[Radiosurgical treatment of XXXX with the Leksell gamma knife].

@entity1 @entity5 @entity4 @entity1653 @entity204
BACKGROUND: Up to the present time radical microsurgery of the @entity5 was considered the most satisfactory treatment. Now an ever more important part in the treatment of these @entity5 is played by radiosurgery. It involves minimal surgical stress, a minimal rate of complications and minimal change of lifestyle during the postoperative period. The objective of the submitted work was to evaluate the authors' results with the use of Leksell's gamma knife. METHODS AND RESULTS: In 1992-1994 48 @entity1 with @entity1653 were indicated for treatment with a gamma knife. The group comprised 12 @entity1 (25%) and 36 @entity1 (75%) aged 18-73 years (mean age 52.8 years which did not differ significantly in the two groups). In 19 @entity1 (39.6%) one or more neurosurgical operations were carried out previously, in 4 @entity1 (8.3%) fractionated radiotherapy. Karnofski's score, as an indicator of the general condition, varied between 30-90%, the mean value for the whole group being 71%. The calculated volume of the @entity1653 was between 0.7 and 25.8 cm3, the average being 7.4 cm3. @entity4 in the adjacent area of the @entity5 was found in 6 @entity1 (12.5%). In 19 @entity1 (39.6%) the @entity5 was at the base of the skull, in 29 @entity1 (60.4%) at other sites. The radiosurgically administered dose was within the range of 6.5-24 Gy, on average 14,2 Gy, on the isodose on average 50.7% (range 40-75%). The dose below the maximum was within the range of 13-45 Gy), on average 28.3 Gy. Only in two @entity1 fractionated administration of the dose was used. After a 6-month interval following operation 30 @entity1 were examined. In 7 @entity1 (23.3%) partial wrinkling of the @entity1653 occurred (range 6-18 months), Karnofski's score improved by 10% in 8 (26.6%) and deteriorated in 3 @entity1 (10%). The neurodeficit improved in 7 (23.3%) and deteriorated in 4 @entity1 (13.3%). @entity4 developed in 5 @entity1 (16.6%) 5-7 months after operation, in about half the @entity1 it was symptom free. During the follow up period 2 @entity1 died (8 and 5 months following surgery): in one the cause of @entity204 was not associated with the basic disease, in the second @entity1 (where radiotherapy was the third neurosurgical operation) the radiosurgical operation could not reverse tha fatal course of the disease. CONCLUSIONS: Radiosurgery of @entity1653 is a safe therapeutic method with zero mortality, minimal surgical stress, a minimal rate of complications and a minimal morbidity. It is indicated in @entity1653 and possibly their residues after subtotal neurosurgery up to a maximal volume of 30 cm3. It is primary treatment suitable in particular in old. @entity1 , @entity1 with a high per- and postoperative risk and in @entity1 refusing open neurosurgery.
