Lessons from a 17-year radiosurgery experience at the Royal Adelaide Hospital

PurposeTo illustrate some of the potential pitfalls of cranial stereotactic radiosurgery (SRS) and its planning based on prospectively gathered data from a 17-year experience at the Royal Adelaide Hospital.Methods and materialsMore than 250 treatments have been planned since 1993 using previously described standard SRS techniques for intracranial benign and malignant lesions.ResultsFive case studies are presented (1 meningioma, 1 acoustic neuroma, 2 solitary brain metastasis, 1 arteriovenous malformation), each of which demonstrates at least one salutary lesson.ConclusionsBecause SRS delivers a highly conformal dose distribution, it is unforgiving of any geographic miss due to inaccurate outlining and thus dependent on neuroradiological expertise and collaboration. There are also potentially significant implications of misdiagnosis in SRS cases without histological proof--in particular, presumed brain metastases.Daniel E. Roos, Brian P. Brophy, James Taylo