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Jason Sheehan

brain using radiation with great precision. Although the Gamma Knife (GK) has always been a dedicated neurosurgical tool, most centers have long adopted a team approach to GK surgery. Conference attendance and participation by neurosurgeons, radiation oncologists, medical physicists, and other medical specialists such as neuroendocrinologists and neuropsychologists are a testament to this type of approach. Radiosurgery has consistently taken advantage of expertise from diverse areas of medicine including neurosurgery, radiology, physics, and radiation oncology. The

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Jason Sheehan

Leksell Gamma Knife Society. The theme for the meeting was “At Least Do No Harm” from the Hippocratic oath many physicians take. In keeping with this concept, there was a focus on preservation of neurological function in patients undergoing Gamma Knife surgery (GKS). Preservation of cranial nerve and pituitary function was among these topics. With improvements in neuroimaging, a more comprehensive understanding of radiobiology (for example, the effect of dose rate), and refinements in Gamma Knife technology, the benefit-to-risk profile of radiosurgery has never been

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Jason Sheehan

other pain syndromes, functional disorders, ocular diseases, and psychological disorders. Indications for Gamma Knife surgery (GKS) have never been so broad. Nevertheless, the recognition not only of its indications for use but also of its limitations voiced at some of the Society's panel discussions illustrates the maturity of the field of GKS. Certainly, more than 40 years of experience with GKS has enabled physicians to better define indications, refine the process, and treat patients. Gamma Knife surgery has expanded the neurosurgeon's treatment armamentarium and

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Introduction

Leksell Gamma Knife Conference in the land down under

Jason Sheehan

.” F ig . 1. Photograph of the Sydney Opera House. Patrick White, an Australian author and recipient of the Nobel Prize for literature in 1973, was known for his varied narrative approaches and stream-of-consciousness technique. At times, the scientific sessions shifted focus as seamlessly as White changed narrative mode. The focus of the meeting shifted through topics such as basic science, clinical outcomes, trial design, and preparation and writing of scientific papers. The field of Gamma Knife surgery (GKS) continues to evolve. This evolution was

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Editorial

Radiation oncology partnership and its impact on neurosurgery

Jason Sheehan

, education, and research funding. Appropriate radiosurgical reimbursement for neurosurgeons must be ensured, but such reimbursement commensurate with our efforts in performing radiosurgery should not come at the expense of suitable reimbursement for our radiation oncology colleagues. Similar to other fields such as endovascular surgery or complex spinal surgery, which have competing external forces, radiosurgery must remain under the watchful eye of neurosurgeons. Neurosurgeons should be proud of the profession's accomplishments in SRS and the more than 5 decades of

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Editorial

Radiosurgery

Jason Sheehan

possibly of cure.” Later publications by Ray, 13 Olivecrona and Riives, 11 Paterson and McKissock, 12 Svien and Peserico, 15 and Bouchard 2 provided further evidence of the potentially beneficial results when radiotherapy was delivered to AVMs. Berdjis 1 had reported that large to medium arteries could tolerate 50–60 Gy when delivered over a 5- to 6-week period. On March 17, 1970, Ladislau Steiner used Gamma Knife surgery to treat an AVM in a patient for the first time. Serendipitously, he chose to use a dose of 50 Gy based on a work published by Berdjis in 1960

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Chun Po Yen, Jason Sheehan, Greg Patterson and Ladislau Steiner

, 9 , 12 , 22 , 26 , 34 have also been reported recently with satisfactory results. The aim of this study was to present our experience using GKS for the management of neurocytoma. Clinical Material and Methods Patient Demographics and Tumor Parameters Between November 1989 and October 2004, seven patients with a total of nine neurocytomas were treated with GKS at Lars Leksell Center for Gamma Surgery, University of Virginia Health System ( Table 1 ). There were one male and six female patients who ranged in age from 17 to 37 years (mean 26.7 years) at

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Gamma Knife surgery–induced meningioma

Report of two cases and review of the literature

Jason Sheehan, Chun PO Yen and Ladislau Steiner

DE , Beckett MA , Yandell DW , Weichselbaum RR : p53 gene mutations and abnormal retinoblastoma protein in radiation-induced human sarcomas . Cancer Res 51 : 6393 – 6396 , 1991 2 Brada M , Rajan B , Traish D , Ashley S , Holmes-Sellors PJ , Nussey S , : The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas . Clin Endocrinol (Oxf) 38 : 571 – 578 , 1993 3 Cahan WG , Woodard HQ , Higinbotham NL , Stewart FW , Coley BL : Sarcoma arising in irradiated bone: report of

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Chun Po Yen, Jason Sheehan, Greg Patterson and Ladislau Steiner

. Gamma Knife surgery, which was originally designed for deep-seated, well-defined, benign intracranial targets, has emerged as an alternative treatment. Clinical Material and Methods Patient and Tumor Characteristics Between March 1989 and March 2005, 53 patients with metastatic brainstem tumors were treated with GKS at the University of Virginia Health System’s Lars Leksell Center for Gamma Surgery ( Table 1 ). The study population consisted of 24 men and 29 women, with a mean age of 57.3 years (range 33–79 years). The primary malignancy was lung cancer in

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Jason Sheehan, Hung-Chuan Pan, Matei Stroila and Ladislau Steiner

T rigeminal neuralgia is a paroxysmal lancinating pain confined to a distribution encompassing one or more of the branches of the trigeminal nerve on one side of the face. It frequently arises in conjunction with a vascular contact between an artery or a vein and the trigeminal nerve at the REZ. This fact led to the hypothesis of a causal relationship between vessel compression and TN and the devising of MVD surgery. 2, 9, 10, 16 First-line treatment in patients with TN is medical therapy. Nonetheless, many patients with this condition eventually do not