Stereotactic Radiosurgery
Stereotactic radiosurgery is the delivery of a large radiation
dose to ablate tissue localized stereotactically.[202]
Sources of ionizing radiation include photon beams produced by either 60
Co
gamma ray or linear accelerators and heavy-ion particle beams. The radiation is
emitted as multiple beams that can be focused on the desired site. The radiation
dose from each beam is small to limit exposure of normal tissue to radiation. However,
the radiation dose at the focus of the beams is high to achieve tissue destruction
in the desired area.[203]
This technique has been
used to treat AVMs, dural arteriovenous fistulas, pituitary adenomas, acoustic neuromas,
trigeminal neuralgia, and malignant tumors.[204]
[205]
[206]
[207]
[208]
The procedure consists of the initial placement of a stereotactic
head frame, usually under local anesthesia, followed by neuroradiologic imaging,
most frequently MRI. Other imaging procedures performed in conjunction with stereotactic
radiosurgery have included angiography and CT. After precise stereotactic localization
of the target, the radiosurgical procedure commences. Most cooperative patients
require only mild sedation/analgesia for the procedure. Uncooperative adults, those
with movement disorders, and pediatrics patients may require general anesthesia for
any or all components of the procedure. The total duration of the anesthetic may
be several hours.[202]
[203]
[208]
Attention to fluid status, temperature maintenance,
and pressure point padding is particularly important during these potentially long
procedures. If general anesthesia is required, intravenous anesthesia with propofol
may provide advantages in maintenance during the multiple patient transfers entailed
by the procedure.[202]
Mechanisms to maintain consistent
standard monitoring throughout the procedure and transfers need to be in place.
After the procedure, the patient goes to a fully staffed and equipped recovery area
and is discharged after meeting standard discharge criteria.
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