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Movement Disorders

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CyberKnife NeuroRadiosurgery

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Abstract

Functional radiosurgery for severe limb tremor was introduced by Leksell in 1951. Since then, several studies described the effectiveness of radiosurgical thalamotomy for intractable tremors, mostly using a frame-based technique. Indeed, lesioning invisible targets residing in the thalamus and basal ganglia to treat movement disorders is still a domain of frame-based procedures, because of the need for a solid reference system registered to the anterior commissure-posterior commissure (AC-PC) line to allow the use of stereotactic atlases for the precise localization of targets that are invisible in MR. CyberKnife (CK) radiosurgery system appears to be a less invasive procedure with potentially equivalent accuracy. Here, we summarize the principles of radiosurgical thalamotomy and describe the technique to obtain tremor control with the CK. We also describe our preliminary clinical experience and discuss the method for determining the 3D coordinates of a known functional target to be treated with frameless radiosurgery. Based on our initial experiences, frameless radiosurgery appears to be a safe alternative treatment for essential tremor, but further studies are necessary to set the minimum dose.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico “C. Besta”, Milan, Italy

    Marcello Marchetti & Laura Fariselli

  2. Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  3. IRCCS ISNB Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Alfredo Conti

  4. Department of Neurosurgery, Charité Faculty of Medicine, Berlin, Germany

    Alfredo Conti

  5. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico “C. Besta”, Milan, Italy

    Angelo Franzini

Authors
  1. Marcello Marchetti
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  2. Alfredo Conti
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  3. Angelo Franzini
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  4. Laura Fariselli
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Corresponding author

Correspondence to Alfredo Conti .

Editor information

Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Marchetti, M., Conti, A., Franzini, A., Fariselli, L. (2020). Movement Disorders. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_48

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