Stereotactic Radiosurgery Alin Teodosiu – „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Definitions Radiosurgery „surgery using radiation, that is, the destruction of precisely selected areas of tissue using ionizing radiation rather than excision with a blade” Or „the delivery of a single or very limited number of relatively large doses of radiation administered to a small, precisely-defined target”

Definitions Stereotaxy στερεός (stereos, "solid") + taxis ("arrangement", "order„) „refers to any technique that involves creating an illusion of depth to the senses within an otherwise-flat surface”

Some Facts The pioneers: 1967 at the Karolinska Institute in Stockholm, Sweden, by Lars Leksell, Ladislau Steiner, a Romanian-born neurosurgeon, and Börje Larsson, a radiobiologist from Sweden's Uppsala University. stereotactic radiosurgery VS fractionated radiotherapy A target accuracy between 1 and 5 mm, most tumors have a maximum indication of 4 cm. The part of the body subjected to this procedure MUST be immobile at all times.

Pathologies Pituitary adenoma (non-secreting) Meningioma Craniopharyngioma Arterio-venous malformation

Operating Steps Precisely locating our pathology. An atlas is a series of cross sections of anatomical structure.

Operating Steps Precisely locating our pathology. „N” localizer Coordinate System Target „N” localizer

Result

Operating Steps 2. Treatment of our pathology. externally generated ionizing radiation to inactivate or eradicate defined targets in the head or spine

To take home Location, location, location. Maximum precision, minimum invasivness The future potential: Parkinson’s or other neurological disorders via Pallidotomy or Thalamotomy, etc (lesioning procedures), or Deep Brain Stimulation (DBS) "practice and check" the surgery, try alternative approaches, assess possible difficulties

References http://neurosurgery.ucla.edu/default.cfm http://www.rwjuh.edu/gamma-knife/gamma-knife-center.aspx Stereotactic cranial radiosurgery - Clark C Chen, MD, PhD Paul H Chapman, MD Jay S Loeffler, MD; http://www.uptodate.com/contents/stereotactic-cranial-radiosurgery/contributors Stereotactic Radiosurgery – Lars Leksell - Journal of Neurology, Neurosurgery, and Psychiatry 1983 ;46:797-803 The N-Localizer and Volume Imaging – Russel A. Brown Brown R A (2014-12-03 14:24:50 UTC) The N-Localizer and Volume Imaging. Cureus 6(12): e232. doi:10.7759/cureus.232 Images: http://en.wikipedia.org/wiki/Stereotactic_surgery http://en.wikipedia.org/wiki/N-localizer