role of srs in benign cns pathology - beacon...
TRANSCRIPT
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Brain Stereotactic Radiosurgery (SRS):
Clinical Applications
Tumours Vestibular Schwannomas
MeningiomasPituitary AdenomasOther
Vascular Malformations AVMs
Other
Functional Applications Trigeminal Neuralgia
EpilepsyMovement disorders
Extending Applications : Hybrid Techniques
Technique: Usually Cone based for Metastatic
• Dedicated Linac: Trilogy Tx
Technique: Frameless intracranial positioning
Technique: Frame-based intracranial positioning
Tumours: Vestibular Schwannomas(Acoustic Neuromas)
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• <3cm• Control rate 90-97%• Hearing preservation 55-70%• Facial nerve palsy 0-5%• Dose 12Gy
Tumours: Vestibular Schwannomas(Acoustic Neuromas)
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Tumours: Vestibular Schwannomas(Acoustic Neuromas)
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• <3cm
• Distant from optic nerves
• Discussion of surgical choice
• Patient’s preference and age
• Medical condition
• Observation and surgery are alternatives
• Reasonable option for residual tumour post op or recurrence
Tumours: Meningiomas
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Technique:Cone based or micromultileaf based on size, shape and location
Tumours: Meningiomas
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Tumours: Meningiomas
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Dose constraints based on optic nerves, chiasm and tract
Tumours: Pituitary Adenomas
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OtherTumours: Gliomas, Glomus Tumours etc.
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Vascular Malformations: AVMs
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• Presentation: Haemorrhage, Seizures, Neuro, Incidental
• Rx: Observation, Surgery, Embolisation, Radiosurgery
Arteriovenous Malformations
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Beam shaping has allowed treating more irregular shaped lesions
Fractionation has allowed treating larger lesions
Fractionation has allowed treating lesions in areas with poor
radiation tolerance
Extending Applications: Fractionation & Hybrid Strategies
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AVM: Large and irregular
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AVM: Large and irregular
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AVM: Large and irregular
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AVM: Large and irregular
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Meningioma in the Optic Nerve
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Meningioma in the Optic Nerve
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Meningioma in the Optic Nerve
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Thank You
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