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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. 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:

Proton Beam SRS uses a different type of radiation, protons, to achieve the same treatment goal of delivering a single, highly focused dose of radiation. Therefore, the uses of Proton Bean SRS are the exact same as the other named SRS devices which, in contrast, all use x-rays to accomplish treatment. Proton Beam SRS is currently only available at a few large university cancer centers and is under active investigation. CyberKnife® and GammaKnife® are devices that use many small circular x-ray beams to treat tumors. However, because these machines can only use small circular beams their ability to treat larger and/or irregular targets is limited. In addition, while the rest of these devices can perform x-ray imaging to confirm targeting prior to SRS treatment allowing for frameless treatment, this technique is known as image-guided radiation therapy (IGRT), GammaKnife® always requires an invasive headframe. Beyond this capability, Trilogy® and TomoTherapy® can also perform computed tomography (CT) scans at the time of treatment allowing doctors to use more accurate imaging to guide the SRS treatment. Lastly, the BrainLAB™ beam shaping system is the only device made that allows doctors to use small circular beams OR larger custom-shaped beams providing the versatility to treat small round targets or large irregular targets with optimal accuracy. Based on these advantages ROA, together with Inova Fairfax Hospital, acquired the powerful Trilogy® machine as well as the BrainLAB™ beam shaping system for use in our SRS program.

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 and the only group in the DC Metropolitan area with the state-of-the art BrainLAB™ system. 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: Stereotactic Headframe placement
Under the guidance of the neurosurgeon and radiation oncologist, the stereotactic headframe will be placed on the head during the morning of the procedure. This headframe holds the skull in the same position for the duration of the treatment using four pins, the size of a pen tip, that are placed on the scalp to keep the headframe immobilized. This procedure is performed under local anesthesia and should be relatively pain-free. For selected patients we now have a Frameless SRS option where image guidance at the time of treatment is used to confirm skull positioning rather than utilizing the Stereotactic Headframe for this purpose. Your ROA doctor will discuss with you which method of immobilization is best for your treatment.

Step 3: CT scan
Once the Stereotactic Headframe or relocatable plastic headframe (for Frameless SRS) has been placed, a CT scan of the brain will be performed in the department of radiation oncology. This scan allows a precise visualization of the tumor in relationship to the 3-D reference system that has been created using a stereotactic attachment. If an MRI was previously performed to optimally define the target volume, it is then fused to these CT images by the BrainLAB™ treatment planning system. This fusion technology allows precise anatomical visualization of the tumor.

Step 4: The Treatment
Within the next several hours, a comprehensive treatment plan will be formed by the radiation oncologist, SRS physicist, and neurosurgeon. The patient will then be brought into the Trilogy® treatment room and positioned on the treatment machine. The Stereotactic Headframe or relocatable plastic headframe (for Frameless SRS) is locked into its position on the treatment couch, allowing both immobilization and localization of the tumor. The treatment is then delivered under constant monitoring by our staff.

Step 5: Discharge
Upon completing the treatment, the Stereotactic Headframe or relocatable plastic headframe is removed by the radiation oncologist. 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 no recovery time.

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.

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