Stereotactic irradiation

Radiosurgery

Radiosurgery uses highly focused beams of radiation, thus administering very high radiation doses in one treatment. This is applied for a number of brain disorders: arteriovenous malformations (AVM) in the brains, small tumours such as acoustic neuromas and metastases.

Typical of this kind of radiotherapy is that almost the entire dose coincides with the borders of the lesion so that the healthy surrounding brain tissue is not affected.

To this purpose, a stereotactic framework must be secured onto the patient's head. This forms the basis for the calculations, which – of course – must be very accurate.

Who qualifies for this treatment ?

Stereotactic radiosurgery is applied for certain deviations as listed below:

  1. Arteriovenous malformations: these are blood vessel clews that may cause or have caused a bleeding. They are irradiated if they cannot be treated by surgery or embolisation. After an embolisation it may occur that part of the AVM remains open. This remaining part is then irradiated. The radiosurgery is a once-only treatment, but may be repeated. After the radiotherapy, the AVM will gradually close over a period of two years.
  2. Acoustic neuromas (benign tumours of the acoustic nerve): can also be treated by surgery; irradiation however gives good results and is in our opinion preferable.
  3. Metastases: these are disseminations of tumours from elsewhere in the body to the brains. Usually, these are treated by conventional irradiation of the whole of the brain, but sometimes they may or should be irradiated using stereotactic radiosurgery.
  4. Brain tumours: these qualify less for once-only irradiation. However, they can be irradiated stereotactically in several sessions. In this case, no framework but a mask is made.
  5. Other less frequent tumour indications:
    • Skull base meningiomas
    • Tumours of the hypophysis
    • Cavernous angiomas
    • N. Opticus gliomas
  6. Trigeminus neuralgia: if conventional treatments fail, stereotactic radiosurgery may be suggested.

Practically

Stereotactic radiosurgery is carried out with one overnight hospitalisation.

First, an MR scan is made, usually in the morning immediately after the admission in hospital.

Half an hour before putting on the stereotactic framework, an infusion is inserted and the patient is given an analgesic and light sedative.

After local anaesthesia, the stereotactic framework is then secured onto the head. This is the most tricky part of the treatment.

Then, with the framework on the patient’s head, the examination of the blood vessels (in case of arteriovenous malformations) is conducted and the CT scan is made.

While the images are sent to the PC and calculations are being made, the patient goes back to his room for a while. During this period, the linear accelerator (radiotherapy device) is adjusted and checked.

Around 17.00 h, the actual radiotherapy is performed.

After the irradiation the framework is removed from the head and after a night’s rest the patient can return home.

Une irradiation stéréotaxique nécessite une nuit d’hospitalisation.  

Stereotactic radiosurgery team

Dr. F. Martens, neurosurgeon
Dr. L. Verbeke, radiotherapist
Engineer M. Piessens, physician
Engineer J. De Jans, physician

Neurosurgery and radiotherapy nurses

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