Neurosurgery Department Shuang Ho Hospital New Taipei City, Taiwan Wei-Lun Lo, M.D. THE APPLICATION OF PERFEXION GAMMA KNIFE RADIOSURGERY FOR INFRA-SKULL.

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Presentation 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 Jan-Jun; 1(1): 23-28

Primary lesion at neck Extracranial ↑↓ Intracranial POSTING DIFFICULTY FOR GKS

COMPARISON OF GK SYSTEMS

CASE DISTRIBUTION (N = 14)

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: /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 in petroclival, foramen magnum, and ventral C5 regions s/p surgical excision of C5 meningioma 2013/8/23 TV: /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: /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: , 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