asian gks meeting version
TRANSCRIPT
Neurosurgery Department Shuang Ho Hospital
New Taipei City, Taiwan
Wei-Lun Lo, M.D.
THE APPLICATION OF
PERFEXION GAMMA KNIFE
RADIOSURGERY
FOR INFRA-SKULL BASE LESIONS
TECHNICAL LIMIT OF GKS
Traditional lower limit of treatment related to lesion
locations: Foramen mangnum
Kondziolka et al: Radiosurgery of meningiomas. Neurosurg Clin N Am 3:219–230,
1992
However, the data from new Perfexion version was not
included.
J Craniovertebr Junction Spine. 2010 Jan-Jun; 1(1): 23-28
• Primary lesion at
neck
• Extracranial
↑↓
Intracranial
POSTING DIFFICULTY FOR GKS
COMPARISON OF GK SYSTEMS
CASE DISTRIBUTION (N = 14)
Meningioma
Paraganglioma
Low brain stem cavernoma
Trigeminal neuroma
Low cranial nerve
neuroma
Skull base metastasis
Dural arteriovenous
fistula
3
4
1
3
Paraganglioma
39 y/o female
horseness and dysphonia; paraganglioma from posterior fossa with extension to neck region s/p partial resection by ENT doctor
2013/10/15
TV: 18.32014/4/22
TV: 7
Volume: 18.3c.c.
RV: 23.5c.c.
PD: 12.5 Gy
MD: 22.3 Gy
ID: 56%
Mean dose: 16.7 Gy
Foramen Mangnum
Meningioma
37 year-old female
Meningiomatosis inpetroclival, foramen magnum , and ventral C5 regions
s/p surgical excision of C5 meningioma
2013/8/23
TV: 1.2
2014/2/24
TV: 1.2
Volume: 1.2 c.c.
RV: 3.3 c.c.
PD: 12 Gy
MD: 21.8 Gy
ID: 55%
Mean dose: 16.6 Gy
Skull Base
Metastasis
74 year-old female
Hx of breast cancer
s/p operation; facial
numbness, difficult
swallowing, tongue
atrophy
2013/7/11
TV: 27.2
2014/7/24
TV: 3.5
Marked regression
Improvement of tongue atrophy
& swallowing function
Volume: 27.2 c.c.
RV: 35.2 c.c.
PD: 12.8 Gy
MD: 24.6 Gy
ID: 52%
Mean dose: 17.5 Gy
PRELIMINARY RESULT
Tumor
• Tumor shrinkage, stationary, or loss of central
enhancement in all cases
Vascular lesion
• No interval hemorrhage in follow up period
MOTION ERROR
J Neurosurg (Suppl) 117: 211-216, 2012
Cervical
Immobilization !!
GKS FOR EXTRACRANIAL LESION:
CAROTID BODY TUMOR
C2
C3
PRE-TREATMENT MANAGEMENT
Cervical immobilizationFeasibility evaluation
TV: 3.2 c.c.
Radiation volume: 4.8 c.c.
Peripheral dose: 15.5 Gy
Maximum dose: 28.2 Gy
Isodose level at periphery: 55%
Mean dose: 22.4 Gy
THANKS FOR ATTENTION