I was debating whether or not to post this simply because it’s technical and too detailed in spots. But then I thought I should post it in case anyone is interested in how well Cyberknife surgery works on brain mets. These results occurred after a single treatment that lasted about 90 minutes. If you are sitting on the fence between radiosurgery and traditional open cranium, if you can do the Cyberknife, do it (if you are given a choice):
EXAMINATION: Brain MRI. HISTORY: 40 year-old male with metastatic renal cell carcinoma. COMPARISON: Brain MRI 3/26/2009 through 12/16/ 2009. TECHNIQUE: Sagittal T1, axial pre- and post-gadolinium T1, T2 FSE, T2 GRE, FLAIR, diffusion, sagittal post-gadolinium MP-RAGE with axial and coronal reformatted sequences of the brain were obtained.
FINDINGS: There has been significant interval decrease in size of the intracranial metastatic lesions. The most striking interval change is decrease in the 16 x 20 mm heterogeneously enhancing mass within the deep right frontal periventricular white matter, contrasting with a previous measurement of 31 x 23 mm. There is significantly diminished, though persistent mass effect upon the right lateral ventricle. The lesion abuts that ependymal surface without evidence for diffuse subependymal spread. There is also diminished associated vasogenic edema. There has been decrease in size of the lesions within the left occipital lobe, now measuring 8 and 3 mm, with diminished vasogenic edema. No new lesion is present. Post-operative changes following prior right frontoparietal craniectomy with post-operative dural enhancement are stable. There are stable foci of susceptibility artifact, likely post-surgical, with slightly increased susceptibility artifact associated with the deep right frontal lesion, which may represent petechial hemorrhage, correlating with the intrinsic T1-shortening on the pre-contrast sequences.
IMPRESSION: Significant interval decrease in size of the intracranial metastatic lesions as well as diminished vasogenic edema, with no new lesion. The study and the report were reviewed by the staff radiologist.