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Article: [RADIATION-INDUCED TUMOR DEVELOPING AFTER RADIOSURGERY: WHAT ARE THE ODDS?]

Spiegelmann, Roberto

2022 Volume 162, Issue 4, Page(s) 234–235

Abstract: Introduction: Stereotactic radiosurgery is a disruptive therapeutic technique that has transformed neurosurgery and the treatment of intracranial tumors in the last few decades. Achieving tumor control rates over 90%, it is performed mostly in a single ... ...

Abstract	Introduction: Stereotactic radiosurgery is a disruptive therapeutic technique that has transformed neurosurgery and the treatment of intracranial tumors in the last few decades. Achieving tumor control rates over 90%, it is performed mostly in a single session, as an outpatient procedure involving no skin cuts, head shaving, or anesthesia, Radiosurgery stands out as a treatment modality with few and mostly transient side effects. Even though ionizing radiation (the energy used in radiosurgery) is known to be cancerogenic, radiosurgery-induced tumors have been exceedingly rare. In this issue of Harefuah, the Hadassah group reports a case of glioblastoma multiforme originating in the radio surgically treated site of an intracerebral arterio-venous malformation. We discuss what we can learn from this dire occurrence.
MeSH term(s)	Humans ; Neoplasms, Radiation-Induced/etiology ; Neoplasms, Radiation-Induced/epidemiology ; Neoplasms, Radiation-Induced/surgery ; Radiosurgery/adverse effects ; Radiosurgery/methods ; Glioblastoma/etiology ; Glioblastoma/radiotherapy ; Glioblastoma/surgery ; Brain Neoplasms/etiology ; Brain Neoplasms/radiotherapy ; Brain Neoplasms/surgery
Language	Hebrew
Publishing date	2022-01-21
Publishing country	Israel
Document type	Case Reports ; English Abstract ; Journal Article
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Zs.B 291: Show issues

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Article ; Online: Introduction.

Spiegelmann, Roberto

Journal of neuro-oncology

2010 Volume 98, Issue 2, Page(s) 153

MeSH term(s)	Cooperative Behavior ; Humans ; Neoplasms/surgery ; Radiosurgery/methods
Language	English
Publishing date	2010-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	604875-4
ISSN	1573-7373 ; 0167-594X
ISSN (online)	1573-7373
ISSN	0167-594X
DOI	10.1007/s11060-010-0219-4
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Zs.A 1825: Show issues

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Article: [FRACTIONATED STEREOTACTIC RADIOSURGERY: A GAME CHANGER FOR NEUROSURGERY].

Nissim, Ouzi / Spiegelmann, Roberto

Harefuah

2016 Volume 155, Issue 5, Page(s) 304, 321

Abstract: The article by Dr. Cohen-Inbar published in this issue of Harefuah is a timely review that brings to the general medical community the recent important developments in the field of radiosurgery--the evolution of multi-session radiosurgery [or "FSR", ... ...

Abstract	The article by Dr. Cohen-Inbar published in this issue of Harefuah is a timely review that brings to the general medical community the recent important developments in the field of radiosurgery--the evolution of multi-session radiosurgery [or "FSR", standing for Fractionated Stereotactic Radiation]. Radiosurgery and FSR continue to have a tremendous impact on modern neurosurgery. Sharing sub-millimetric accuracy in radiation delivery made possible by real-time-imaging positioning, frameless single and multisession radiosurgery have become two faces of a therapeutic technique with wide application in the field of intracranial pathology. Blending dose fractionation with delivery precision, FSR is a hybrid tool that can be implemented safely and effectively for practically any intra-cranial pathology without restrictions of volume or location. Dr. Cohen Inbar reviews the available data regarding doses, fractionation schemes, and results for the different pathologies in which FSR is being increasingly applied. FSR, as single-dose radiosurgery since the late 1980s, has changed the practice of neurosurgery. Radical microsorgical tumor removal at any cost in demanding intracranial locations has been replaced by upfront conservative volume-reduction surgery, leaving the more complicated part of those tumors to safer elimination by precise irradiation in single or multiple sessions. In Israel, further to the first unit operative since 1993 at the Sheba Medical Center, 3 new active LINAC based treatment sites have been added in recent years, with facilities either planned or under construction in the remaining major medical centers with neurosurgical and radiotherapy resources. They are evidence of the central role this modality has captured in the management of intracranial pathology.
MeSH term(s)	Brain Neoplasms/surgery ; Dose Fractionation ; Humans ; Israel ; Neurosurgery ; Radiosurgery
Language	Hebrew
Publishing date	2016-05
Publishing country	Israel
Document type	Comment ; Editorial ; English Abstract
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Article: Spinal radiosurgery using the synergy-S system.

