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Elekta
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Treatment of Meningiomas with Leksell Gamma Knife® Perfexion™
Patient diagnosis and history
This patient is a 44 year old female with a history of headaches. MRI showed multiple extra-axial lesions consistent with meningiomas, the largest of which included right frontal, left CP angle, and right sphenoid wing lesions.
Treatment
Dr. Jason Sheehan, MD, PhD and Associate Director of the University of Virginia Gamma Knife Center met with the patient and explained the treatment options, which included Gamma Knife for the larger lesions and serial imaging follow-up of the others; or resection of the lesions if they continued to grow and become symptomatic. The patient decided Gamma Knife surgery was the best option.
Dr. Sheehan treated a total of 4 lesions. The treatment involved a total of 25 isocenters with more than 4,500 beams, including 6 composite isocenters. Prescription doses varied both by dose and isodose, ranging from 12 Gy at 50 percentage to 15 Gy at 50 percentage and 15 Gy at 70 percentage. Dynamic shaping was used to determine sector patterns to minimize dose to the optic pathways which were close to the sphenoid wing lesion.
Even with the composite shots and sector blocking, the beam-time for the entire treatment was under 90 minutes, and the actual treatment time was not more than a few minutes longer than this.
Conclusion
The patient was relieved to learn that all four lesions could be treated in a single procedure. This would not have been possible with either a single craniotomy or traditional radiation therapy. At UVA a treatment like this takes approximately four hours from start to finish. This includes; frame fixation, stereotactic imaging, conformal treatment planning, radiosurgery and frame removal. Post Gamma Knife radiosurgery, the patient returned to work the next day. Her headaches have improved and she remains neurologically intact.
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Case Study
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