- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, USA
Antonio De Salles
Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, USA
DOI:10.4103/2152-7806.95416Copyright: © 2012 De Salles A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Salles AD, Gorgulho A, Benhke E. Integration of surgery and radiosurgery. Surg Neurol Int 26-Apr-2012;3:
How to cite this URL: Salles AD, Gorgulho A, Benhke E. Integration of surgery and radiosurgery. Surg Neurol Int 26-Apr-2012;3:. Available from: http://sni.wpengine.com/surgicalint_articles/integration-of-surgery-and-radiosurgery/
Standing between neurosurgery and radiation oncology, radiosurgery has spearheaded advances in both specialties. Radiation oncologists rapidly integrated and enhanced the benefits of the stereotactic frame, as well as adopted the concepts of frameless stereotaxis, seeing a revolution in their practice. Better target definition and delivery of radiation with exquisite accuracy permitted decrease in number of radiation fractions with more focus on tumor kill, instead of relying strictly on the principles of radiobiology to avoid side effects. This has brought enthusiasm to the radiation oncologists witnessing excellent results with more patient comfort and economy of resources. They are progressively abandoning the term stereotactic for one more akin to their specialty. Image Guided Radiation Therapy (IGRT) has been the center of discussion in the major Radiation Oncology Congresses; radiosurgery concepts are now applied to the whole body, leaving the realm of neurosurgery.[
Neurosurgery has lagged behind in this development. Although stereotactic radiosurgery has made a great impact in neurosurgery, representing 15–20% of the caseload in the major neurosurgery departments,[
Now that the stereotactic frame is no longer necessary[
This issue of Surgical Neurology International Stereotactic focuses on this integration of radiosurgery, image guided surgery, operating room imaging, and novel applications of stereotactic surgery. Having the paradigm of traditional surgery threatened during the end of the last century with the trend persisting and following the fast pace of neuroimaging improvement, neurosurgeons need to rapidly adapt to this reality. MRI with functional and chemical analysis and molecular imaging progressing are rapidly obviating the need of histological confirmation for treatment of several neurosurgical diseases, i.e., acoustic neuromas, meningiomas, arteriovenous malformations, and others. While neurosurgery will always exist, neurosurgeons and those training the future generations have to bring these technological advances in to the training programs and assure that neurosurgery continues to participate as the main integrative specialty in the treatment of these traditionally neurosurgical diseases– while also extending the horizon toward the neurological degenerative diseases and recapturing leadership in the management of vascular disorders, which in large part passed to the realm of the interventional radiologist.
Mass effect needs surgery; it must be dealt with a consciously planned and performed decompressive surgery, now possible with software dedicated to this approach. The neurosurgeon has to keep in mind intact neurologic function, avoiding the risks of radical surgery, relying on the advances of radiosurgery, stereotactic radiotherapy, and endovascular interventional techniques. Brainlab, Inc., dedicated to bridge imaging developments, radiosurgery and surgery, has generously supported the publication of this issue of SNI Stereotactic.
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