P14.115 A Neurologist’s Foray into Gamma Knife: Lessons Learned from the first 100 cases:

Abstract

Abstract BACKGROUND Gamma Knife Radiosurgery typically involves a neurosurgeon, radiation oncologist and physicist. Neurologists performing Gamma Knife provides a potential paradigm shift. METHODS The first 100 Gamma Knife procedures were completed on an Elekta Perfexion or ICON system between October 2015 and August 2018. Head frames were placed by the treating neurologist who also completed the contouring and targeting. The Radiation Oncologist defined the prescription dose and verified the plan, along with the physicist. RESULTS Of the first 100 cases completed by the treating neurologist, 52 were females and 48 males. The average age was 61.4 years. There were 64 metastatic cases, 25 meningiomas, 8 gliomas, 2 hemangioblastoma and 1 pituitary adenoma. There were 245 individual lesions targeted. No frame related placement complications occurred. Five large metastasis were treated as a staged procedure 1 month apart. A bolus was used on 4 occasions for lesions invading the skull. Secondary to large bifrontal craniotomies, cheek posts were used on 2 occasions, and 3 posts were used in 5 cases secondary to large unilateral frontal craniotomies. Four cases were completed under general anesthesia. In one patient with a very large head, the frame would not fit and was deconstructed, placed around the neck, reconstructed with pins placed in the cheeks. 64 of the treated patients are still alive. CONCLUSION While unconventional, neurologists can function as a surgical surrogate to treat intracranial neoplasms with Gamma Knife. This offers unique advantages, especially in regards to continuity of care as many of these patients had been followed and will continue to follow with neurology. With the advent of the ICON frameless based system, concerns about frame placement also become less of an issue and more facile for neurologists to perform these procedures.