Brandt, Reynaldo André; Salvajoli, João Vitor; Oliveira, Vinio Cintra; Carmignani, Marcia; Cruz, José Carlos da; Leal, Heidi Demura; Ferraz, Lygia

doi:10.1590/S0004-282X1995000100007

Resumos

A radiocirurgia consiste na irradiação precisa de um volume alvo intracraniano com uma alta dose de energia, preservando o tecido nervoso adjacente. O desenvolvimento tecnológico dos aceleradores lineares, dos equipamentos estereotáxicos e da ciência de computação simplificaram o procedimento e tornaram-no acessível. Suas indicações principais são as lesões intracranianas inoperáveis como malformações artério-venosas, schwanomas vestibulares e de outros nervos cranianos, meningeomas da base do crânio, gliomas e metástases cerebrais. Mais recentemente o desenvolvimento da radioterapia estereotáxica fracionada ampliou o espectro" de indicações da radiocirurgia para lesões maiores e adjacentes a estruturas nervosas críticas. Apresentamos a nossa experiência inicial com estas técnicas no tratamento de 31 pacientes. Observamos controle adequado das lesões neoplásicas tratadas e aguardamos o tempo necessário para a observação de resultados nas malformações artério-venosas.

radiocirurgia; radioterapia; estereotaxia; malformação artério-venosa cerebral; glioma; schwanoma; meningeoma; metastase cerebral

Radiosurgery is the precise radiation of a known intracranial target with a high dose of energy, sparing the adjacent nervous tissue. Technological advances in the construction of linear accelerators, stereotactic instruments and in computer sciences made this technique easier to perform and affordable. The main indications for radiosurgery are inoperable cerebral vascular malformations, vestibular and other cranial schwannomas, skull base meningiomas, deep seated gliomas and cerebral metastases. More recently, the development of fraccionated stereotactic radiotherapy increased the spectrum of indications to bigger lesions and to those adjacent to critical nervous structures. We present our initial experience in the treatment of 31 patients. An adequate control of the neoplastic lesions was obtained and the adequate time of observation is still needed to evaluate the results in arteriovenous malformations.

radiosurgery; radiotherapy; stereotaxis; cerebral arteriovenous malformation; glioma; schwannoma; meningioma; brain metastasis

Radiocirurgia por acelerador linear

Linear accelerator radiosurgery

Reynaldo André Brandt^I; João Vitor Salvajoli^II; Vinio Cintra Oliveira^II; Marcia Carmignani^III; José Carlos da Cruz^IV; Heidi Demura Leal^V; Lygia Ferraz^VI

^INeurocirurgião

^IIRadioterapeuta

^IIImagenologista

^IVFísico

^VEnfermeira

^VIInstrurnentadora

RESUMO

A radiocirurgia consiste na irradiação precisa de um volume alvo intracraniano com uma alta dose de energia, preservando o tecido nervoso adjacente. O desenvolvimento tecnológico dos aceleradores lineares, dos equipamentos estereotáxicos e da ciência de computação simplificaram o procedimento e tornaram-no acessível. Suas indicações principais são as lesões intracranianas inoperáveis como malformações artério-venosas, schwanomas vestibulares e de outros nervos cranianos, meningeomas da base do crânio, gliomas e metástases cerebrais. Mais recentemente o desenvolvimento da radioterapia estereotáxica fracionada ampliou o espectro" de indicações da radiocirurgia para lesões maiores e adjacentes a estruturas nervosas críticas. Apresentamos a nossa experiência inicial com estas técnicas no tratamento de 31 pacientes. Observamos controle adequado das lesões neoplásicas tratadas e aguardamos o tempo necessário para a observação de resultados nas malformações artério-venosas.

Palavras-chave: radiocirurgia, radioterapia, estereotaxia, malformação artério-venosa cerebral, glioma, schwanoma, meningeoma, metastase cerebral.

