|The JOHNS HOPKINS Brain Tumor
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JOHNS HOPKINS International Brain Tumor Program
Jeffery A. Williams, M.D.
Director, Stereotactic Radiosurgery
Department of Neurosurgery
JOHNS HOPKINS Hospital
600 North Wolfe Street
Baltimore, MD 21205-8811
Dr. Jeffery A. Williams
Director, Brain Tumor Stereotactic Radiosurgery
Dr. Williams is the only Radiosurgeon / Neurosurgeon in the world who is:
Board Certified: Neurological Surgery and
Board Certified: Radiation Oncology
Email Dr. Jeffery Williams (email@example.com) for on-line brain tumor radiosurgery discussions. In the text please
Explore these Features of the JOHNS HOPKINS Brain Tumor Radiosurgery Program
JOHNS HOPKINS International Radiosurgery Topics
Johns Hopkins Stereotactic Radiosurgery employs the non-invasive (no pins in scalp) relocatable system for precise localization of the brain tumor during radiosurgery. This system is easily tolerated and leaves no scars.
Stereotactic Radiosurgery (SRS) allows precise delivery of high doses of radiation to specific targets within the brain. SRS successfully treats both benign and malignant brain tumors. This site describes the conditions for which SRS is beneficial, the processes for patient evaluation and treatment, the participating medical staff and their qualifications, and the subsequent processes for communication with the referring physician and follow-up for the patient.
Johns Hopkins Stereotactic Radiosurgery employs the non-invasive (no pins in scalp) relocatable system for precise localization of the tumor during radiosurgery. This system is easily tolerated because it requires no "pin" placement as with conventional frames. The Hopkins system results in no incision or resultant scar.
For treatment of tumors, fractionation of SRS uses multiple smaller treatments (fractions) instead of one large treatment. This allows administration of a higher total dose of radiation without increasing the risk of toxicity to normal brain.
Such treatment is not currently
possible with radiosurgical devices that utilize multiple cobalt
Both benign and malignant intracranial tumors are successfully treated with fractionated SRS. Malignant tumors include metastases and malignant intrinsic brain neoplasms. Benign tumors include meningioma, acoustic neuroma and pituitary adenomas.
The desirable imaging characteristics of tumors are:
Fractionated SRS for tumors is a non-invasive, outpatient procedure
that involves a limited number of separate visits. During the
first visit, the patient is fitted with a relocatable plastic
mask that precisely contours the face and head. The stereotactic
frame is then fitted to the mask. After the contrast-enhanced
CT scan with mask and frame in place, computerized dosimetry calculates
the most effect targeting. This outpatient radiation treatment
is fractionated, i.e., it takes place over a number of separate
visits. Usually, the treatment can be completed in one to two
weeks. Hopkins offers assistance to patients who travel to Baltimore
in locating accommodations for the duration of their treatment.
A wide range of facilities and prices are available. Additionally, the Marburg Pavilion offers the highest quality inpatient accommodations.
The acoustic neuromas may be treated surgically or by stereotactic radiosurgery. Radiosurgery offers less risk to the seventh (facial motor) and fifth (trigeminal: facial sensory) nerves. Further, the rates of the preservation of hearing appear to be higher following radiosurgery when compared to surgical resection. When compared to conventional surgical resection, radiosurgery does not result in complications such as spinal fluid leak or infection, nor does radiosurgery require a stay in the hospital. To learn the questions related to radiosurgical treatment of acoustic neuroma, please visit JOHNS HOPKINS Acoustic Neuroma Radiosurgery Trial
The meningiomas most suitable for radiosurgery are those of the skull base (rendering resection difficult) or those recurrent after conventional surgery and conventional external beam radiotherapy. Those meningiomas involving the cavernous sinus (middle of skull base) are particularly suited for radiosurgery.
Most pituitary adenomas are suitable for radiosurgery. This technique offers sparing of the optic chiasm, sparing of the hypothalamus (thus sparing the "releasing hormones" that drive the pituitary's normal function) and sparing of the scalp (and hair) when compared to conventional external beam irradiation. For recurrent pituitary adenomas following surgery and regular radiation, radiosurgery is particularly well suited. To learn the questions related to radiosurgical treatment of pituitary adenoma please visit JOHNS HOPKINS Pituitary Adenoma Radiosurgery Trial
Malignant brain tumors include brain metastases, primary malignant tumors (glioblastoma, anaplastic astrocytoma), hemangiopericytomas, malignant meningioma and others. In most cases surgery is the treatment of first choice. However, many times the tumor is in a location that renders resection difficult or impossible. For these cases, conventional radiation is often prescribed, and radiosurgery can provide the safe "boost" of radiation to improve the local control. If, some time after conventional therapy alone, the tumor recurs and if the "performance status" is high, then stereotactic radiosurgery may be indicated. Radiosurgery may again provide the "boost" to increase the response and local control. To learn the questions related to radiosurgical treatment of the malignant tumors, please visit JOHNS HOPKINS RADIOSURGERY Trial
The AVM most appropriate for SRS have the following characteristics:
On a single day, the patient has sequential placement of the BRW head frame, angiography and SRS. Using sophisticated treatment planning software, computerized dosimetry allows contouring of the dose distribution to the AVM to maximize efficacy and minimize toxicity to the normal brain. For treatment, the specially modified linear accelerator administers highly collimated, narrow beams of radiation to the target with sub-millimeter accuracy. After treatment, patients generally stay that night in the hospital for observation. Outpatient follow-up includes clinical and radiographic (MRI) evaluations that are scheduled for one month, three months, and then every 6 months after SRS. Ablation of the lesion usually occurs over 24 to 36 months. For the international patient, MRI films may be mailed to Dr. Williams for review.
Patient Evaluation: AVM and Tumor
The patient is first referred to the Radiation Oncology Department for the initial evaluation. The patient should bring any outside medical records and radiographic studies. This evaluation involves.
For AVM or tumors, the patient's case is presented before the JOHNS HOPKINS Multidisciplinary Vascular or Tumor Board. The following experts evaluate and discuss the patient's case before the treatment plan is finalized:
These conferences ensure that top experts in the ancillary fields provide consultation regarding the patient's treatment plan.
Once a treatment plan is determined, the referring physician receives a phone call, email or fax (depending on the preference of the physician) communicating the proposed approach. At the end of treatment, a summary is similarly communicated to the physician. Hopkins physicians keep the referring physician apprised of the patient's progress after every follow-up visit. We are available to discuss the patient at any time with the referring physician, either directly or through the Hopkins Access Line (HAL).
For an on-line evaluation, please email Dr. Williams (firstname.lastname@example.org). In the body of the text, please outline the problem and any treatments given so far. If possible, please report the important findings on the MRI to:
Welcome to JOHNS HOPKINS USA (1-800-507-9952), the Gateway to the Nation's Premier Medical Center. A group of friendly, service-oriented professionals are solely dedicated to assisting patients with the full spectrum of arrangements for a visit to Hopkins Radiosurgery including travel, lodging and the appointment. A number of hotels offer sharply reduced rates for Hopkins Radiosurgery patients. Hopkins USA is a single point of contact for out-of-town patients and their referring physicians to ensure smooth access to JOHNS HOPKINS RADIOSURGERY. A single toll-free phone call is all it takes!
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