Stereotactic Radiosurgery

arterial angiography. New protocols are already being developed (e.g. one in our unit, termed "MR-DSA") to be used for post-radiosurgery assessment of the nidus, although at present an apparent cure would still have to be confirmed by high-quality digital subtraction angiography.

The currently used planning software for the gamma knife technique and for some of the Linac techniques allows protection of adjacent eloquent structures. Automated planning will make these procedures even safer and easier in the future. It will be helpful to include functional information in the planning of treatment near important cortical structures, and a combination of structural MRI with functional MRI will no doubt be increasingly utilized. The role of PET is likely to grow, both in pre-operative work-up and post-radiosurgery assessment of tumors, in the same manner as it is currently used to differentiate between radionecrosis and recurrence after radiotherapy.

Delivery of focused radiation is also likely to change. The precision and reliability of the gamma knife is far superior to LINAC-based systems, but it is hoped that the latter techniques will add flexibility to treat larger lesions and those in extracranial positions. The role of fractionated delivery will be clarified. The potential for malignant changes and other late complications will also be explored in years to come.

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Cure Your Yeast Infection For Good

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