SUMMARY

Radiosurgery is the precise radiation of a known intracranial target with a high dose of energy, sparing the adjacent nervous tissue. Technological advances in the construction of linear accelerators, stereotactic instruments and in computer sciences made this technique easier to perform and affordable. The main indications for radiosurgery are inoperable cerebral vascular malformations, vestibular and other cranial schwannomas, skull base meningiomas, deep seated gliomas and cerebral metastases. More recently, the development of fraccionated stereotactic radiotherapy increased the spectrum of indications to bigger lesions and to those adjacent to critical nervous structures. We present our initial experience in the treatment of 31 patients. An adequate control of the neoplastic lesions was obtained and the adequate time of observation is still needed to evaluate the results in arteriovenous malformations.

Key words: radiosurgery, radiotherapy, stereotaxis, cerebral arteriovenous malformation, glioma, schwannoma, meningioma, brain metastasis.

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Aceite: 2-julho-1994.

Dr. Reynaldo André Brandt - Avenida Albert Einstein 627 sala 392 - 05651-901 São Paulo SP - Brasil

1. Alexander E III, Loeffler JS. Radiosurgery using a modified linear accelerator. Neurosurg Clin N Am 1992, 3:167-190.
2. Alexander E III, Coffey R, Loeffler JS. Radiosurgery for gliomas. In Alexander E III, Loeffler JS, Lunsford LD. (eds). Stereotactic neurosurgery, New York: McGraw Hill 1993, p 207-219.
3. Alexander E III, Black PMcL, Wen PY, Fine H, Loeffler JS. Results of radiosurgery versus brachytherapy for malignant gliomas. In De Salles AAF, Goetsch SJ (eds). Stereotactic surgery and radiosurgery, Madison: Medical Physics Publ 1993, p 455-461.
4. Betti O, Derechinsky VE. Hyperselective encephalic irradiation with a linear accelerator: treatment of arteriovenous malformations. Neurosurgery 1989, 24:311-321.
5. Colombo F, Benedetti A, Pozza F. Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 1989, 24:833-840.
6. Fabrikant J, Lyman J, Hososbuchi Y. Stereotactic heavy-iron bragg peak radiosurgery for intracranial vascular disorders: method for treatment of deep arteriovenous malformations. Br J Radiol 1984, 57:479-90.
7. Fontanesi J, Loeffler JS, Alexander E III. The role of radiosurgery in the management of pediatric intracranial lesions. In Alexander E III, Loeffler JS, Lunsford LD (eds). Stereotactic neurosurgery. New York: McGraw Hill 1993, p 189-196.
8. Glaholm J, Bloom HJG, Crow JH. The role of radiotherapy in the management of intracranial meningiomas: The Royal Marsden Hospital experience with 186 patients Int J Radiat Oncol Biol Phys 1990,18:755-761.
9. Graham JD, Nahum AE, Brada M. A companion of techniques for stereotactic radiotherapy by linear accelerator based on 3-dimensional dose distributions. Rad Oncol 1991, 22:29-35.
10. Heros RC, Korosue K, Diebold PM. Surgical experience of cerebral arteriovenous malformations: late results. Neurosurgery 1990, 26:250-578.
11. Kondziolka D, Lunsford LD, Linskey ME, Flickinger JC. Skull base radiosurgery. In Alexander E III, Loeffler JS, Lunsford LD (eds). Stereotactic neurosurgery. New York: McGraw Hill 1993, p 175-188.
12. Kondziolka D, Lunsford LD, Flickinger JC. Current concepts in gamma knife radiosurgery. Neurosurg Quart 1993, 3:253-271.
13. Larson B, Leksell L, Rexed B. The use of high energy protons for cerebral radiosurgery in man. Acta Chir Scand 1963, 125:1-7.
14. Larson B, Leksell L, Rexed B. The high energy proton beam as a neurosurgical tool. Nature 1985, 182:1222-1223.
15. Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 1951, 102:316-319.
16. Lunsford, LD. Vascular malformations: the role of stereotactic radiosurgery in the management of brain vascular malformations. In Alexander E III, Loeffler JS, Lunsford LD (eds). Stereotactic neurosurgery, New York: McGraw Hill 1993, p 111-121.
17. Lutz W, Winston KR, Maleki N. A system for stereotatic radiosurgery with a linear accelerator. Int J Radiat Oncol Biol Phys 1988, 14:373-381.
18. Mehta M. Radiosurgery for brain metastases. In: De Salles AAF, Goetsch SJ (eds). Stereotactic surgery and radiosurgery. Madison: Medical Physics Publ 1993, p 353-368.
19. Podgorsak EB, Olivier A, Lefevre P, Hazel J. Dynamic stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 1987, 13:1553-1557.
20. Schell MC, Smith V., Larson DA, Wu A, Flickinger JC. Treatment planning optimization with cumulative dose volume histograms in linac-based radiosurgery. Int J Radiat Oncol Biol Phys 1991, 20:1287-1295.
21. Selch MT, Ciacci JD, De Salles AA, Goetsch S, Brekhus SD. Radiosurgery for primary malignant brain tumors. In De Salles AAF, Goetsch SJ (eds). Stereotactic surgery and radiosurgery, Madison: Medical Physics Publ 1993, p 335-352.
22. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986, 65:476-483.
23. Spetzler RF, Hargraves RW, McCormick PW, Zabramski JM, Flam RA, Zimmerman RS. Relationship of perfusion pressure and size to risk of hemorrage from arteriovenous malformations. J Neurosurg 1992, 76:918-923.
24. Steiner L. Stereotactic radiosurgery with the cobalt-60 gamma unit in the surgical treatment of intracranial tumors and arteriovenous malformations. In Schmidek HH, Sweet WH (eds). Operative neurosurgical techniques. Philadelphia: W.B. Saunders 1988, Vol I, p 515-529.
25. Sturm V, Kober B, Hover KH, Schelgel W, Boesecke R, Pastyr O, Kunze S, Lorenz WJ. Stereotactic percutaneous single dose irradiation of brain metastases with a linear accelerator. Int J Radiat Oncol Biol Phys 1987, 13:279-282.
26. Winston KR, Lutz W. Linear accelerator as a neurosurgical tool for stereotatic radiosurgery. Neurosurgery 1988, 22: 454-464.

