Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.279702
Source of Support: None, Conflict of Interest: None
Series :Progress in Neurological Surgery
Editors :Ajay Niranjan, L. Dale Lunsford, H. Kano
Series editor :L. Dale Lunsford
Publisher :Karger Publications
Published year :2019
Total pages :321
Radiosurgery, as a subspecialty of neurosurgery, would still be considered in its infancy given its history dating back to only five decades. For a long time, there was no comprehensive textbook on radiosurgery except one by Jeremy N Ganz. The Pittsburgh group should be congratulated to have enlightened the neurosurgical community and trained a significant number of neurosurgeons, radiation oncologists, and medical physicists over the last three decades. The newly published book on radiosurgery, “Leksell Radiosurgery,” is an excellent compilation of the current evidence of gamma knife radiosurgery (GKRS) in all the practiced indications.
“Leksell Radiosurgery” is a part of a series of books published under “Progress in Neurological Surgery” for various disciples. The same author group has authored books on functional neurosurgery and radiosurgery including “Current Concepts in Movement Disorder Management” and “Gamma Knife Radiosurgery for Brain Vascular Malformations.” Though the earlier books concentrated on a particular disorder such as an arteriovenous malformation (AVM), the current book is a comprehensive textbook detailing the role of GKRS in all the possible indications and future endeavors.
The book contains five subsections, that is, general topics, tumor radiosurgery, vascular malformation radiosurgery, functional radiosurgery, and ocular radiosurgery. The chapters under general radiosurgery are of significant help for starting centers or yet to start radiosurgery services. They provide consolidated information for any center, including a checklist for radiosurgery, imaging requirements, quality assurance checks, patient information and preparation, anesthesia considerations, and GKRS safety and regulatory requirements. Most of the centers are still practicing frame-based GKRS with the Leksell Gamma Knife Perfexion machine. The new technique named ICON has the advantage of being frameless, which not only increases the patient's comfort and compliance but also gives flexibility for staged radiosurgery. ICON has increased the radiosurgical acceptance for pediatric patients as frame fixation and the need for anesthesia were relative contraindications in this pediatric and claustrophobic patients. With their vast experience with both the techniques, a chapter on comparative ease, safety, efficacy, and relative indications/contraindications has been written on frame versus frameless radiosurgery.
The subsection on tumor radiosurgery includes 17 chapters which detail the role of GKRS in all the benign and malignant intracranial pathologies. Metastasis is the most common indication for GKRS among malignant brain tumors worldwide. The issue of oligometastatic disease and more than 10 metastases has been discussed in three separate chapters with the role of targeted therapies in brain metastases. The role of GKRS in traditional indications such as vestibular schwannomas, meningiomas, paraganglioma, and pituitary adenomas has been reiterated with the current level of evidence. New chapters have been added for the role of GKRS in not so common indications such as pineal region tumors, 3Hs (hemangioma, hemangiopericytoma, and hemangioblastoma), central neurocytomas, and low-grade gliomas. These chapters help the neurosurgical community to counsel and offer GKRS to the selective group of patients in the light of best evidence to date.
AVM has been the blue-eyed boy of radiosurgery, and the book explains the role of GKRS with the updated evidence for individual chapters on separate pathologies, that is, AVM, dural arteriovenous fistulas, and cavernous malformations. Separate chapters are added on long-term outcomes, reevaluation of the role of GKRS for failures, adverse radiation effects, and their management.
The section on functional radiosurgery details the role of GKRS in the management of pain disorders (with a specific role in trigeminal neuralgia), movement disorders, and behavioral disorders. Historically, GKRS was envisioned for the management of the behavioral disorder and its functional indications, especially Parkinson's disorder and essential tremors. With the promotion of stimulation technique and availability of levodopa, the lesioning procedures took a backseat but with time, it has been observed that stimulation surgeries and drug therapy have their complication profile and limitations. Some patients should still be treated with lesioning surgeries with comparable efficacy and complication profile. The chapter on behavioral disorder authored by Marinez-Alvarez explains the current evidence of GKRS, especially for obsessive-compulsive disorder and major depressive disorders.
The concluding chapters of the book are focused on ocular radiosurgery. The use of radiosurgery for ocular disorders remains a less traveled road. Radiosurgery is a useful alternative for many difficult disorders in which management remains at crossroads such as uveal and choroidal melanoma. An exciting chapter is on the role of radiosurgery for other ocular disorders such as glaucoma, age-related macular degeneration, choroidal hemangioblastoma, orbital and uveal metastases of carcinoma, and retinoblastoma, and so on.
To conclude, this book is a balanced overview of the spectrum of GKRS, its indications, safety, efficacy, and complication profile with a comparative evaluation of the other management options in simple yet concise, scientific language. Each chapter has been written by the experts of GKRS with individual experience and literature evidence on specific disorders. The contact details of the authors have been mentioned at the end of each chapter for the curious minds for personal communication.
GKRS is a marvel of engineering which has proven its worth for a variety of indications. It has made a paradigm shift in the management of complicated intracranial ailments, including disorders at traditionally remote locations of the brain such as glomus tumors and functional disorders. This book is a useful guide for students and practicing neurosurgeons in the fascinating field of radiosurgery.