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- Title
Nuances of Gamma Knife Radiosurgery for Upper Cervical Spine Lesions with Leksell Frame Fixation at Maxilla.
- Authors
Tripathi, Manjul; Mukherjee, Kanchan
- Abstract
Background: Traditional restriction of foramen magnum as the lower limit for target location for GKRS makes treatment of upper cervical spinal lesions formidable. Leksell frame fixation above supraorbital margins helps in achieving targets up to axis vertebra level (Figure). To target lesions in upper cervical spine with ensured immobility remains a challenging task. We describe our experience of treating lesions located in or extending into upper cervical spine while ensuring immobilisation and the precision of treatment. Methods: We treated three cases of upper cervical spinal lesions (2 intradural extramedullary tumors and one skull base lesion). To minimize the movement at craniovertebral junction, Philadelphia collar was placed and frame was docked on it. The constant relative head neck position was maintained by keeping glabellar-floor and sternal-floor distance constant. Patient positioning system (PPS) and docking gamma angle were maintained at same values throughout the procedure. Results: All patients tolerated the procedure well. There was no complication at one-year follow up interval. One patient showed >50% tumour size reduction at one-year follow up. Conclusion: We tried to push the limits of stereotactic frame by fixing it on maxilla while maintaining immobilization by using strict protocol. Zygomatic process of maxilla might be considered a potential alternate site for frame fixation to target lesions upto C3 vertebra. The well-established dose algorithm for Cyberknife/LINAC system helps in validation of safe dose range for spinal lesions. This proof of concept model also facilitates treatment of lesions in patients with bony defects of previous surgeries (e.g. bifrontal decompressive craniectomy etc.).
- Publication
Stereotactic & Functional Neurosurgery, 2017, Vol 95, p405
- ISSN
1011-6125
- Publication type
Article