Introduction of an adaptor to fix Y/Z slides during Leksell gamma knife radiosurgery to treat concomitant bilateral far-lateral lesions.

Abstract

The authors develop and introduce an adaptor in gamma knife radiosurgery to fix the Y/Z slides inside the Leksell coordinate G frame for the treatment of concomitant bilateral far-lateral intracranial lesions. The new adaptor was used to treat a 60-year-old woman with renal cell carcinoma and multiple brain metastases. She experienced sudden onset of left-sided weakness and disturbed consciousness. Brain computed tomographic scans showed a large right temporal intracerebral hematoma. After a craniectomy for the removal of the hematoma, she received a complete course of whole brain radiotherapy. However, several new tumors were detected on the follow-up brain magnetic resonance imaging scan. The longest distance of these far-lateral lesions on the x axis was approximately 108 mm. It was not possible to treat some of these tumors in one session with the normal use of the Y/Z slides in the trunnions mode. We developed a new adaptor to fix the Y/Z slides inside the G frame. By using the adaptor, the far-lateral located tumors were treated successfully in a single session. This newly developed adaptor can fix the Y/Z slides inside the G frame. It increases the range of the coordinates on the x axis from 52 to 148 mm to 30 to 170 mm. Using the adapter, gamma knife radiosurgery is a simple and accurate procedure for the treatment of bilateral far-lateral lesions in one session, particularly for lesions that cannot be approached with the normal use of the Y/Z slides in the trunnions mode.