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Mar 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alexander E III, Loeffler JS. Radiosurgery using a modified linear accelerator. Neurosurg Clin N Am 1992, 3:167-190.

[2] 2. Alexander E III, Coffey R, Loeffler JS. Radiosurgery for gliomas. In Alexander E III, Loeffler JS, Lunsford LD. (eds). Stereotactic neurosurgery, New York: McGraw Hill 1993, p 207-219.

[3] 3. Alexander E III, Black PMcL, Wen PY, Fine H, Loeffler JS. Results of radiosurgery versus brachytherapy for malignant gliomas. In De Salles AAF, Goetsch SJ (eds). Stereotactic surgery and radiosurgery, Madison: Medical Physics Publ 1993, p 455-461.

[4] 4. Betti O, Derechinsky VE. Hyperselective encephalic irradiation with a linear accelerator: treatment of arteriovenous malformations. Neurosurgery 1989, 24:311-321.

[5] 5. Colombo F, Benedetti A, Pozza F. Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 1989, 24:833-840.

[6] 6. Fabrikant J, Lyman J, Hososbuchi Y. Stereotactic heavy-iron bragg peak radiosurgery for intracranial vascular disorders: method for treatment of deep arteriovenous malformations. Br J Radiol 1984, 57:479-90.

[7] 7. Fontanesi J, Loeffler JS, Alexander E III. The role of radiosurgery in the management of pediatric intracranial lesions. In Alexander E III, Loeffler JS, Lunsford LD (eds). Stereotactic neurosurgery. New York: McGraw Hill 1993, p 189-196.

