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Academia Mexicana de Neurología, A.C.

2017, Number 3

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Rev Mex Neuroci 2017; 18 (3)

Topography of Cerebral Lesions Treated with Stereotactic Surgery with Gamma Knife in a Reference Center

Jiménez RA, Toledo BV

Language: Spanish
References: 42
Page: 24-33
PDF size: 574.53 Kb.


ABSTRACT

Introduction. Stereotactic radiosurgery with Gamma Knife is a non-invasive method that uses 201 Cobalt-60 sources to deliver radiation with millimetric precision to a diverse array of cerebral lesions, especially neoplastic, with the use of a frame that adjusts to the skull of the patient. The principal indication is for lesions who are surgically inaccessible, recurrent or residual disease after surgery, or if there is a major contraindication for an invasive procedure.
Objective. To study the anatomical location with a topographic map using a T2 weighted magnetic resonance image of lesions treated with Gamma Knife during a two year period.
Methods. This was a retrospective, observational study that included 201 adult patients treated with Gamma Knife for diverse lesions from January 2012 to December 2014. Patients were selected using the following criteria: single lesion with likely response to radiosurgery, maximum lesion diameter of 4 cm, Karnofsky Performance Scale › 70, recurrent or residual disease and patients who were not candidates or had contraindications for surgery. The preoperative MRI was studied and coded on a topographic map using a cranial MRI using a T2 sequence using colored circles to indicate location and etiology of the lesion. The dose in Gy varied depending on the diagnosis. The study was performed at the Gamma Knife Unit in Hospital San Javier at Guadalajara, Jalisco.
Results. A total of 201 patients were included, with both benign and malignant lesions, treated at the Gamma Knife Unit at Hospital San Javier in a two year period. 91 (45%) men were treated and 110 (55%) were women. The top 5 lesions treated were: pituitary adenoma/craniopharyngioma n=39 (19%), meningioma n=44 (20%), arteriovenous malformation n=26 (13%), cavernoma/ hemangioblastoma 25 (12%), vestibular Schwanomma n= 19 (7%) and glioma n=18 (9%).
Conclusion. Stereotactic radiosurgery with Gamma Knife is a noninvasive method for the management of diverse benign and malignant intracranial lesions that include diverse superficial and anatomical locations. This map provides multiple examples of common superficial and deep brain and skull base lesions that are treated with Gamma Knife due to the indications discussed.


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