• Neurosurgery · Feb 2017

    Emerging Indications for Fractionated Gamma Knife Radiosurgery.

    • Emory McTyre, Corbin A Helis, Michael Farris, Lisa Wilkins, Darrell Sloan, William H Hinson, J Daniel Bourland, William A Dezarn, Michael T Munley, Kounosuke Watabe, Fei Xing, Adrian W Laxton, Stephen B Tatter, and Michael D Chan.
    • Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
    • Neurosurgery. 2017 Feb 1; 80 (2): 210-216.

    BackgroundGamma Knife radiosurgery (GKRS) allows for the treatment of intracranial tumors with a high degree of dose conformality and precision. There are, however, certain situations wherein the dose conformality of GKRS is desired, but single session treatment is contraindicated. In these situations, a traditional pin-based GKRS head frame cannot be used, as it precludes fractionated treatment.ObjectiveTo report our experience in treating patients with fractionated GKRS using a relocatable, noninvasive immobilization system.MethodsPatients were considered candidates for fractionated GKRS if they had one or more of the following indications: a benign tumor >10 cc in volume or abutting the optic pathway, a vestibular schwannoma with the intent of hearing preservation, or a tumor previously irradiated with single fraction GKRS. The immobilization device used for all patients was the Extend system (Leksell Gamma Knife Perfexion, Elekta, Kungstensgatan, Stockholm).ResultsWe identified 34 patients treated with fractionated GKRS between August 2013 and February 2015. There were a total of 37 tumors treated including 15 meningiomas, 11 pituitary adenomas, 6 brain metastases, 4 vestibular schwannomas, and 1 hemangioma. At last follow-up, all 21 patients treated for perioptic tumors had stable or improved vision and all 4 patients treated for vestibular schwannoma maintained serviceable hearing. No severe adverse events were reported.ConclusionFractionated GKRS was well-tolerated in the treatment of large meningiomas, perioptic tumors, vestibular schwannomas with intent of hearing preservation, and in reirradiation of previously treated tumors.

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