Complications Of Radiosurgery

It is true that there are almost no immediate complications of radiosurgery, but complications do occur. Such problems include small patches of alopecia for tumors adjacent to the scalp, brain edema, radiation necrosis, neurological deficits, and failure to achieve the intended goal. The risk of complications is a function of the tissue volume being treated, the dose delivered, the location, and prior radiation treatments.

There is no absolute maximal tolerated dose that important neuroan-atomical structures, such as the optic nerve, can tolerate, but our general guidelines are included in Table 2. The maximum volume treated also depends on the location, the radiosurgical indication, and prior therapies. Large volumes are more easily treated in the frontal lobe, as compared with the brainstem. In general, treating volumes larger than 10 cm3 increase the risk of complications. A study by Flickinger et al. found that complications after

Table 2 Potential Complication Limits

Location

Dose

Scalp—temporary epilation

3 Gy

Scalp—main erythema

6 Gy

Scalp—permanent epilation

7 Gy

Scalp—desquamation/atrophy

> 10 Gy

Scalp—ulceration/necrosis

> 15 Gy

Ocular lens

0.08 Gy

Optic nerve

8 Gy

Brainstem

14 Gy

AVM radiosurgery varied dramatically with location and the volume of tissue receiving greater than 12 Gy [9]. Locations in order of increasing risk for radiosurgery complications were frontal, temporal, intraventricular, parietal, cerebellar, corpus callosum, occipital, medulla, thalamus, basal ganglia, and pons/midbrain. Oncologic indications may dictate the use of higher doses, accepting higher risk, than nononcological indications.

The risk-benefit ratio weighs heavily in favor of radiosurgery. In our experience treating more than 3500 cases with the Gamma Knife, the risk of significant morbidity is approximately 3%. The chance of successful tumor control is more than 90% for most lesions. Long-term results now demonstrate that radiosurgery is an important therapeutic alternative for patients who are ineligible for surgery because of deep-seated lesions or serious medical conditions, or for patients who would like to avoid the risks of microsurgery.

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