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The book 'CyberKnife NeuroRadiosurgery: A Practical Guide' serves as a comprehensive resource for image-guided stereotactic radiosurgery and hypofractionated radiotherapy for brain and spine conditions. It compiles insights from leading experts across various disciplines, covering historical perspectives, physics, imaging, and clinical applications of CyberKnife technology. The text aims to provide practical guidance and critical analysis of treatment options, enhancing the understanding and implementation of this advanced therapeutic approach in neurosurgery.
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100% found this document useful (8 votes)
213 views14 pages

CyberKnife NeuroRadiosurgery A practical Guide - 1st Edition Digital Download

The book 'CyberKnife NeuroRadiosurgery: A Practical Guide' serves as a comprehensive resource for image-guided stereotactic radiosurgery and hypofractionated radiotherapy for brain and spine conditions. It compiles insights from leading experts across various disciplines, covering historical perspectives, physics, imaging, and clinical applications of CyberKnife technology. The text aims to provide practical guidance and critical analysis of treatment options, enhancing the understanding and implementation of this advanced therapeutic approach in neurosurgery.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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CyberKnife NeuroRadiosurgery A practical Guide - 1st

Edition

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Alfredo Conti • Pantaleo Romanelli
Evangelos Pantelis • Scott G. Soltys
Young Hyun Cho • Michael Lim
Editors

CyberKnife
NeuroRadiosurgery
A practical Guide
Editors
Alfredo Conti Pantaleo Romanelli
Associate Professor of Neurosurgery Scientific Director
Alma Mater Studiorum University AB Medica
of Bologna Milano, Italy
Bologna, Italy
Consultant and Scientific Director
IRCCS ISNB Istituto delle Scienze Neurosurgery and Brain Radiosurgery
Neurologiche di Bologna CyberKnife Center, CDI
Bologna, Italy Milano, Italy
Resident Research Scientist Visiting Scientist
Charité University European Synchrotron Radiation
Berlin, Germany Facility (ESRF)
Grenoble, France
Evangelos Pantelis
Assistant Professor, Medical Physics CyberKnife Center, CDI
Laboratory, Medical School Via Saint Bon 20
National and Kapodistrian Milano, Italy
University of Athens
Mikras Asias 75 Scott G. Soltys
Athens, Greece Associate Professor, Department
of Radiation Oncology
Young Hyun Cho Stanford University Cancer Center
Associate Professor, Department of 875 Blake Wilbur Drive
Neurosurgery and Radiosurgery Center Stanford, CA
Asan Medical Center, University of USA
Ulsan, College of Medicine
Seoul, Republic of Korea Michael Lim
Department of Neurosurgery
The Johns Hopkins University School
of Medicine
Baltimore, MD
USA

ISBN 978-3-030-50667-4    ISBN 978-3-030-50668-1 (eBook)


https://doi.org/10.1007/978-3-030-50668-1

© Springer Nature Switzerland AG 2020


This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
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exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
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This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
“Beautiful things have dents and scratches too”
This book is dedicated to Nathalie Chadeau for her immense
passion.
Foreword 1

I am very delighted to write a foreword for this comprehensive book on


image-guided robotic (CyberKnife) neuro-radiosurgery for at least three
important reasons.
The first reason is that single and hypofractionated stereotactic radiation
therapy represents, nowadays, a well-established adjunct to our armamentar-
ium for the treatment of several neurosurgical diseases. I am sure that the
neurosurgical community will find a thorough assessment of appropriate
indications, clinical benefits, risks, and pitfalls related to this technology
useful.
The second reason is related to the fact that I was proud to introduce the
CyberKnife at the University Hospital of Messina, Italy, in 2006. At that time,
I realized how important it was to make this novel technology available and
to evaluate its role and limits in the neurosurgical practice. Since the begin-
ning, Dr. Alfredo Conti, a gifted investigator and neurosurgeon working at
that time with me in Messina, was able to bridge his knowledge and experi-
ence of image-guided surgery of brain and spine lesions to a new robotic
radiosurgical facility.
The third reason is that I consider it extremely important to have a bal-
anced view of the potential and limits of this technology. Sometimes, radio-
surgery is proposed as primary option for neurosurgical diseases which could
be definitively cured by microsurgical procedures. Thus, it is extremely
important to neurosurgeons and radiation oncologists to cooperate in the
patient selection and decision-making process and share common experi-
ences and cultural background. Only this factual collaboration will result in
the best treatment option for each individual patient.
The occasional overindication for Stereotactic Radiosurgery (SRS) is due,
on the one hand, to an understandable enthusiasm and familiarity of radiation
oncologists with this technique. On the other hand, neurosurgeons with direct
responsibility in SRS should reconsider the definition of SRS as a minimally
invasive treatment that can be, to some extent, misleading to patients. As a
matter of fact, although radiation is image-guided on targets with a sufficient
safety, we cannot underestimate the fact that long-term adverse effects, poten-
tially threatening the quality of life of patients, may occur. Nonetheless, SRS
remains a strategic tool for the treatment of hazardous lesions, remnants, and
recurrences for fragile patients.

