Stereotactic Radiosurgery in the Management of Brain Metastasis

Michael L. Smith, M.D.; John Y. K. Lee, M.D.

Disclosures

Neurosurg Focus. 2007;22(3) 

In This Article

Stereotactic Radiosurgery Technique

Stereotactic radiosurgery is performed with either a LINAC or a Co-60 gamma source unit. Masks or cranial pin frames provide immobilization. Regardless of technique, preoperative imaging is paramount. Gadolinium-enhanced T1-weighted MR imaging is standard. Contrast-enhanced computed tomography scans can be used if MR imaging is not possible. Tailored MR imaging techniques are available to increase detection of small and emerging metastases. Triple-dose Gd and MT magnetization transfer can be used to detect lesions not seen on single-dose images.[54] Triple-dose imaging can help clarify any equivocal findings on single-dose imaging, but it is more expensive, is time consuming, carries an increased false-positive rate, and is probably not justified for routine use.[53]

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