ABSTRACT
Sixty-three patients with metastatic brain tumors have had stereotactic radiosurgery 90 times with the Leksell Gamma Knife over a 29-month period. Initially, a single treatment of 35 to 45 Gy was delivered to the enhanced CT margin. This dose was found to be inadequate for tumor control. We then raised the marginal dose to 50 to 55 Gy, but even this radiosurgical dose did not appear to control tumor growth. However, we have found that metastatic brain tumors can be controlled successfully using enhanced MR scans and a peripheral dose of 60 Gy or even 65 Gy adjacent to the enhanced margins of the metastatic brain tumors, especially melanomas.
Subject(s)
Brain Neoplasms/secondary , Radiosurgery , Adult , Aged , Brain/pathology , Brain/surgery , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging , Male , Melanoma/pathology , Melanoma/secondary , Melanoma/surgery , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm, Residual/pathology , Neoplasm, Residual/surgery , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Twenty patients who suffered persistent intractable pain from a variety of disorders underwent medial thalamotomy with the Leksell Gamma Knife. The lesions were directed at the intralaminar nuclei, the lateral portion of the medial dorsal nucleus, the centromedian and the parafascicular nuclei. Lesions were made with radiation doses from 140 to 180 Gy using a 4-mm beam collimator helmet and either a single isocenter (1 patient), two isocenters (17 patients) or three isocenters (2 patients). Two thirds of the patients experienced either excellent or good pain relief in a follow-up period between 1 and 22 months. One patient showed temporary complications which resolved, and 2 other patients also suffered complications which currently are improving. One patient died due to radiation necrosis following a bilateral thalamotomy. Gamma Knife thalamotomy may offer a potentially safe and effective alternative for the treatment of certain difficult persistent pain problems.
Subject(s)
Pain, Intractable/surgery , Radiosurgery , Thalamus/surgery , Chronic Disease , Follow-Up Studies , Humans , Treatment OutcomeABSTRACT
The Leksell Gamma Knife is a useful and safe method to perform thalamotomy and pallidotomy in selected older patients with Parkinson's disease and related movement disorders. In this preliminary report, 2 of 3 patients with severe intention tremor were relieved of their symptoms by thalamotomy, as were 4 of 7 patients with Parkinson's tremor. Four of 8 patients had significant improvement of contralateral rigidity following pallidotomy.
Subject(s)
Globus Pallidus/surgery , Parkinson Disease, Secondary/surgery , Parkinson Disease/surgery , Radiosurgery/methods , Thalamus/surgery , Aged , Aged, 80 and over , Female , Globus Pallidus/pathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Muscle Rigidity/pathology , Muscle Rigidity/surgery , Neurologic Examination , Parkinson Disease/pathology , Parkinson Disease, Secondary/pathology , Postoperative Complications/diagnosis , Postoperative Complications/pathology , Thalamus/pathology , Treatment Outcome , Tremor/pathology , Tremor/surgeryABSTRACT
Stereotactic radiosurgery under local anesthesia with the Leksell Gamma Knife can effectively treat some patients with recurrent tic douloureux after unsuccessful medical/surgical procedures. Seven of 12 patients have shown complete relief or improvement of their trigeminal neuralgia. No complications have been observed.