vii
viii Foreword 1

These are all good reasons to welcome this book reporting the perspec-
tives of clinicians and physicists with a large experience in the field of SRS
gained through years spent in outstanding international institutions.
The rationale for the use of radiosurgery is highlighted by each contributor
in a very systematic discussion of personal data, an extensive literature review
with special reference to safety-effectiveness, and a final summary of indica-
tions and contraindications. The chapters cover different issues, an historical
review, physics, imaging, and a thorough essay of brain and spine tumors,
cerebral vascular lesions, and functional disorders. The structure of each
chapter is perfectly organized in order to provide a practical guide and to
make this book an excellent resource for residents, fellows, and practicing
neurosurgeons.
Definitely, I am impressed by the broad and deep insight into applications
of this novel robotic tool with different radiation doses and modalities. I am
confident that the invaluable scientific information delivered by this book will
benefit the international neurosurgical community. The editors and contribu-
tors are to be commended for their effort in making us aware of the current
possibilities and limitations of radiosurgery for the treatment of neurosurgical
disorders.

 Francesco Tomasello, MD
University of Messina
Messina, Italy
Foreword 2

The concept of radiosurgery is, and always has been, a genuine neurosurgical
concept. The ability to treat and control neurosurgical pathologies with an
(invisible) sharp knife, at low risk, has been a success story since its introduc-
tion by neurosurgical pioneers. In addition, the therapeutic approach,
decision-­making, perception of perilesional surgical anatomy, and the pre-­
interventional risk assessment strongly benefit from decades of lessons
learned from open neurosurgical operations. While radiosurgery was initially
reserved for benign intracranial tumors, the indications have been broadened
over the years into vascular, functional, pediatric, and spinal arenas. This is
the reason why skull base, stereotactic, functional, and so on hybrid neurosur-
geons, active in radiosurgical and open neurosurgical fields, seem to have an
easier career pathway than endovascular/open vascular neurosurgical hybrids,
for unknown reasons (although I have my ideas). Being a hybrid neurosur-
geon or working in an interdisciplinary setting allows us to better appreciate
the advantages and disadvantages of each therapeutic modality that we are
able to offer to our patients. This will finally eliminate therapeutic bias from
the decision-making process. The patients will benefit most from this devel-
opment, and this is what counts. I am also a strong supporter of hybrid neu-
rosurgeons since a thorough dual training is the most effective strategy to
prevent therapeutic extremism, as we have observed in the past, also in the
field of radiosurgery. By this, not everything will look like a nail since one has
not only a single hammer. One reason for this smooth and successful develop-
ment in radiosurgery is the trustful collaboration with our friends and col-
leagues from radiooncology, to whom we are, and always will be, grateful for
their support and friendship.
This view, however, as appealing as it may sound, is currently regarded as
“romantic,” “unrealistic,” or “useless” by critical neurosurgeons and radiation
oncologists, even among my friends. This just demonstrates that many still
need to be convinced by science- and evidence-based success and progress in
the field, and maybe also by overcoming classical borders when it comes to
neurointerventions. The single most important aspect that will consolidate
the hybrid neurosurgical concepts is the thrive for high-end clinical and aca-
demic training in both fields, in order to tackle the argument that one person
cannot be good at both therapies. Admittedly, there is still room for improve-
ment in this field for the next years or so.
Having said all this, it is a pleasure to hold this textbook that comprises all
aspects of radiosurgery, traditional and innovative ones in my hands. The