[8] 8. Glaholm J, Bloom HJG, Crow JH. The role of radiotherapy in the management of intracranial meningiomas: The Royal Marsden Hospital experience with 186 patients Int J Radiat Oncol Biol Phys 1990,18:755-761.

[9] 9. Graham JD, Nahum AE, Brada M. A companion of techniques for stereotactic radiotherapy by linear accelerator based on 3-dimensional dose distributions. Rad Oncol 1991, 22:29-35.

[10] 10. Heros RC, Korosue K, Diebold PM. Surgical experience of cerebral arteriovenous malformations: late results. Neurosurgery 1990, 26:250-578.

[11] 11. Kondziolka D, Lunsford LD, Linskey ME, Flickinger JC. Skull base radiosurgery. In Alexander E III, Loeffler JS, Lunsford LD (eds). Stereotactic neurosurgery. New York: McGraw Hill 1993, p 175-188.

[12] 12. Kondziolka D, Lunsford LD, Flickinger JC. Current concepts in gamma knife radiosurgery. Neurosurg Quart 1993, 3:253-271.

[13] 13. Larson B, Leksell L, Rexed B. The use of high energy protons for cerebral radiosurgery in man. Acta Chir Scand 1963, 125:1-7.

[14] 14. Larson B, Leksell L, Rexed B. The high energy proton beam as a neurosurgical tool. Nature 1985, 182:1222-1223.

[15] 15. Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 1951, 102:316-319.

[16] 16. Lunsford, LD. Vascular malformations: the role of stereotactic radiosurgery in the management of brain vascular malformations. In Alexander E III, Loeffler JS, Lunsford LD (eds). Stereotactic neurosurgery, New York: McGraw Hill 1993, p 111-121.

[17] 17. Lutz W, Winston KR, Maleki N. A system for stereotatic radiosurgery with a linear accelerator. Int J Radiat Oncol Biol Phys 1988, 14:373-381.

[18] 18. Mehta M. Radiosurgery for brain metastases. In: De Salles AAF, Goetsch SJ (eds). Stereotactic surgery and radiosurgery. Madison: Medical Physics Publ 1993, p 353-368.

[19] 19. Podgorsak EB, Olivier A, Lefevre P, Hazel J. Dynamic stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 1987, 13:1553-1557.

[20] 20. Schell MC, Smith V., Larson DA, Wu A, Flickinger JC. Treatment planning optimization with cumulative dose volume histograms in linac-based radiosurgery. Int J Radiat Oncol Biol Phys 1991, 20:1287-1295.

[21] 21. Selch MT, Ciacci JD, De Salles AA, Goetsch S, Brekhus SD. Radiosurgery for primary malignant brain tumors. In De Salles AAF, Goetsch SJ (eds). Stereotactic surgery and radiosurgery, Madison: Medical Physics Publ 1993, p 335-352.

[22] 22. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986, 65:476-483.

[23] 23. Spetzler RF, Hargraves RW, McCormick PW, Zabramski JM, Flam RA, Zimmerman RS. Relationship of perfusion pressure and size to risk of hemorrage from arteriovenous malformations. J Neurosurg 1992, 76:918-923.

[24] 24. Steiner L. Stereotactic radiosurgery with the cobalt-60 gamma unit in the surgical treatment of intracranial tumors and arteriovenous malformations. In Schmidek HH, Sweet WH (eds). Operative neurosurgical techniques. Philadelphia: W.B. Saunders 1988, Vol I, p 515-529.

[25] 25. Sturm V, Kober B, Hover KH, Schelgel W, Boesecke R, Pastyr O, Kunze S, Lorenz WJ. Stereotactic percutaneous single dose irradiation of brain metastases with a linear accelerator. Int J Radiat Oncol Biol Phys 1987, 13:279-282.

[26] 26. Winston KR, Lutz W. Linear accelerator as a neurosurgical tool for stereotatic radiosurgery. Neurosurgery 1988, 22: 454-464.