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Initial North American Experience in 207 Patients

L. Dade Lunsford, MD; John Flickinger, MD; Robert J. Coffey, MD

Arch Neurol. 1990;47(2):169-175.

Abstract
• The first North American gamma knife for stereotactic radiosurgery of brain tumors and arteriovenous malformations entered the therapeutic armamentarium at the University of Pittsburgh (Pa) on August 14, 1987. In this article, we report our initial testing and subsequent experience with this technique. In the first 16 months of operation, 207 patients were treated (113 had arteriovenous malformations, 78 had extra-axial skull base neoplasms, 9 had glial neoplasms, and 7 had metastatic tumors). The patients' lesions either were considered previously as "inoperable" or were residual lesions after attempted surgical resection, or the radiosurgery was performed after the patient declined surgical excision. Gamma radiosurgery was associated with no surgical mortality and no significant early morbidity, and the results were encouraging during the minimum follow-up period of 6 months. Compared with treatment by conventional intracranial surgery (craniotomy), both the average length of stay and hospital charges for radiosurgery were significantly lower. Our initial experience further suggests that stereotactic radiosurgery using the gamma knife is a therapeutically effective and economically sound alternative to microneurosurgical removal of selected intracranial tumors and vascular malformations.

Author Affiliations
From the Departments of Neurological Surgery (Drs Lunsford and Coffey), Radiology (Dr Lunsford), and Radiation Oncology (Dr Flickinger), University of Pittsburgh School of Medicine, Presbyterian-University Hospital, and the Joint Radiation Oncology Center, Pittsburgh, Pa.

Footnotes
Accepted for publication September 25, 1989.

This study was presented in part at the American Society of Therapeutic Radiology and Oncology Meeting, New Orleans, La, October 11, 1988.

Reprint requests to Department of Neurological Surgery, University of Pittsburgh School of Medicine, 9402 Presbyterian-University Hospital, 230 Lothrop St, Pittsburgh, PA 15213 (Dr Lunsford).

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