ix
x Foreword 2

leaders in the field are discussing these aspects in a very balanced and scien-
tific way to highlight areas of opportunities, challenges, controversy, and
common sense. The real value of this book, however, is that all authors
involved fulfill my introductory remarks about hybrid neurosurgeons or expe-
rienced interdisciplinary teams. They stand for high-quality concepts and bal-
anced views, always struggling for the best outcome in our patients.
It is a pleasure to see Alfredo Conti, a role model of an academic hybrid
neurosurgeon and to whom the Charité CyberKnife Program is grateful for
his collaboration and expertise, as the editor of this book. I applaud him for
this masterpiece. In addition, it is a pleasure to have Francesco Tomasello as
author of the second foreword. Francesco, as a very prominent representative
of the Italian Neurosurgical Society, has always been a mentor and close
friend for me over many years, for what I am truly grateful. However, in the
midst of the COVID-19 pandemic and all the associated suffering (when
these words are printed), I cannot resist to acknowledge and congratulate the
entire Italian Neurosurgical Society for their dedication to all the positive
aspects of our neurosurgical life: friendship, positivity, humbleness, elegance,
innovation, family, and strong shoulders that carry on and come up with
excellent books like this.

 Peter Vajkoczy, MD
Department of Neurosurgery
Charité-Universitätsmedizin Berlin
Berlin, Germany
Preface

This book aims to represent a practical guide for image-guided stereotactic


radiosurgery and hypofractionated stereotactic radiotherapy of the brain and
spine. Leading physicians and scientists from four continents will provide the
readers with basic concepts, current evidence, and guidelines for the treat-
ment of neoplastic and non-neoplastic disease of the central nervous system.
Radiosurgery is one of the mainstreams of modern neurosurgery. Indeed,
it perfectly complies with the current requirements of a minimally invasive
neurosurgery and preservation of health-related quality of life.
Neurosurgery is a formidable challenge that, during its 100-year history,
has expanded the opportunities for healing many human diseases, previously
invariably mortal. Nonetheless, despite the amazing evolution of techniques
and technologies, it remains a substantially invasive and pervasive discipline
that often produces a negative impact on the cognitive performance of patients
and eventually dramatic effects on their quality of life.
Image-guided radiosurgery represents a refinement of a revolution initi-
ated almost 40 years ago through the introduction of frame-based radiosur-
gery. As a matter of fact, it has introduced several advantages for both the
patient and the physician.
Image-guided radiosurgery offers greater comfort for the patient who does
not need to be invasively attached to a stereotaxic frame. Treatment is usually
delivered as an outpatient procedure; imaging and treatment should not be
performed in a few hours, providing more time for physicians and physicists
to work out the best possible treatment for the patient.
Above all, image-guidance has introduced the concept of multisession
radiosurgery or hypofractionation, a term that indicates a radiotherapy treat-
ment with a shorter course than conventional radiotherapy with a dose distri-
bution that cannot be significantly different to that of single fraction
radiosurgery. This approach has significantly changed the horizon of radio-
surgery by expanding its boundaries of curative potential. Actually, by multi-
session radiosurgery it is now possible to treat larger brain tumors and tumors
close to the most critical structures of the brain and spine.
The great value of these features introduced through the first image-guided
radiosurgery device, the CyberKnife (Accuray Inc., Sunnyvale, CA), is testi-
fied by the adoption of image-guidance by other systems (i.e., Gamma Knife
Icon).

xi
xii Preface

The increasingly recognized value of image-guidance urges the wide-


spread diffusion of the knowledge gathered after the treatments of thousands
of patients over a period of 20 years.
The purpose of this book is to present the potential of image-guidance in
the treatment of neurosurgical diseases, including neuro-oncological, vascu-
lar, and functional disorders, to the radiosurgical community.
This text gathers the experience of different centers and professionals with
a long and renowned experience in the use of image-guided radiosurgery.
In each chapter, the literature on the topic is critically reviewed.
Several aspects are analyzed in order to present the reader with a critical
analysis of single and hypofractionated treatments.
Each chapter provides all the basic radiobiological parameters and risks
associated to the treatment. These data represent a summary of the authors’
experiences together with the available literature on the topic and a practical
guide for the selection of dose, fractions, isodose line, margins, imaging, and
other parameters as well as to evaluate the risks associated to each
treatment.
To date, literature on image-guided radiosurgery is scarce, and there are
currently no texts with a similar practical approach available. Twenty years
after the introduction of image-guided radiosurgery, it is time to present a
textbook to summarize all the evidence on its great effectiveness and a practi-
cal guide for new users to quickly and easily manage this powerful tool.

