title: Linac radiosurgery as a tool in neurosurgery.
abstract: Stereotactic radiosurgery is a radiation technique that uses a high radiation dose focused on a stereotactic defined intracranial target in single fraction with high precision. In the 1980s, linear accelerators were introduced as a tool for radiosurgery beneath the already accepted gamma unit. Technique and mechanical precision of LINACs have become equal to the gamma unit and LINAC radiosurgery became more and more used recently. From January 1996 to August 2003 we have treated 237 patients with LINAC radiosurgery. A combination of the University of Florida system and the X Knife System, developed by Radionics, was used in all patients. A number of 110 patients had 161 brain metastases treated, whereas the local tumor control rate was 89.4%. The 1-year survival rate was 54.9% with a median survival of 54 weeks. In 55 patients we have treated 57 meningiomas, mostly located at the skull base (37 out of 55 patients). Local tumor control rate in our patients with skull base meningiomas at 5-year follow up was 97.2%. In this time period, we have also treated acoustic schwannoma, glioma, pituitary adenoma, arteriovenous malformations and patients with trigeminal neuralgia. LINAC radiosurgery has become a daily tool in neurosurgery and changed treatment strategies especially in the treatment of brain metastases and skull base meningiomas towards a less aggressive and multimodality approach. It is not only an alternative to open surgery, but also a very effective adjuvant treatment modality in many neuro-oncological patients, which helps us to enhance tumor control rate, minimize morbidity and increase postoperative quality of life.
authors.affiliation: Department of Neurosurgery, Klagenfurt General Hospital, Austria. r.deinsberger@kh-st-poelten.at
authors.forename: R
authors.initials: R
authors.lastname: Deinsberger
authors.forename: J
authors.initials: J
authors.lastname: Tidstrand
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery; D016634:Radiosurgery / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
references.citation: Neurosurgery. 1998 Jan;42(1):1-5; discussion 5-6
references.pmid: 9442497
references.citation: J Neurosurg Sci. 1990 Jul-Dec;34(3-4):303-8
references.pmid: 2098510
references.citation: Int J Radiat Oncol Biol Phys. 1985 Jun;11(6):1185-92
references.pmid: 3997600
references.citation: Neurosurgery. 1995 Sep;37(3):445-53; discussion 453-5
references.pmid: 7501109
references.citation: Neurosurgery. 1994 Jan;34(1):14-20; discussion 20-1
references.pmid: 8121550
references.citation: Clin Neurosurg. 1999;45:18-20
references.pmid: 10461496
references.citation: Clin Neurosurg. 1992;38:445-71
references.pmid: 1537197
references.citation: Int J Radiat Oncol Biol Phys. 2003 Jul 1;56(3):801-6
references.pmid: 12788188
references.citation: Neurology. 1985 Feb;35(2):219-26
references.pmid: 3969210
references.citation: Int J Radiat Oncol Biol Phys. 1992;24(4):619-25
references.pmid: 1429083
references.citation: J Neurosurg. 1996 May;84(5):748-54
references.pmid: 8622147
references.citation: J Neurosurg. 2000 Dec;93 Suppl 3:68-73
references.pmid: 11143266
references.citation: J Neurosurg. 1996 Jan;84(1):20-8
references.pmid: 8613831
references.citation: Neurosurg Clin N Am. 1999 Jul;10(3):503-11
references.pmid: 10419574
references.citation: Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1097-106
references.pmid: 15234044
references.citation: Stereotact Funct Neurosurg. 1996;66 Suppl 1:184-92
references.pmid: 9032860
references.citation: Acta Chir Scand. 1968;134(8):585-95
references.pmid: 5713443
references.citation: Neurosurgery. 2001 Feb;48(2):285-94; discussion 294-6
references.pmid: 11220370
references.citation: Surg Neurol. 1989 Nov;32(5):334-42
references.pmid: 2683164
references.citation: J Neurosurg. 1999 Jul;91(1):44-50
references.pmid: 10389879
references.citation: Neurosurgery. 1993 May;32(5):699-704; discussion 704-5
