Main description:

This book attempts to combine many different threads into a comprehensible whole. Since the subject is the Gamma Knife and the author is a neurosurgeon, the field of clinical interest is restricted to intracranial pathology. The discipline of radiosurgery now applies to patients who may reasonably be referred by internists, neurologists, otolaryngologists, endocrinologists and several others. Some of the topics, touched upon, such as stereotaxy and the construction of a radio surgical instrument are unfamiliar to the majority of medical men. Other topics, such as those pertaining to the reactions between radiation and living tissue, are not exactly unfamiliar and yet, for most of us, they are not comfortable areas of expertise: in that we have some basic knowledge but not enough to draw conclusions and interpret. In particular, it is not easy to answer the very sensible questions that patients ask, when being considered for this particular form of treatment. The author has attempted to describe the basic relevant phenomenology in terms that should be readily understandable to a non-specialist physician. To do this, he has been heavily dependent on the expertise of a number of mathematically sophisticated collaborators, who have checked his manuscript. They are named in the acknowledgments section. The relevance of the different sections of this book will naturally be assessed differently, according to the experience and interest of the reader. To simplifY access to the information that is required, the book is divided into three main sections.

Contents:

I. Introduction and Basic Principles.- 1. Introduction.- 2. Principles of Stereotaxy.- Principles.- The Leksell System.- Target Identification.- Newer Localization Methods.- Modern Indications for Stereotaxy.- 3. Ionising Radiation and its Physical and Chemical Effects on Living Tissue.- Radiophysics.- Basic Concepts.- Units.- Electromagnetic Radiation.- Particle Radiation.- The Effect of Electromagnetic Radiation on Matter.- Pair Production.- The Effect of Charged Particles on Matter.- Radiochemistry.- Early Effects.- Biological Changes.- 4. Biological Effects of Ionising Radiation.- Cell Survival Studies.- The Linear Quadratic Equation.- Different Factors Affecting the Effects of Radiation.- Biological Factors.- The Cell Cycle.- Oxygenation.- Radiation Factors.- Fractionation and Fraction Size.- Time Between Fractions.- Dose.- Clinical Radiobiological Correlates.- The Fate of the Normal Tissue.- Hierarchical Tissues (H-type).- Flexible Tissues (F-type).- Tissue Architecture.- Cell Cycle Time (Tc) and Tumour Doubling Time (Td).- The Fate of Irradiated Tumour Cells.- The Radiosensitivity of the Tumour.- The Volume of the Tumour.- Accelerated Repopulation.- The Tumour Bed Effect.- The Hypoxic Fraction.- Reoxygenation.- 5. Ionising Radiation and Clinical Practice.- The Therapeutic Index.- Time Dose Relationships.- The Linear Quadratic Equation and Late Complications.- Early and Late Reactions.- Early Reactions.- Late Reactions.- Radiation Quality.- 6. Development of the Gamma Knife.- Preparatory Basic Research.- The First Patients.- The First Gamma Unit.- Requirements.- Early Experience.- The Second Gamma Unit.- The Third Gamma Unit.- Summary of the Current Gamma Knife Method.- Dose Planning.- 7. Radiophysics, Radiobiology and the Gamma Knife.- Radiophysics and the Gamma Knife.- Energy.- Radiobiology and the Gamma Knife.- Factors Affecting Cell Survival.- Dose.- Dose Rate.- Dose Volume.- Dose Homogeneity.- Delayed Radiation Damage of Nervous Tissue and the Gamma Knife.- Radiation Tolerance of the CNS.- Dose Latency Relationships.- CNS Radiation Tolerance and Dose Volume.- CNS Radiation Tolerance and Fractionation.- Tumour Tissue and the Gamma Knife.- II. The Patient's Experience.- 8. Gamma Knife Radiosurgery: A Patient's Eye View.- Information at the First Consultation..- The Nature of the Technique.- The Safety of the Technique.- The Degree of Disruption to the Patient's Life.- The Waiting.- Information on Admission to Hospital.- The Brochure.- The Day Before.- The Day of Treatment.- The Day after Treatment.- III. Clinical Aspects.- 9. Diverse Clinical Aspects.- Variations in Intracerebral Radiosensitivity.- Variations in Extracerebral Radiosensitivity.- The Effects of Lesion Volume on Dose Planning.- The Effect of a Peripheral Intracranial Location on Treatment Planning.- The Effects of Treatment on Symptoms.- 10. Cerebral Arteriovenous Malformations.- Nomenclature.- Arteriovenous Malformation.- Clinical Presentation.- Aims of Treatment.- Changes in Arteries following Radiation.- The Role of Radiation Treatment.- Results of Gamma Knife Surgery.- Patient Assessment for Gamma Knife Surgery.- Acceptance of Patient for Treatment.- Follow-up.- Cavernous Haemangiomas.- 11. Acoustic Schwannomas.- Diagnosis.- Results of Different Forms of Treatment.- Aims of Treatment.- Choice of Treatment or Treatment of Choice.- Changes in Acoustic Neurinomas Following Radiation.- Patient Assessment for Gamma Knife Surgery.- Acceptance of Patient for Treatment.- Dose.- Patient Follow-up.- Patients with Bilateral Tumours.- 12. Gamma Knife Applications in and around the Pituitary Fossa.- Hypophysectomy for Cancer Pain.- Choice of Treatment.- Radiosensitivity of the Anterior Hypophysis.- Cushing's Disease.- Radiosensitivity of Pituitary Adenoma Tissue.- Diagnosis.- Aims of Treatment.- Results of Different Forms of Treatment.- Choice of Treatment.- Patient Follow-up.- Prolactinoma.- Acromegaly.- Nelson's Syndrome.- Non-Hormone Producing Pituitary Adenomas.- Craniopharyngiomas.- 13. Meningiomas.- Types of Meningioma Commonly Referred to the Gamma Knife.- Regions where Radical Surgery is Commonly Difficult.- Results of Treatment.- Tumours Referred for Primary Treatment.- Tumours which Recur even after Radical Surgery.- Diagnosis.- Assessment for Treatment.- Tumours Related to the Cavernous Sinus..- Other Locations.- Dose.- Patient Follow-up.- 14. Miscellaneous Indications for Gamma Knife Radiosurgery.- Malignant Tumours - Metastases.- Clinical Presentation.- Aims of Treatment.- Patient Assessment for Gamma Knife Surgery.- Dose.- Acceptance of Patient for Treatment.- Malignant Tumours - Gliomas.- Type of Tumour.- Clinical Presentation.- Aims of Treatment.- Results of Gamma Knife Surgery.- Patient Assessment for Gamma Knife Surgery.- Follow-up.- Malignant Tumours - Optic Melanoma.- Clinical Presentation.- Aims of Treatment.- Patient Assessment for Gamma Knife Surgery.- Acceptance of Patient for Treatment.- Follow-up.- Other Benign Tumours.- Gliomas.- Non-gliomatous Benign Tumours.- Functional Radiosurgery.- Parkinsonism.- Trigeminal Neuralgia.- Cancer Pain.- Psychosurgery.- 15. The Future.- Target Limitations.- The Reemergence of Functional Indications for Gamma Knife Radiosurgery.- Quantification of the Effects of Treatment.- Radiobiological Variables.- References.