Harel, Ran / Spiegelmann, Roberto

The Israel Medical Association journal : IMAJ

2013 Volume 15, Issue 11, Page(s) 712–713

MeSH term(s)	Female ; Humans ; Male ; Pain, Intractable/surgery ; Radiosurgery/methods ; Spinal Neoplasms/surgery ; Stereotaxic Techniques
Language	English
Publishing date	2013-11
Publishing country	Israel
Document type	Comment ; Editorial
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Zs.A 5470: Show issues

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Article ; Online: Targeting the vim by direct visualization of the cerebello-thalamo-cortical pathway in 3 T proton density MRI: correlation with focused ultrasound lesioning.

Páez-Nova, Maximiliano / Spiegelmann, Roberto / Korn-Israeli, Simon / Zibly, Zion / Illera-Rivera, Diego / Daza-Cordoba, Carmen / Alcazar-Daza, Juan Carlos / Garcia-Ballestas, Ezequiel

Neurosurgical review

2022 Volume 45, Issue 3, Page(s) 2323–2332

Abstract: Surgical targeting of the ventral intermediate nucleus of the thalamus (VIM) has been historically done using indirect strategies. Here we depict the cerebello-thalamo-cortical tract (CTCT) through 3 T proton density (PD) in a cohort of patients who ... ...

Abstract	Surgical targeting of the ventral intermediate nucleus of the thalamus (VIM) has been historically done using indirect strategies. Here we depict the cerebello-thalamo-cortical tract (CTCT) through 3 T proton density (PD) in a cohort of patients who underwent high-intensity focus ultrasound (HIFUS) thalamotomy. Forty-seven patients treated in our institution with MR-guided HIFUS VIM thalamotomy were included in this study. PD weighted 3 T MRI used for presurgical planning was compared with postoperative MRI obtained 1 month after surgery. Images were processed with ISTX software (Brain lab, Munich, Germany). The coordinates of the VIM lesion concerning the inter-commissural line (ICL) were annotated. Deterministic tractographies using three ROIs were used to verify the different tracts. The triangle seen in the 3 T PD sequence at the level of the mesencephalic-diencephalic junction was systematically recognized. The posterior angle of this triangle at the junction of the CTCT and the ZI was denominated as "point P." The area of this triangle corresponds to the posterior subthalamic area (PSA) harboring the Raprl fibers. The CTCT was visible from 1 to 2.5 mm below the ICL. The average center of the final HIFUS lesion (point F) was 11 mm from the medial thalamic border of the thalamus (14.9 mm from the midline), 6.4 mm anterior to PC, and 0.6 mm above the ICL. The FUS point was consistently 1-2 mm directly above point P. The anterior border of the external angle of this triangle (point P) can be used as an intraparenchymal point for targeting the ventral border of the VIM. Three ROIs placed in a single slice around this triangle are a fast way to originate tractography of the CTCT, lemniscus medialis, and pyramidal tract.
MeSH term(s)	Cerebellum ; Essential Tremor/diagnostic imaging ; Essential Tremor/surgery ; Humans ; Magnetic Resonance Imaging/methods ; Protons ; Thalamus/diagnostic imaging ; Thalamus/surgery
Chemical Substances	Protons
Language	English
Publishing date	2022-02-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-022-01752-0
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Zs.A 1445: Show issues

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Article ; Online: LINAC radiosurgery in the management of parasagittal meningiomas.

Hadelsberg, Uri / Nissim, Uzi / Cohen, Zvi R / Spiegelmann, Roberto

Stereotactic and functional neurosurgery

2015 Volume 93, Issue 1, Page(s) 10–16

Abstract: Background: At present, there is no general agreement for the best approach to parasagittal meningiomas. Invasion of the superior sagittal sinus is frequent and responsible for relatively high recurrence rates following conventional microsurgery. ... ...

