title: Jaw Immobilization for Gamma Knife Surgery in Patients with Mandibular Lesions: A Newly, Innovative Approach.
abstract: The purpose of our report is to describe an innovative system used for mandibular immobilization during Gamma Knife surgery (GKS) procedures. It is based on an approach originally developed in Marseille in extracranial lesions, close to or involving the mandible, which may imply a certain degree of movement during the therapeutic image acquisitions and/or GKS treatment.
  
  
  
  The maxillofacial surgeon applied bone titanium self-tapping monocortical screws (4; 2 mm diameter, 10 mm length) between roots of the teeth in the fixed gingiva (upper and lower maxillae) the day before GKS (local anesthesia, 5-10 min time). Two rubber bands were sufficient for the desired tension required to undergo GKS. We further proceeded with application of the Leksell stereotactic G frame and carried out the usual GKS procedure.
  
  
  
  The mean follow-up period was 2.3 years (range 0.6-3). Three patients have been treated with this approach: 2 cases with extracranial trigeminal schwannomas involving the mandibular branch, with decrease in tumor size on MR follow-up; 1 case with residual paracondylian mandibular arteriovenous malformation following partial embolization, completely obliterated at 7 months (digital subtraction angiography programmed 1 year after treatment).
  
  
  
  Jaw immobilization appears to be a quick, minimally invasive, safe and accurate adjunctive technique to enhance GKS targeting precision.
authors.affiliation: Neurosurgery Service and Gamma Knife Center, Department of Clinical Neurosciences, University of Lausanne, Lausanne, Switzerland.
authors.forename: Constantin
authors.initials: C
authors.lastname: Tuleasca
authors.forename: Martin
authors.initials: M
authors.lastname: Broome
authors.forename: Pascal J
authors.initials: PJ
authors.lastname: Mosimann
authors.forename: Luis
authors.initials: L
authors.lastname: Schiappacasse
authors.forename: Michele
authors.initials: M
authors.lastname: Zeverino
authors.forename: Antoine
authors.initials: A
authors.lastname: Dorenlot
authors.forename: Jérôme
authors.initials: J
authors.lastname: Champoudry
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007103:Immobilization / Q000295:instrumentation / Q000379:methods; D062069:Inventions; D007568:Jaw / Q000000981:diagnostic imaging; D008297:Male; D008339:Mandibular Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000601:surgery*; D056948:Orthognathic Surgical Procedures; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D020433:Trigeminal Nerve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*