• Asian Oncology Nursing
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• v.12 no.4
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• pp.323-330
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• 2012

Purpose: Gamma knife radiosurgery (GKR) requires frame positioning because the treatment target should be as close as possible to the center of the frame. The purpose of this study was to identify the level of pin-fixing (PFP) and removal pain (PRP), and the associated factors with the pain undergoing GKR. Methods: A total of 116 patients who underwent GKR for their brain tumor were recruited from C University hospital located in H city, J province. The level of pain was measured by the 10 cm VAS. Results: The level of PFP and PRP were 6.36 and 3.26 points, respectively. Step-wise multiple regressions found that the group who have not perceived numbness after applying 5% EMLA cream was the highest associated factor with PFP, following the time from lidocaine injection to pin-fixation, which explained 21% of total variance of the level of PFP. On the other hand, a group who did not perceive numbness after applying 10% lidocaine spray was the highest factor with PRP, among female patients, which explained 27% of total variance of the level of PRP. Conclusion: Both of PFP and PRP of the stereotactic frame were moderate so that nurses should consider diverse strategies to reduce pain among patients undergoing gamma knife radiosurgery.

• Journal of the Korean Physical Society
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• v.73 no.12
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• pp.1814-1820
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• 2018

With the publication of TRS-483 in late 2017 the IAEA has established an international code of practice for reference dosimetry in small and non-standard fields based on a formalism first suggested by Alfonso et al. in 2008. However, data on beam quality correction factors ($k^{f_{msr},f_{ref}}_{Q_{msr},Q_0}$) for the Leksell Gamma $Knife^{(R)}$ $Perfexion^{TM}$ is scarce and what little data is available was obtained under conditions not necessarily in accordance with the IAEA's recommendations. This study constitutes the first systematic attempt to calculate those correction factors by applying the new code of practice to Monte Carlo simulation using the GEANT4 toolkit. $k^{f_{msr},f_{ref}}_{Q_{msr},Q_0}$ values were determined for three common ionization chamber detectors and five different phantom materials, with results indicating that in most phantom materials, all chambers were well suited for reference dosimetry with the Gamma $Knife^{(R)}$. Similarities and differences between the results of this study and previous ones were also analyzed and it was found that the results obtained herein were generally in good agreement with earlier PENELOPE and EGSnrc studies.

• Journal of Korean Neurosurgical Society
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• v.66 no.4
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• pp.476-481
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• 2023

Objective : The latest version of the Leksell Gamma Knife Icon^TM allows for mask- and frame-based fixation. Although mask fixation provides fractionated treatment and immobilization using a noninvasive method, it is not free from collision. The authors investigated the collision problem with a modified mask fixation method. Methods : This study presents a case of two meningiomas in the frontal area, where a collision occurs in the occipital area. A modified mask fixation method was introduced to avoid the collision : first, the edges of the head cushion were cut off and polystyrene beads with a diameter of approximately 5 cm were removed. Next, the head cushion was sealed using a stapler. Finally, the head cushion was flattened in the adapter. We compared the shot coordinates, 3-dimensional (3D) error, clearance distance, and vertical depth of the head cushion between the initial and modified mask fixations. Results : When comparing the initial and modified mask fixations, the difference in the shot coordinates was +10.5 mm along the y-axis, the difference in the 3D error was approximately 18 mm, and the difference in clearance was -10.2 mm. The head cushion was approximately 8 mm deeper in the modified mask fixation. Conclusion : Based on these findings, we recommend a modified mask fixation method for gamma knife radiosurgery using ICON with a collision.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4609-4614
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• 2016

Purpose: To evaluate the therapeutic effects of copper reduction on angiogenesis-related factors in patients with glioblastoma multiforme treated by gamma knife radiosurgery. Materials and Methods: In the present block randomized, placebo-controlled trial, fifty eligible patients with a diagnosis of glioblastoma multiforme who were candidates for gamma knife radiosurgery were randomly assigned into two groups to receive daily either 1gr penicillamine and a low copper diet or placebo for three months. The intervention started on the same day as gamma knife radiosurgery. Serum interleukin-6 (IL-6), tumor necrosis $factor-{\alpha}$ ($TNF-{\alpha}$), vascular endothelial growth factor (VEGF) and copper levels were measured at baseline and after the intervention. The serum copper level was used as the final index of compliance with the diet. In order to control probable side effects of intervention, laboratory tests were conducted at the beginning, middle and end of the study. Results: The patients had a mean age and Karnofsky Performance Scale of 43.7 years and 75 respectively. Mean serum copper levels were significantly reduced in intervention group. Mean survival time was 18.5 months in intervention group vs. 14.9 in placebo group. VEGF and IL-6 levels in the intervention group were also significantly reduced compared to the placebo group and $TNF-{\alpha}$ increased less. Conclusions: It seems that reducing the level of copper in the diet and dosing with penicillamine leads to decline of angiogenesis-related factors such as VEGF, IL-6 and $TNF-{\alpha}$. Approaches targeting angiogenesis may improve survival and can be used as a future therapeutic strategy.

