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Multisession stereotactic radiosurgery for large vestibular schwannomas

Leopoldo Casentini, Umberto Fornezza, Zeno Perini, Egle Perissinotto, and Federico Colombo

. Standard therapeutic strategies for VSs are surgical removal, stereotactic radiosurgery (SRS), and, with small tumors, a wait-and-scan policy. 2 , 12 Microsurgery is the first option if the tumor is large or symptoms of mass effect and hydrocephalus are present. 4 , 21 , 35 , 36 SRS is generally used to treat small- to medium-sized VSs but has also demonstrated satisfactory results with larger lesions as well. 20 , 30 , 31 , 39–41 , 45 Nevertheless, the latter represent a challenge for both surgeons and radiosurgeons, because a direct correlation between tumor size

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Stereotactic radiosurgery of meningiomas

Douglas Kondziolka, L. Dade Lunsford, Robert J. Coffey, and John C. Flickinger

perform incomplete resections. Some patients with meningiomas are considered unsuitable for surgery if they are elderly or are “medically unfit.” 2, 13 Single-fraction precisely guided multiple photon-beam irradiation (stereotactic radiosurgery) offers treatment to such patients: those with tumors in high-risk locations; those with residual meningiomas after surgical resection; and those whose advanced age or associated medical illness pose unacceptable risks for surgical removal. This report is the first comprehensive clinical analysis of stereotactic radiosurgery

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Stereotactic radiosurgery for brainstem metastases

Chuan-Fu Huang, Douglas Kondziolka, John C. Flickinger, and L. Dade Lunsford

neurological defects and the poor overall expected survival rates. Stereotactic radiosurgery is a potentially useful therapeutic strategy that provides high-dose irradiation to a localized tumor volume in a single session. It is not limited by tumor location or depth but rather the ability to image a well-defined target within stereotactic space. Although brainstem metastases may be unsuitable for microsurgical resection because of their location, this limitation does not preclude radiosurgery. Because radiosurgery is an alternative to surgical resection for many brain

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Stereotactic radiosurgery for convexity meningiomas

Clinical article

Douglas Kondziolka, Ricky Madhok, L. Dade Lunsford, David Mathieu, Juan J. Martin, Ajay Niranjan, and John C. Flickinger

treatment for symptomatic patients with these tumor types. 20 Image guidance techniques have allowed the optimal creation of craniotomies that extend beyond the tumor margin to facilitate removal of any involved dura mater or bone. Nevertheless, resection is not always feasible if the tumor presents in an elderly or frail patient, or when it is located adjacent to critical brain regions or important cortical veins. Stereotactic radiosurgery is an effective strategy for basal meningiomas. 9 , 13 , 15 , 16 The role of radiosurgery for convexity meningiomas has been

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Stereotactic radiosurgery for Cushing disease: a review

Nelson M. Oyesiku

–80%. 4 , 8 , 22 , 31 , 37 , 38 , 41 Currently, SRS or fractionated stereotactic radiotherapy is the main of adjuvant treatment for CD after failed surgery. 20 , 33 , 39 Conventional radiotherapy, although successful, is now used less often because of the availability and efficacy of the stereotactic therapies. 13 , 21 Stereotactic radiosurgery was introduced in Sweden in 1969 by Lars Leksell and has since been used successfully in the treatment of ACTH-producing adenomas. The current indications for SRS include the following: 1) a previously failed resection; 2) a

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Standardization of terminology in stereotactic radiosurgery: Report from the Standardization Committee of the International Leksell Gamma Knife Society

Special topic

Michael Torrens, Caroline Chung, Hyun-Tai Chung, Patrick Hanssens, David Jaffray, Andras Kemeny, David Larson, Marc Levivier, Christer Lindquist, Bodo Lippitz, Josef Novotny Jr., Ian Paddick, Dheerendra Prasad, and Chung Ping Yu

T he original concept of stereotactic radiosurgery arose within the specialty of neurosurgery, 32 and the majority of intracranial radiosurgical procedures have been performed using the Leksell Gamma Knife system (Elekta AB, Stockholm, Sweden)—probably more than 800,000 cases as of 2013. 31 This has involved the empirical elaboration of neurosurgery-based terms and procedures in parallel with radiotherapy. To improve coordination and communication, both across disciplines and between practitioners, there is a need for standardization. The present report

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Stereotactic radiosurgery for cerebral metastatic melanoma

Salvador Somaza, Douglas Kondziolka, L. Dade Lunsford, John M. Kirkwood, and John C. Flickinger

Chemotherapeutic agents, various protocols for fractionated radiation therapy, 19, 20, 33 and immunotherapy have been used alone or sometimes after surgical resection. Despite these efforts, the prognosis for a patient with single or multiple melanoma metastasis to the brain remains poor (median survival 2 to 3 months). 28 Stereotactic radiosurgery is an attractive therapeutic strategy less invasive than other modalities that provides high-dose, single-session irradiation to a localized tumor volume. Recent reports indicate that radiosurgery is being used in an increasing

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Stereotactic radiosurgery for tremor: systematic review

International Stereotactic Radiosurgery Society practice guidelines

Nuria E. Martínez-Moreno, Arjun Sahgal, Antonio De Salles, Motohiro Hayashi, Marc Levivier, Lijun Ma, Ian Paddick, Jean Régis, Sam Ryu, Ben J. Slotman, and Roberto Martínez-Álvarez

identified early as the most suitable anatomical target site for controlling tremor. 35 Localizing the VIM was done indirectly by pneumoencephalography at first, subsequently by CT, and then by MRI. 46 Radiofrequency ablation of the VIM was one of the first procedures, 51 followed by deep brain stimulation (DBS) in 1967. 2 , 3 , 7 , 30 , 31 , 32 , 37 Although stereotactic radiosurgery (SRS) was first developed for functional indications, 39 the application to movement disorders occurred only once advances in imaging technology allowed for precision targeting. At first

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Stereotactic radiosurgery for cerebral dural arteriovenous fistulas

Bradley A. Gross, Alexander E. Ropper, A. John Popp, and Rose Du

location and lack of CVD, small DAVF size likely improves obliteration rates after SRS. Conclusions Stereotatic radiosurgery with or without adjunctive embolization is an effective therapy for DAVFs that are not amenable to surgical or endovascular monotherapy. Including our own data, a review across 14 series revealed an overall obliteration rate of 71%. Transient worsening occurred in 9.1% of patients, permanent worsening in 2.4%, and post-SRS hemorrhage in 1.6% of cases (4.8% of those with CVD). Stereotactic radiosurgery is best suited for lesions without CVD

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Stereotactic radiosurgery for cerebellopontine angle meningiomas

Clinical article

Seong-Hyun Park, Hideyuki Kano, Ajay Niranjan, John C. Flickinger, and L. Dade Lunsford

C erebellopontine angle (CPA) meningiomas are a relatively rare anatomical subgroup of meningiomas and comprise 6%–15% of all tumors in the region of the CPA. 15 , 20 , 23 , 24 , 27 Complete resection has often proved difficult because of the relationship of the tumor to critical neurovascular structures in the posterior fossa. 1 , 16 , 20 , 22 Stereotactic radiosurgery (SRS) has become an alternative frequently used management option for such tumors and is reported to lead to high tumor control rates and low complication rates. 13 , 18 In the present