The document discusses advances in radiosurgery technology that have allowed for more precise targeting of lesions in or near the brain and spine. It describes new radiosurgery systems like the Leksell Gamma Knife Perfexion and Cyberknife that can perform stereotactic radiosurgery with enhanced features like dynamic shaping and treatment of suboccipital and extracranial targets. While the gamma knife is limited by its use of a stereotactic frame and inability to treat lesions far from the cranium, new technologies overcome limitations of standard radiation techniques for spinal tumors which require large treatment fields and cannot exclude the spinal cord from high radiation doses.

2.  The term “radiosurgery” has been modified to; the
stereotactic application in one to five fractions of
high-dose radiation to a target with ablative intent,
where “high dose” means more than 2–3 Gy,
fractional doses commonly used in conventional
radiotherapy.
 Recent advances in robotics and technology resulted
in:
 Leksell Gamma Knife Perfexion
 Cyberknife and enhanced RT systems
 Spinal stereotactic radiosurgery

6. Dynamic shaping

8. Suboccipital targets

9. Extracranial targets

10. Multiple targets

11. Gamma knife with Extend program

12. The 2 major limitations of the gamma knifeThe 2 major limitations of the gamma knife
are:are:
(1) stereotactic frame
(2) inability to treat lesions far away from the cranium
HOWEVERHOWEVER,

22. Limitations of standard radiation techniquesLimitations of standard radiation techniques
for treating spinal tumors:for treating spinal tumors:
1)treatment fields extending up to two vertebral segments above and
below the target to compensate for set-up errors and patient movement
during treatment
2)close proximity of the spinal cord typically makes it impossible to
exclude it from the highest dose region
3)relapse within the treatment field is not uncommon BUT unacceptable
to use larger and more therapeutically beneficial doses, given the risk of
spinal cord injuries such as radiation-induced myelopathy

23. Immobilisation

24. CT simulation & Treatment planning

25. Spinal arteriovenous
malformations

27. Benign Spinal tumors

28. Combined kyphoplasty and spinal
radiosurgery for spinal mets

29. Thank YouThank You