Stereotactic radiosurgery in New Zealand

Aims. To explain the use of Stereotactic Radiosurgery for intracranial lesions and report Dunedin Hospital's early experience with this treatment. Methods. Review of a prospective computer database and departmental clinical files. Results. 74 patients underwent 78 radiosurgical procedures between 30 July 1994 to 18 December 1997. 28 patients with arteriovenous malformations were treated with an obliteration rate of 82% (95% CI: 48% to 98%) at two years. Seventeen vestibular schwannomas (acoustic neuroma's) were treated, with follow-up magnetic resonance imaging available in eleven in whom there was no tumour progression after a mean period of twelve months. There was preservation of some hearing in all patients not already deaf, but one developed a new facial palsy and another had worsening palsy as late side effects. Other tumours, including selected metastases, gliomas and skull base tumours have been treated in smaller numbers. Conclusion. Rates of arteriovenous malformation obliteration, vestibular schwannoma control, and side effects of radiosurgery in Dunedin are comparable to those reported in other uncontrolled series. Radiosurgery is quick and has a low procedure-related morbidity but does have important limitations and delayed side effects, which means the decision to treat needs to be based on thorough multidisciplinary review.