After Radiosurgery for Vestibular Schwannomas Conclusion References Outcome After Resection of Craniopharyngiomas and the Important Role of Stereotactic Radiosurgery in Their Management Introduction Patients and Methods Main Surgical Group Surgical Grading System for Craniopharyngiomas Surgical Approach Follow-Up Supplementary Surgical Group and CyberKnife Radiosurgery Statistics Results Clinical and Surgical Correlates of Craniopharyngioma Surgical Grades Gamma Knife Radiosurgery CyberKnife Radiosurgery Discussion Surgical Classifications and Grading Systems for Craniopharyngiomas Gamma Knife Radiosurgery CyberKnife Radiosurgery Comparison of Gamma Knife and CyberKnife Radiosurgery Conclusion References Gamma Knife Radiosurgery for Pituitary Adenomas Invading the Cavernous Sinus: Tokyo Women’s Medical University Experience Introduction Imaging for Evaluation of Cavernous Sinus Microanatomy Advantages of CISS Images Radiosurgery Treatment Planning Clinical Results Illustrative Case 1 Illustrative Case 2 Illustrative Case 3 Alternative Treatment Options Remaining Questions and Future Perspectives Is Selective Treatment Reasonable? Conclusion References Stereotactic Radiosurgery for Pituitary Carcinoma Introduction General Characteristics of Pituitary Carcinomas Radiotherapy and Stereotactic Radiosurgery for Pituitary Adenomas Impact of Radiotherapy on Tumorigenesis of Pituitary Carcinomas Radiotherapy for Pituitary Carcinomas Efficacy of Combined Treatment Stereotactic Radiosurgery for Pituitary Carcinomas Conclusion References Evidence-Based Recommendations for Seizure Prophylaxis in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery Introduction Materials and Methods Results Risk of Seizures in Patients with Brain Metastases After Radiosurgery Efficacy of Prophylactic Antiepileptic Therapy in Patients with Brain Metastases After Radiosurgery Patterns of Clinical Practice for Prophylactic Antiepileptic Therapy in Patients with Brain Metastases After Radiosurgery Discussion Conclusion References Cumulative Intracranial Tumor Volume as a Prognostic Factor in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery Introduction Prognostic Scales for Radiosurgery-Treated Patients with Brain Metastases Caveats About Terminology The Recursive Partitioning Analysis Classification Modified Recursive Partitioning Analysis Subclassifications The Basic Score for Brain Metastases The Score Index for Radiosurgery The Graded Prognostic Assessment The Diagnosis-Specific Graded Prognostic Assessment Prognostic Value of the Cumulative Intracranial Tumor Volume The Cumulative Intracranial Tumor Volume Versus the Largest Intracranial Tumor Volume Supportive Clinical Data Incorporating the Cumulative Intracranial Tumor Volume into the Diagnosis-Specific Graded Prognostic Assessment Future Directions Conclusion References Treatment Options for Leptomeningeal Metastases of Solid Cancers: Literature Review and Personal Experience Introduction Diagnosis of Leptomeningeal Metastases Magnetic Resonance Imaging Cerebrospinal Fluid Examination Therapeutic Options for Leptomeningeal Metastases Systemic Chemotherapy Intrathecal Chemotherapy Radiation Therapy Stereotactic Radiosurgery Immunotherapy Molecular Targeted Therapy Treatment Response Assessment Personal Experience Case 1 Case 2 Case 3 Case 4 Conclusion References Stereotactic Radiosurgery to Prevent Local Recurrence of Brain Metastasis After Surgery: Neoadjuvant Versus Adjuvant Introduction Controlling Brain Metastases with Surgery and Whole-Brain Radiation Therapy Stereotactic Radiosurgery Adjuvant Radiosurgery Prospective, Randomized Trials Technical Nuances of Target Contouring Timing Neoadjuvant Radiosurgery Advantages and Disadvantages Alternatives to Single-Session Radiosurgery Which Treatment Strategy Is Better? Interplay of Immunomodulation and Radiosurgery Conclusion References Redistributing Central Target Dose Hot Spots for Hypofractionated Radiosurgery of Large Brain Tumors: A Proof-of-Principle Study Introduction Materials and Methods Generalized Biologically Effective Dose Formula Comparative Analysis Results Discussion Conclusion References Possible Overcoming of Tumor Hypoxia with Adaptive Hypofractionated Radiosurgery of Large Brain Metastases: A Biological Modeling Study Introduction Materials and Methods Dose Escalation in the Target and Control for Irradiation of Normal Brain Tissue Accounting for Tumor Hypoxia Comparative Analysis Results Discussion Conclusion References Differentiating Radiation-Induced Necrosis from Tumor Progression After Stereotactic Radiosurgery for Brain Metastases, Using Evaluation of Blood Flow with Arterial Spin Labeling (ASL): The Importance of Setting a Baseline Introduction Materials and Methods Results Discussion Differentiating Radiation-Induced Effects from Tumor Progression Advantages of Perfusion Imaging with Arterial Spin Labeling Importance of Perfusion Measurements at Baseline Conclusion References Gamma Knife Radiosurgery for Symptomatic Cavernous Malformations: Tokyo Women’s Medical University Experience Introduction Materials and Methods Results Annual Hemorrhage Rates Seizure Control Illustrative Cases Case 1 Case 2 Discussion Conclusion References Gamma Knife Thalamotomy for a Medically Refractory Tremors: Longitudinal Evaluation of Clinical Effects and MRI Response Patterns Introduction Patients and Methods Radiosurgical Technique Clinical and Radiological Evaluations Results MRI Response Patterns Associations Between MRI Response Patterns and Clinical Effects Complications Discussion Conclusion References Pituitary Radiosurgery for Management of Intractable Pain: Tokyo Women’s Medical University Experience and Literature Review Introduction Physiological Mechanisms of Hypophysectomy for Management of Pain Current Indications for Pituitary Radiosurgery Metastatic Bone Disease Disseminated Cancer Without Bone Involvement Poststroke Thalamic Pain Pituitary Radiosurgery Treatment Planning Radiosurgical Target Treatment Dose Protection of the Anterior Visual Pathways and Other Critical Structures Clinical Results Side Effects and Complications Histopathological Changes After Pituitary Radiosurgery Remaining Questions and Future Research Perspectives Effects of High-Dose Irradiation on the Hypothalamic–Pituitary Axis Conclusion References Feasibility and Significance of Dose Adaptation via Linear Couch Translations to Correct for Rotational Shifts During Frameless Brain Radiosurgery with the Gamma Knife IconTM Introduction Materials and Methods Image Processing Corrected Translation of Isocenters Data Analysis Results Illustrative Case Discussion Conclusion References Impact of the Skull Size on the Normal Brain Radiation Dose During Gamma Knife Radiosurgery: Results of a Pilot Study Introduction Materials and Methods Results Discussion Conclusion References Respiratory Monitoring During Gamma Knife Radiosurgery: Anesthesiological Aspects Introduction Potential Risks of Gamma Knife Radiosurgery Patient Monitoring During Sedation Assessment of Respiratory Status Pulse Oximetry Capnography Conclusion References The Proud History of Psychosurgery in the USA Introduction Public Psychiatric Care at the Time Development of Prefrontal Lobotomy Results of Prefrontal Lobotomy Patient Selection for Psychosurgery Further Technical Developments: From Transorbital Lobotomy to Stereotaxis The Dark Side of the Story The Decline of Psychosurgery Conclusion References Author Index Subject Index