references.pmid: 8492844
references.citation: Lancet. 2004 May 22;363(9422):1665-72
references.pmid: 15158627
references.citation: Neurosurgery. 2002 Dec;51(6):1373-79; discussion 1379-80
references.pmid: 12445342
references.citation: J Neurosurg. 1995 Nov;83(5):825-31
references.pmid: 7472550
references.citation: Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):87-93
references.pmid: 15093903
references.citation: Int J Radiat Oncol Biol Phys. 1994 Oct 15;30(3):521-9
references.pmid: 7928482
references.citation: Int J Radiat Oncol Biol Phys. 1988 Feb;14(2):373-81
references.pmid: 3276655
references.citation: Int J Radiat Oncol Biol Phys. 1997 Jan 15;37(2):375-83
references.pmid: 9069310
references.citation: Neurosurgery. 1997 Oct;41(4):776-83; discussion 783-5
references.pmid: 9316038
references.citation: Cancer. 2004 Apr 15;100(8):1705-11
references.pmid: 15073860
references.citation: Acta Neurochir (Wien). 2001 Nov;143(11):1141-52
references.pmid: 11731865
references.citation: Neurosurgery. 2003 Feb;52(2):296-307; discussion 307-8
references.pmid: 12535357
references.citation: Neurosurgery. 1997 Nov;41(5):1019-25; discussion 1025-7
references.pmid: 9361055
references.citation: Int J Radiat Oncol Biol Phys. 1996 Apr 1;35(1):27-35
references.pmid: 8641923
references.citation: Neurosurgery. 1993 Apr;32(4):643-57
references.pmid: 8474655
references.citation: J Neurosurg. 1991 Oct;75(4):512-24
references.pmid: 1885968
references.citation: Adv Neurol. 1978;19:579-92
references.pmid: 570349
references.citation: Neurosurgery. 1989 Jan;24(1):18-30
references.pmid: 2927595
references.citation: J Neurosurg. 2000 May;92(5):745-59
references.pmid: 10794287
references.citation: J Neurosurg. 1994 Feb;80(2):195-201
references.pmid: 8283256
references.citation: Neurosurg Clin N Am. 1994 Apr;5(2):299-330
references.pmid: 8032229
references.citation: J Neurosurg. 1996 Dec;85(6):1013-9
references.pmid: 8929489
references.citation: J Natl Cancer Inst. 1995 Jan 4;87(1):34-40
references.pmid: 7666461
references.citation: Acta Neurochir (Wien). 2001;143(6):555-62
references.pmid: 11534672
references.citation: J Clin Neurosci. 2001 Nov;8(6):528-33
references.pmid: 11683599
references.citation: Acta Chir Scand. 1951 Dec 13;102(4):316-9
references.pmid: 14914373
references.citation: Int J Radiat Oncol Biol Phys. 1994 Mar 1;28(4):797-802
references.pmid: 8138431
references.citation: Int J Radiat Oncol Biol Phys. 1987 Feb;13(2):279-82
references.pmid: 3102416
references.citation: J Neurosurg. 1999 Jul;91(1):35-43
references.pmid: 10389878
references.citation: Neurosurgery. 1985 Mar;16(3):421-30
references.pmid: 3885072
references.citation: J Clin Neurosci. 2001 May;8 Suppl 1:12-4
references.pmid: 11386818
references.citation: Strahlenther Onkol. 2004 May;180(5):263-7
references.pmid: 15127155
references.citation: Neurosurg Clin N Am. 1992 Jan;3(1):141-66
references.pmid: 1633444
references.citation: Acta Neurochir (Wien). 2000;142(6):621-6
references.pmid: 10949435
references.citation: Neurosurgery. 1998 Mar;42(3):446-53; discussion 453-4
references.pmid: 9526976
references.citation: Int J Radiat Oncol Biol Phys. 1999 Jan 15;43(2):321-7
references.pmid: 10030256
references.citation: Urol Oncol. 2004 Jan-Feb;22(1):25-31
references.pmid: 14969800
references.citation: Cancer. 1993 Feb 15;71(4):1353-61
references.pmid: 8435811
references.citation: Neurosurgery. 1998 Aug;43(2):213-20; discussion 220-1
references.pmid: 9696072
references.citation: Neurosurgery. 1985 Feb;16(2):154-60
references.pmid: 3883221
references.citation: Minim Invasive Neurosurg. 2004 Dec;47(6):333-8
references.pmid: 15674748
references.citation: Stereotact Funct Neurosurg. 1998;71(1):43-50
references.pmid: 10072673
references.citation: Int J Radiat Oncol Biol Phys. 1979 Oct;5(10):1725-31
references.pmid: 231022
references.citation: N Engl J Med. 1990 Feb 22;322(8):494-500
references.pmid: 2405271
references.citation: J Neurosurg. 1994 Feb;80(2):187-90
references.pmid: 8283254