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Abstract Details

A Neurologists role in Gamma Knife: time for a paradigm shift?
Neuro-oncology
P4 - Poster Session 4 (5:30 PM-6:30 PM)
13-007

 The objective is to expand the role for neurologists in the field of Gamma Knife Stereotactic Radiosurgery.


Gamma Knife Radiosurgery typically involves a neurosurgeon, radiation oncologist and physicist. Neurologists performing Gamma Knife provides a potential paradigm shift.
The first 150 Gamma Knife procedures were completed on the Elekta Perfexion and ICON systems between October 14, 2015 and November 2018. Head frames were placed by the treating neurologist who also completed the contouring and targeting. The Radiation Oncologist defined the prescription dose and verified the plan, along with the physicist.
Of the first 150 cases completed by the treating neurologist, 86 were females and 64 males. The average age was 62 years. There were 84 metastatic cases, 42 meningiomas, 18 gliomas, 3 hemangioblastomas and 3 pituitary adenomas. There were 325 individual lesions targeted. No frame related placement complications occurred. 10 large metastasis were treated as a staged procedure 1 month apart (18-12 Gy/fraction). A bolus was used on 5 occasions for lesions invading the skull. Secondary to large bifrontal craniotomies, cheek posts were used on 2 occasions, and 3 posts were used in 8 cases. Six cases were completed under general anesthesia. In two patients with very large heads, the frame would not fit and were deconstructed, placed around the neck, reconstructed with pins placed in the cheeks.
While unconventional, neurologists can function as a surgical surrogate to treat intracranial neoplasms with Gamma Knife. This offers unique advantages, especially in regards to continuity of care as many of these patients had been followed and will continue to follow with neurology.  With the advent of the ICON frameless based system, concerns about frame placement also become less of an issue and more facile for neurologists to perform these procedures.
Authors/Disclosures
Glen H. Stevens, DO, PhD, FÂ鶹´«Ã½Ó³»­ (Cleveland Clinic Foundation)
PRESENTER 		The institution of Dr. Stevens has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Stevens has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO. The institution of Dr. Stevens has received research support from National Cancer Institute.