The Cyberknife Stereotactic Surrgery by John R. Adler Essay

The Cyberknife Stereotactic Surrgery by John R. Adler Essay

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The Cyberknife stereotactic surgery, developed in 1997 by John R. Adler, a professor of Neurosurgery and Radiation Oncology from Stanford University, and manufactured by Accuracy, Inc., involves a frameless robotic system focusing high concentrations of radiation to target small, critically located tumors without invasive surgery of the skull. This image guided robotic radiosurgery has helped replace external beam radiotherapy and have proved to be a safe and effective for patients with pituitary adenomas (Cho et al., 2009).
This procedure utilizes a robot, which manipulates an X-band linear accelerator that is coupled to a radiographic tracking system to monitor potential target movement during radiation beam delivery (Chang, Main, Martin, Gibbs, Heilbrun, 2003). The robotic arm carries a 130 kg compact 6-MV x-ray linear accelerator called the LINAC and maneuvers to direct the LINAC to target location (Cho et al., 2009, Adler, Murphy, Chang, & Hancock, 1999). Two diagnostic X-ray tubes are firmly secured to the ceiling of the operating room, positioned on either side of patient’s head, and are to establish two right angle images of the target (Chang et al., 2003, Adler et al., 1999). The real time radiographs are acquired at repeated intervals during treatment with the help of two silicon x-ray screens capable of generating high-resolution digital images. They are automatically registered to digitally reconstruct radiographs originating from the treatment planning computed tomographic (CT) scan. This process allows cranium position and the treatment site, obtained from the CT scan, to be translated to the coordinate frame of the LINAC. The communication between the imaging system and the robotic arm of the Cyberknife adjusts t...

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...fe SRS in tumor volume, visual disorders, and hypopituitarism. In addition, it successfully treated large tumors that are not normally treated with Gamma Knife SRS or tumors close to optical pathways, with the use of multi-session hypofractionated stereotactic radiotherapy. In another study by Cho et al. (2009), tumor control rate were 92.3%, comparable to other forms of fractionated radiotherapy and were similar to that of Gamma Knife. Endocrinopathies showed improvement rates of 100%, similar to that of the Gamma Knife and superior to other fractionated radiation. Vision loss, a common complication of radiation therapy, produced complication rates of 7.6%, similar to that of Gamma Knife and superior to other fractionated radiation. Also, there were no incidences of pituitary dysfunction in the study, which may have been a result of the multi-session radiosurgery.

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