Portal de Periódicos da CAPES

CYBERKNIFE IMAGE-GUIDED RADIOSURGERY

2009; Lippincott Williams & Wilkins; Volume: 64; Issue: 2 Linguagem: Inglês

10.1227/01.neu.0000312703.46158.54

1524-4040

John R. Adler, Steven D. Chang,

Vascular Malformations Diagnosis and Treatment

Stereotactic radiosurgery was conceived by the Swedish neurosurgeon Lars Leksell in 1951 as stereotactic delivery of high-dose ionizing radiation for the purpose of noninvasively extirpating lesions deep within the brain. Since its introduction, radiosurgery has evolved from an investigational concept into a mainstream neurosurgical procedure for the management of a wide variety of neurological disorders of the brain and spine. Today's neurosurgeons routinely use radiosurgery either as a definitive or adjuvant modality in the fields of neuro-oncology, cerebrovascular disorders, and functional neurosurgery. One of the more recent advancements in the field of stereotactic radiosurgery was the development of image-guided radiosurgery. This allowed the neurosurgeon to do away with the stereotactic frame and made feasible both multisession and extracranial radiosurgery. Increasing from a few centers in the 1990s, image-guided radiosurgery centers today have proliferated to hundreds of centers worldwide. A rapid growth in the number of neurosurgical articles focusing on image-guided radiosurgery has paralleled this expansion. The 7th annual CyberKnife Users' Meeting showcased many of the recent studies on CyberKnife image-guided radiosurgery. This annual meeting has seen rapid growth from 40 members at the first meeting, held in 2000, to more than 500 members attending the latest meeting, held in January 2008. This supplement to NEUROSURGERY highlights several of the key papers presented at this meeting. The first 4 articles provide current results of treatment of common intracranial disorders. The article by Colombo et al. includes one of the largest experiences of CyberKnife treatment of intracranial meningiomas. The next 2 articles (Sakamoto et al. and Killory et al.) provide perspective on the treatment of trigeminal schwannomas and perichiasmatic pituitary adenomas. In both series, multisession radiosurgery was used to minimize risk to the anterior optic pathways. In the fourth paper, Hara et al. review their experience in using CyberKnife radiosurgery to treat renal cell carcinoma and melanoma metastases, which are typically considered to be radioresistant tumors. Spinal radiosurgery has emerged as one of the most rapidly growing fields of radiosurgery, and 6 articles provide the state of the current experience in the role of radiosurgery for spinal disorders. Intermediate-term results for the treatment of foraminal spinal schwannomas is provided by Murovic et al. The next 2 clinical reviews (Henderson et al. and Levine et al.) provide the results of CyberKnife treatment for spinal chordomas and sarcomas. The results of these 2 series show control rates similar to those achieved by other forms of radiosurgery, including proton beam therapy. Thariat et al. provide their rationale for the use of computed tomographic myelography in improving the delineation of the spinal cord during radiosurgical treatment. As with intracranial radiosurgery, complications can occur during spinal radiosurgery, as Gibbs et al. discuss in their article on radiation myelopathy after spinal cord radiosurgery. The final article in this section (Papatheofanis et al.) discusses the economics of spinal radiosurgery by providing a cost-utility analysis of the use of radiosurgery to treat spinal metastases. Functional radiosurgery is dominated by the treatment of trigeminal neuralgia. Three articles (Adler et al., Borchers et al., and Fariselli et al.) cover this treatment in detail, including the anatomic and morphological variables that affect treatment outcome. Two technical studies complete this supplement, including an article by Wowra et al. on 3-dimensional time-of-flight 3-Tesla magnetic resonance angiography targeting for intracranial arteriovenous malformations, and an article by Saito et al. on the efficacy of continuous patient motion monitoring during CyberKnife treatment. These articles provide a glimpse of the myriad studies occurring within the field of image-guided radiosurgery. Image-guided radiosurgery is still in its infancy. We expect this field to continue to grow exponentially in the coming decade. While finalizing this supplement, we suffered the loss of Doyle John Borchers, M.D., one of our neurosurgical colleagues. Dr. Borchers, who contributed to several manuscripts in this supplement, was dedicated to the development of new applications in the field of image-guided radiosurgery. He was particularly interested in new applications of radiosurgery for the treatment of pain and psychiatric disorders, applications he called “radiomodulation.” This supplement is dedicated to Dr. Borchers. His intellectual curiosity and friendship are deeply missed. John R. Adler, Jr. Steven D. Chang Stanford, California