![]() 11, 18 The target tissues for functional GKRS, normal CNS tissues, have a greater innate potential for DNA repair than tumor tissues do, a fact that may be more important to consider in functional GKRS than in GKRS-based tumor management. ![]() Cobalt-60 source age directly correlates with dose rate and treatment time, factors that may independently influence the biologically effective dose (BED) of treatment depending on the propensity for the target tissue to undergo intrafraction, sublethal, double-strand break (DSB) DNA-damage repair. 6, 19, 22, 27 Given that functional GKRS is used to improve the quality of life of patients with functional disorders, it is of utmost importance to investigate factors that may contribute to treatment-related adverse effects in GKRS.Īlthough there have been studies supporting an association of functional GKRS parameters such as prescription dose, target location, and treatment volume with toxicity, 20, 24 the impact of the age of the cobalt-60 source has been seldom studied. Although functional GKRS has been reported to have low rates of toxicity in most series, it has, in rare instances, been associated with severe neurological sequelae and even death from radionecrosis. 12, 14, 22 The doses used in functional GKRS typically range from 80 to 180 Gy and therefore are much higher than those used in the treatment of patients with malignant or benign tumors. 6 In these interventions, functional radiosurgery typically consists of a 1-time, high-dose treatment to a predefined, specific neuroanatomical location, involving a single GKRS shot with a 4-mm collimator. First applied in the management of trigeminal neuralgia (TN), functional GKRS has since been used for treating patients with essential, parkinsonian, and multiple sclerosis–related tremor movement disorders obsessive-compulsive disorder and medically refractory aggressiveness. O ver the past several decades, use of Gamma Knife radiosurgery (GKRS) for managing functional neurological disorders has become more common.
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