• Korean Journal of Biological Psychiatry
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• v.3 no.2
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• pp.302-308
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• 1996

A case of rapid cycling mania secondary to gamma-knife radiosurgery for the treatment of refractory epilepsy was reported. A 21-year old woman who had a gamma-knife radiosurgical operation for the treatment of refractory seizure two years ago was admitted because of manic episodes. Although seizure was relieved, manic symptoms like decreased need for sleep, elated mood, unprovoked laughing, grandiose delusion and bizarre behaviors were developed 11 months after the operation. These symptoms recurred lour rimes for eight months. There were no past personal and family history of mood disorders. Laboratory examinations including electroencephalogram ana endocrinological study did not show any abnormal findings. The rapid cycling secondary manic was relieved by lithium. She was then discharged after 5 months. Mood change was not significant during follow-up while hypomania emerged by dose reduction. The secondary mania seemed to be caused or triggered by the right temporal lobe damage induced by gamma-knife radiosurgery.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.652-656
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• 2001

Uveal melanoma is uncommon but life-threatening intraocular malignancy and has been treated by irradiation, local excision and enucleation. Gamma-Knife radiosurgery allows a high dose of radiation to be delivered to an intracranial target with a very high spatial accuracy and has been used for the treatment of ocular melanomas. We have treated two cases of uveal melanoma between October 1994 and December 1999. They include one man and one woman(34, 62 years, respectively). They were followed up for 12 momths. Mean maximal dose was 65Gy. In one case, the tumor disappeared 7 months after gamma-knife radiosurgery. In another case, multiple tumors (uveal, suprasellar and cerebellar tumor) had decreased in size. These results show that single and high dose gamma-knife radiosurgery is may be an option in the local control of uveal melanoma which can spare the eyeball and vision.

• Quality Improvement in Health Care
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• v.8 no.1
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• pp.74-83
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• 2001

Background : Since a Gamma Knife had been installed on December 1997, 405 patients have been treated until December 1999 at department of neurosurgery of Seoul National University hospital. The authors analyzed results of a work to improve satisfaction of Gamma Knife surgery patients and to reduce hospital length of stay. Methods : To understand main discontent of patients, a pre-survey was performed from October 1998 to December 1999 using a questionnaire. By Analyzing 93 questionnaire received from 234 patients, pain on frame application, explanation before surgery, waiting time before surgery, waiting time before medical procedure were main discontent factor and overall satisfaction ratio was 71.0%. To improve satisfaction ratio, several quality improvement activity works were designed and applied to 123 patients during the period between January 2000 and September 2000. The same questionnaire were analyzed. Works to reduce the patient hospital LOS were devised and applied during the same period. Results : The overall satisfaction ratio of Gamma Knife radiosurgery patients was increased to 83.7%(P=0.10). The main factor to improve satisfaction ratio was to reduce waiting time(P=0.05) and improvement of discomfort during the surgery(P=0.06). The average LOS was reduced from 3.1 to 2.7 days(P=0.003). Conclusion : As a result of quality assurance activities, the overall satisfaction ratio of patients was improved and LOS was reduced. The pain during frame application was remained as a main discontent factor and a further study is required to reduce this pain.

• Nuclear Engineering and Technology
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• v.52 no.10
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• pp.2334-2338
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• 2020

In recent years, 3D printing technology has received significant research attention. Additionally, 3D printing technology is being applied to study radiation dosimeters of various materials. In this study, a plastic scintillator for 3D printing was developed in a laboratory and used to manufacture a plastic scintillation dosimeter (PSD) with a shape identical to that of the ionization chamber PTW31010. The 16-mm beam of Gamma Knife® Perfexion™ was irradiated to derive the absorbed dose rates of the PSD and PTW31010; they were subsequently compared with the dose rates of the treatment plan. The differences in the dose rates of the Gamma Knife treatment plan and the absorbed dose rates of PTW31010 were within 0.87%. The difference between the dose rates of the Gamma Knife treatment plan and the absorbed dose rates of the PSD were within 4.1%. A linear fit of the absorbed dose rates of four shots involving different dose rates and irradiation angles yielded an adjusted R-square value exceeding 0.9999. A total of 10 repeated measurements were conducted for the same shot to confirm its reproducibility, with a relative error of 0.56%.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.273-280
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• 2001

Objectives : The purpose of this study is to assess the long-term outcome and delayed complications of Gamma Knife radiosurgery for low grade glioma(LGG). Methods : Among 31 patients of LGG who had been treated by using Leksell Gamma Knife between March 1992 and December 1996, we could follow up more than 5 years(range 5-9 years) in 17 patients and evaluated their clinical feature, changes of tumor volume and post-radiosurgical complications. Results : During the mean follow-up period of 7.6 years, the tumor was decreased in 5 patients(29.4%), unchanged in 4(23.5%), increased in 4(23.5%) and recurred in 4(23.5%). The tumor control rate was 52.9%(9/17). We have experienced eighteen postradiosurgical complications in 10 patients(58.8%). Early complication was none and delayed complications included radiation necrosis with cyst in ten cases, bleeding in five, radiation-induced edema in one and malignant transformation in one. Two patients ultimately died as a result of tumor progression during the follow-up period. The mortality rate was 11.7%. Conclusion : Gamma Knife radiosurgery may be useful as an adjunctive therapy for small volume, deep-seated LGG. Although radiosurgery can effectively prevent growth of solid tumor, several delayed complications such as radiation necrosis, cyst formation, bleeding or malignant transformation can develop during the long-term followup period. Because of the possible slow growth rate of LGG and development of the delayed complications, the long-term efficacy of radiosurgery requires further analysis.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2006.08a
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• pp.66-66
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• 2006