Bologna, Italy Alfredo Conti


Milan, Italy  Pantaleo Romanelli
Athens, Greece  Evangelos Pantelis
Stanford, CA, USA  Scott G. Soltys
Seoul, Republic of Korea  Young Hyun Cho
Baltimore, MD, USA  Michael Lim
Contents

Part I Historical Perspectives

1 Creating the Future ������������������������������������������������������������������������   3


John R. Adler Jr.
2 CyberKnife Warfare in America: Battles at the Border
Between Neurosurgery and Radiation Oncology��������������������������   5
Cole A. Giller

Part II Physics

3 The CyberKnife Robotic Radiosurgery System���������������������������� 31


Argyris Moutsatsos and Evangelos Pantelis
4 The Target Locating System for CyberKnife
Neuroradiosurgery�������������������������������������������������������������������������� 45
Warren Kilby
5 Treatment Planning ������������������������������������������������������������������������ 59
Matthias Schlüter, Daniela Schmitt, Christoph Fürweger,
Achim Schweikard, and Alexander Schlaefer
6 Small Field Dosimetry �������������������������������������������������������������������� 75
Evangelos Pantelis and Argyris Moutsatsos
7 Quality Control�������������������������������������������������������������������������������� 89
Evangelos Pantelis and Argyris Moutsatsos

Part III Imaging

8 Morphological Imaging ������������������������������������������������������������������ 109


Eleftherios P. Pappas and Evangelos Pantelis
9 Functional Imaging�������������������������������������������������������������������������� 129
Argyris Moutsatsos and Evangelos Pantelis
10 Diffusion Tensor Imaging (DTI) Tractography ���������������������������� 141
Enmin Wang
11 Metabolic Imaging �������������������������������������������������������������������������� 155
Andrea d’Amico

xiii
xiv Contents

Part IV Radiobiology

12 Radiobiology of Radiosurgery and Hypofractionated


Treatments���������������������������������������������������������������������������������������� 165
Antonio Pontoriero
13 Organs at Risk (OAR) Tolerance in Hypofractionated
Radiosurgery������������������������������������������������������������������������������������ 185
Alfredo Conti

Part V Oncology

14 Brain Metastases Surgical Management: Diagnostic,


Therapeutic and Strategic Considerations������������������������������������ 201
Philippe Metellus
15 Brain Metastasis: The Experience of the Burdenko
Institute of Neurosurgery���������������������������������������������������������������� 213
Elena R. Vetlova, Andrey V. Golanov, Sergey M. Banov,
Natalia A. Antipina, Amayak A. Durgaryan,
Elena N. Igoshina, Mikhail V. Galkin,
and Elena I. Butenko
16 Multiple Brain Metastases�������������������������������������������������������������� 225
Frederic Dhermain
17 CyberKnife Neuroradiosurgery for Large
Brain Metastases and Tumor Bed�������������������������������������������������� 233
Maximilian I. Ruge
18 Convexity and Parasagittal Meningiomas ������������������������������������ 241
Alfredo Conti
19 Skull Base Meningiomas����������������������������������������������������������������� 249
Giuseppe Minniti, Alfredo Conti, and Antonio Pontoriero
20 High-Grade Meningiomas and Hemangiopericytomas���������������� 263
Güliz Acker
21 Perioptic Meningiomas�������������������������������������������������������������������� 271
Laura Fariselli, Valentina Pinzi, Sara Morlino,
and Marcello Marchetti
22 Optic Nerve Sheath Meningiomas�������������������������������������������������� 277
Carolin Senger
23 Vestibular Schwannomas���������������������������������������������������������������� 283
Alexander Muacevic, Paul Windisch, Joerg-­Christian Tonn,
Christoph Fürweger, Berndt Wowra, Markus Kufeld,
and Christian Schichor
24 Large Vestibular Schwannomas������������������������������������������������������ 293
Alfredo Conti
Contents xv

