role of srs in benign cns pathology - beacon...

Christopher R. Mascott, M.D.,FRCS(C), FAANS

Brain.Tumour.Help@gmail.com

Role of SRS in

Benign CNS Pathology

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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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