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Stereotactic Radiosurgery

Intracranial Stereotactic Radiosurgery (SRS) is a non-invasive method of delivering a single highly-focused dose of radiation to a target within the brain. This technology is being used by ROA doctors to treat malignant brain tumors (such as brain metastases and gliomas), benign brain tumors (such as acoustic neuromas, meningiomas, and pituitary adenomas), arterio-venous malformations, and functional disorders (such as trigeminal neuralgia). SRS represents an excellent alternative to surgery for many patients. This technology is one of the major advances in the field of neurosurgery and oncology allowing our doctors to cure many diseases during a single, non-invasive treatment in our department. The most common diseases treated with intracranial SRS include:

  • Brain metastases
  • Malignant Gliomas
  • Acoustic Neuromas
  • Meningiomas
  • Pituitary Adenomas
  • Glomus Tumors
  • Arterio-venous Malformations
  • Trigeminal Neuralgia

ROA has by far the longest and most extensive experience with SRS in Northern Virginia and we are proud to offer Frameless SRS for selected patients utilizing the CyberKnife® robotic radiosurgery system and the Trilogy® machine.

ROA has by far the longest and most extensive experience with SRS in Northern Virginia and we are proud to offer Frameless SRS for selected patients. There are several commercially available devices that can perform SRS including Proton Beam, CyberKnife®, GammeKnife®, Trilogy®, and TomoTherapy®. This alphabet soup of technology can often be confusing to patients. Here is a brief summary describing these applications:

The brain tumor specialists of ROA are SRS experts, having performed hundreds of cases and publishing numerous papers on SRS since 1999 when our program opened. ROA is the first in Northern Virginia to offer Frameless SRS. Together with Inova Fairfax Hospital and our neurosurgical partners we have created a World Class SRS program and are proud to offer the highest quality medical care in the area

Typical SRS Procedure

Step 1: Consultation
After a comprehensive consultation with one of our radiation oncologists that specializes in SRS, the appropriate imaging studies will be ordered to best visualize the tumor. Typically this is an MRI that is performed with a special SRS protocol. Overall patient management and imaging studies are generally reviewed at our many multidisciplinary tumor boards where input is obtained from staff radiologists, pathologists, surgeons, and medical oncologists.

Step 2: Treatment Planning
Under the guidance of the neurosurgeon and radiation oncologist, a treatment plan is designed that is best for you. Unlike other radiosurgery treatments, the CyberKnife® and Trilogy® Systems do not require patients to be fitted with a rigid and invasive head frame. Instead, you will receive a custom-fitted mesh mask designed to keep your head and neck still during treatment, which allows for precise targeting of your tumor. While wearing the mask, a CT scan of the brain will be performed in the department of radiation oncology for treatment planning. If an MRI was previously performed to optimally define the exact size, shape and location of your brain tumor, it is then fused to these CT images by treatment planning system. This fusion technology allows precise anatomical visualization of the tumor. Using the imaging data, your radiation oncologist and neurosurgeon will determine the precise volume of tumor to be targeted by radiation, and identify critical normal structures in the brain where radiation should be minimized, allowing for the delivery of a safe and accurate radiation treatment to your brain tumor.

Step 3: The Treatment
A comprehensive treatment plan will be formed by the radiation oncologist, SRS physicist, and neurosurgeon. The patient will then be brought into the CyberKnife® or Trilogy® treatment room and positioned on the treatment machine. You will wear your custom-fitted mask during treatment to ensure accurate localization of the tumor. The treatment is then delivered under constant monitoring by our staff. During CyberKnife treatment, the system’s computer-controlled robot will move around your body to various locations to delivery the radiation treatment precisely to your tumor, as you rest and relax on the table. The radiation is generally delivered in one to five treatment sessions, over the course of a week.

Step 4: Discharge
Upon completing the treatment, the custom-fitted mask is removed, and the patient is then discharged to home. SRS does not require an overnight hospital admission. The treatment is also painless. The entire procedure is performed in a single day and there is generally no recovery time, so that there is little interruption in your daily normal activities. Your radiation oncologist will review all possible side-effects before and after your treatment, and will review with you the plan for follow-up appointments after your treatment.

Intracranial Stereotactic Radiosurgery Publications by ROA Doctors

  1. Bajaj GK, Kleinberg L, Terezakis Z. Current concepts and controversies in the treatment of parenchymal brain metastases: improved outcomes with aggressive management. Cancer Investigation. 23(3): 363-376, 2005.
  2. Wardak Z, Augustyn A, Zhu H, Mickey BE, Whitworth LA, Madden CJ, Barnett SL, Abdulrahman RE, Nedzi LA, Timmerman RD, Choe KS. Pre-treatment factors associated with detecting additional brain metastases at stereotactic radiosurgery. J Neurooncol. 2016 Jun;128(2):251-7.
  3. Klinger DR, Flores BC, Lewis JJ, Hatanpaa K, Choe K, Mickey B, Barnett S. Atypical Meningiomas: Recurrence, Reoperation, and Radiotherapy. World Neurosurg. 2015 Sep;84(3):839-45.
  4. Chun SG, Nedzi LA, Choe KS, Abdulrahman RE, Chen SA, Yordy JS, Timmerman RD, Kutz JW, Isaacson B. A retrospective analysis of tumor volumetric responses to five-fraction stereotactic radiotherapy for paragangliomas of the head and neck (glomus tumors). Stereotact Funct Neurosurg. 2014;92(3):153-9.

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