25 Pituitary Adenomas ������������������������������������������������������������������������ 301


Hiromitsu Iwata and Yuta Shibamoto
26 Craniopharyngiomas ���������������������������������������������������������������������� 309
Andrey V. Golanov, Alexander N. Savateev, Yury Y. Trunin,
Natalia A. Antipina, Konstantin V. Nikitin,
and Alexander N. Konovalov
27 Malignant Gliomas�������������������������������������������������������������������������� 323
Franziska Loebel
28 Pilocytic Astrocytomas�������������������������������������������������������������������� 329
Yury Y. Trunin, Andrey V. Golanov, Alexander N. Konovalov,
Natalia A. Antipina, and Konstantin V. Nikitin
29 Pineal Tumors���������������������������������������������������������������������������������� 337
Eun Suk Park and Young Hyun Cho
30 Reirradiation of Skull Base Tumors���������������������������������������������� 355
Sławomir Blamek
31 Chordoma and Chondrosarcoma �������������������������������������������������� 371
Steve Braunstein
32 Paragangliomas of the Head and Neck������������������������������������������ 377
Kaan Oysul and Sait Sirin
33 Paragangliomas: A Case Series from Burdenko
Center of Neurosurgery������������������������������������������������������������������ 389
Svetlana V. Zolotova, Andrey V. Golanov, Natalia A. Antipina,
Anastasia V. Barabanova, and Konstantin V. Nikitin
34 Brainstem Tumors���������������������������������������������������������������������������� 399
Gokhan Ozyigit and Sezin Yuce Sari
35 Uveal Melanoma������������������������������������������������������������������������������ 411
David Roberge
36 Pediatric Radiosurgery�������������������������������������������������������������������� 419
Valérie Bernier-Chastagner
37 Immunotherapy and Radiosurgery������������������������������������������������ 423
Ravi Medikonda and Michael Lim

Part VI Spine

38 Spinal Metastases ���������������������������������������������������������������������������� 439


Souvik Roy, Nitin Agarwal, Steven A. Burton, John C.
Flickinger, and Peter Gerszten
39 Re-irradiation of Spinal Metastases ���������������������������������������������� 451
Emma M. Dunne, Timothy K. Nguyen, Jay Detsky,
Mitchell Liu, Simon S. Lo, and Arjun Sahgal
xvi Contents

40 Radiosurgery for Benign Spinal Tumors �������������������������������������� 465


Scott G. Soltys, Antonio Meola, Alex Chin, and Erqi Pollom
41 Intradural Spinal Lesions��������������������������������������������������������������� 473
Kita Sallabanda, Morena Sallabanda, and Peter Gerszten

Part VII Vascular Lesions

42 Cerebral Arteriovenous Malformations���������������������������������������� 483


Umberto Fornezza, Zeno Perini, Gianpaolo Zambon, Mariano
Zanusso, and Leopoldo S. Casentini
43 Large Arteriovenous Malformations���������������������������������������������� 497
Umberto Fornezza, Zeno Perini, Leopoldo S. Casentini,
Gianpaolo Zambon, and Mariano Zanusso
44 Cyberknife Radiosurgery for Cerebral Cavernous
Malformations���������������������������������������������������������������������������������� 505
François Nataf
45 Dural Arteriovenous Fistulas���������������������������������������������������������� 517
Juhana Frösen and Antti Lindgren
46 Cavernous Sinus Hemangioma ������������������������������������������������������ 531
Enmin Wang

Part VIII Functional Disorders

47 Trigeminal Neuralgia���������������������������������������������������������������������� 543


Pantaleo Romanelli and Alfredo Conti
48 Movement Disorders������������������������������������������������������������������������ 557
Marcello Marchetti, Alfredo Conti, Angelo Franzini,
and Laura Fariselli
49 Image-Guided Robotic Radiosurgery for the
Treatment of Drug-Refractory Epilepsy���������������������������������������� 565
Pantaleo Romanelli and Alfredo Conti
50 Behavioral/Psychiatric Disorders �������������������������������������������������� 579
Sait Sirin and Kaan Oysul

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