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Recent advances in steriotactic radiosurgery
 The term “radiosurgery” has been modified to; the
stereotactic application in one to five fractions of
high-dose radiation to a target with ablative intent,
where “high dose” means more than 2–3 Gy,
fractional doses commonly used in conventional
radiotherapy.
 Recent advances in robotics and technology resulted
in:
 Leksell Gamma Knife Perfexion
 Cyberknife and enhanced RT systems
 Spinal stereotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Dynamic shaping
Recent advances in steriotactic radiosurgery
Suboccipital targets
Extracranial targets
Multiple targets
Gamma knife with Extend program
The 2 major limitations of the gamma knifeThe 2 major limitations of the gamma knife
are:are:
(1) stereotactic frame
(2) inability to treat lesions far away from the cranium
HOWEVERHOWEVER,
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Recent advances in steriotactic radiosurgery
Limitations of standard radiation techniquesLimitations of standard radiation techniques
for treating spinal tumors:for treating spinal tumors:
1)treatment fields extending up to two vertebral segments above and
below the target to compensate for set-up errors and patient movement
during treatment
2)close proximity of the spinal cord typically makes it impossible to
exclude it from the highest dose region
3)relapse within the treatment field is not uncommon BUT unacceptable
to use larger and more therapeutically beneficial doses, given the risk of
spinal cord injuries such as radiation-induced myelopathy
Immobilisation
CT simulation & Treatment planning
Spinal arteriovenous
malformations
Recent advances in steriotactic radiosurgery
Benign Spinal tumors
Combined kyphoplasty and spinal
radiosurgery for spinal mets
Thank YouThank You

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Recent advances in steriotactic radiosurgery

  • 2.  The term “radiosurgery” has been modified to; the stereotactic application in one to five fractions of high-dose radiation to a target with ablative intent, where “high dose” means more than 2–3 Gy, fractional doses commonly used in conventional radiotherapy.  Recent advances in robotics and technology resulted in:  Leksell Gamma Knife Perfexion  Cyberknife and enhanced RT systems  Spinal stereotactic radiosurgery
  • 11. Gamma knife with Extend program
  • 12. The 2 major limitations of the gamma knifeThe 2 major limitations of the gamma knife are:are: (1) stereotactic frame (2) inability to treat lesions far away from the cranium HOWEVERHOWEVER,
  • 22. Limitations of standard radiation techniquesLimitations of standard radiation techniques for treating spinal tumors:for treating spinal tumors: 1)treatment fields extending up to two vertebral segments above and below the target to compensate for set-up errors and patient movement during treatment 2)close proximity of the spinal cord typically makes it impossible to exclude it from the highest dose region 3)relapse within the treatment field is not uncommon BUT unacceptable to use larger and more therapeutically beneficial doses, given the risk of spinal cord injuries such as radiation-induced myelopathy
  • 24. CT simulation & Treatment planning
  • 28. Combined kyphoplasty and spinal radiosurgery for spinal mets