Radiosurgery

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Radiosurgery , also known as stereotactic single-dose convergence radiation , is a form of radiation therapy in which a small volume in the body is removed at one time, i.e. H. is irradiated in one session, but with a very high dose, so that it is immediately destroyed. The effect of the procedure is much stronger than that of conventional radiation therapy, which is fractionated into many small single doses, but it requires the highest precision. The irradiated body part is fixed and must not move during the irradiation. As a rule, this is only possible in the area of ​​the brain skull .

application

Radiosurgery is often used to treat benign and malignant brain tumors , metastases, and tumors of the cranial nerves and appendage organs such as meningiomas, neurinomas and pituitary adenomas . Malformations of the blood vessels in the brain are also among the diseases that can be treated radiosurgery. In ophthalmology , melanomas of the choroid can be treated, and in neurology, trigeminal neuralgia .

history

The high-precision radiation treatment was first performed in 1968 by the Swedish neurosurgeon Lars Leksell together with the Swedish physicist Börje Larsson using the gamma knife . His concept of a single-stage high-precision radiation while sparing the extensive target area structures called Lars Leksell Radiosurgery alluding to the complaining "surgical precision". Modern radiation therapy facilities often do not use a gamma knife, but linear accelerators for the same purpose, which, however, cannot always keep up with the precision of a gamma knife.

execution

Radiosurgical treatment is carried out on an outpatient basis or as part of a short inpatient stay. First, a stereotactic frame with four small thorns is attached to the outside of the bony skull. Now, angiographic , computed tomography or kernspintomografische recordings made that show the tumor precisely as possible. Markings on the stereotactic frame make it possible to calculate an individual treatment plan on the computer, which consists of one or more (up to 20) spherical, overlaid subfields. Ideally, the 100% isodose of the radiation field exactly envelops the disease process. Now one beam point (subfield) after the other is brought into the center of rotation of the linear accelerator or into the isocenter of the gamma knife and irradiated until the previously planned field shape is achieved. Instead of being done manually as in the past, this positioning is now fully automatic and with the highest precision. After the treatment, the stereotactic frame is removed again.

Since the focus of the disease is not simply removed but killed during radiosurgical treatment, it is necessary to check the course at regular intervals. While brain metastases usually shrink significantly after just six weeks, meningiomas or acoustic neuromas require significantly longer for this, which is why control intervals between six weeks and one year are set depending on the type of disease.

user

A radiosurgical treatment is carried out in various hospitals, such as: University Hospital of Giessen and Marburg (location Marburg ), University Hospital Erlangen , the Rudolf Virchow Hospital , Berlin or the University Hospital Dusseldorf .

literature

  • Dag Moskopp , Hansdetlef Wassmann: Neurosurgery: manual for further training and interdisciplinary reference work . Schattauer Verlag, Stuttgart 2014, p. 647 ff. ( Online )
  • Michael Wannemacher, Jürgen Debus, Frederik Wenz (Eds.): Radiotherapy . Springer Science & Business Media, 2006, Chapter 6, pp. 137–144 ( online )
  • Andreas Raabe, Veit Rohde: Vascular Neurosurgery; Functional neurosurgery . Georg Thieme Verlag, Stuttgart 2011, p. 97 ff. ( Online )
  • Uwe Schlegel: Neuro-oncology . Georg Thieme Verlag, Stuttgart 2003, p. 144 ff. ( Online )
  • Manfred G. Krukemeyer: Radiation Medicine: A Guide for the Practitioner . Walter de Gruyter, Berlin 2004, Chapter 16, pp. 271–282 ( online )

Web links

Individual evidence

  1. ↑ Stereotactic Procedures .
  2. ↑ high-precision irradiation .
  3. ↑ Our technologies: Clinac® DHX, Cyberknife, Novalis, Tomotherapy .
  4. ↑ High-precision radiation therapy at the University Hospital Düsseldorf (UKD) .