Abstract	Background: At present, there is no general agreement for the best approach to parasagittal meningiomas. Invasion of the superior sagittal sinus is frequent and responsible for relatively high recurrence rates following conventional microsurgery. Radiosurgery has the potential to treat less accessible portions of these tumors, and its application in this pathology is increasing either as a primary or a complementary therapeutic tool. Objective: To evaluate our results with LINAC radiosurgery for the treatment of parasagittal meningiomas. Methods: The patient cohort consisted of 74 patients treated for parasagittal meningioma by LINAC radiosurgery at our institution's Radiosurgery Unit during a 15-year period. Women accounted for 61% of patients. Thirteen patients (18%) underwent radiosurgery as the primary treatment for their meningioma. Results: The overall actuarial control rate was 90.6% at a mean follow-up of 49 months. In 17 patients (22.9%), there was no volumetric change. Fifty patients (67.5%) showed tumor shrinkage ranging from 15 to 80% of the original mass. In 7 patients, tumor recurrence was observed at an average time of 42.2 months after radiosurgery. All the patients with previously untreated tumors were controlled. Symptomatic transient peritumoral edema developed in 5 patients (6.7%) at a mean of 6.4 months after radiosurgery. Three patients complained of protracted headaches after treatment. Conclusions: LINAC radiosurgery was highly effective for the treatment of parasagittal meningiomas in this series. For small to medium-sized meningiomas with clear invasion of the sinusal lumen, radiosurgery is a reasonable option as a first-line treatment. Either alone or combined with conventional surgery, radiosurgery may improve the control rate for parasagittal meningiomas.
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Brain Edema/drug therapy ; Brain Edema/epidemiology ; Brain Edema/etiology ; Female ; Follow-Up Studies ; Headache Disorders/epidemiology ; Headache Disorders/etiology ; Humans ; Kaplan-Meier Estimate ; Magnetic Resonance Imaging ; Male ; Meningeal Neoplasms/diagnostic imaging ; Meningeal Neoplasms/pathology ; Meningeal Neoplasms/surgery ; Meningioma/diagnostic imaging ; Meningioma/pathology ; Meningioma/surgery ; Middle Aged ; Multimodal Imaging ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/epidemiology ; Neuroimaging ; Postoperative Complications/drug therapy ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Radiation Dosage ; Radiosurgery/methods ; Retrospective Studies ; Superior Sagittal Sinus/diagnostic imaging ; Superior Sagittal Sinus/pathology ; Superior Sagittal Sinus/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Burden
Chemical Substances	Adrenal Cortex Hormones
Language	English
Publishing date	2015
Publishing country	Switzerland
Document type	Evaluation Studies ; Journal Article
ZDB-ID	645069-6
ISSN	1423-0372 ; 1011-6125
ISSN (online)	1423-0372
ISSN	1011-6125
DOI	10.1159/000368440
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Article: Utility of the Polestar N30 low-field MRI system for resecting non-enhancing intra-axial brain lesions.

Ungar, Lior / Zibly, Zion / Wohl, Anton / Harel, Ran / Hadani, Moshe / Attia, Moshe / Spiegelmann, Roberto / Feldman, Zeev / Zaubermann, Jacob / Knoller, Nachshon / Cohen, Zvi R

Neurologia i neurochirurgia polska

2021 Volume 55, Issue 2, Page(s) 202–211

Abstract: Background: To determine the utility of an intraoperative magnetic resonance imaging (iMRI) system, the Polestar N30, for enhancing the resection control of non-enhancing intra-axial brain lesions.: Materials and methods: Seventy-three patients (60 ... ...

Abstract	Background: To determine the utility of an intraoperative magnetic resonance imaging (iMRI) system, the Polestar N30, for enhancing the resection control of non-enhancing intra-axial brain lesions. Materials and methods: Seventy-three patients (60 males [83.3%], mean age 37 years) with intra-axial brain lesions underwent resection at Sheba Medical Centre using the Polestar between February 2012 and the end of August 2018. Demographic and imaging data were retrospectively analysed. Thirty-five patients had a non-enhancing lesion (48%). Results: Complete resection was planned for 60/73 cases after preoperative imaging. Complete resection was achieved in 59/60 (98.3%) cases. After iMRI, additional resection was performed in 24/73 (32.8%) cases, and complete resection was performed in 17/60 (28.8%) cases in which a complete resection was intended. In 6/13 (46%) patients for whom incomplete resection was intended, further resection was performed. The extent of resection was extended mainly for non-enhancing lesions: 16/35 (46%) as opposed to only 8/38 (21%) for enhancing lesions. Further resection was not significantly associated with sex, age, intended resection, recurrence, or affected side. Univariate analysis revealed non-eloquent area, intended complete resection, and enhancing lesions to be predictive factors for complete resection, and non-enhancing lesions and scan time to be predictive factors for an extended resection. Non-enhancement was the only independent factor for extended resection. Conclusions: The Polestar N30 is useful for evaluating residual non-enhancing intra-axial brain lesions and achieving maximal resection.
MeSH term(s)	Adult ; Brain/diagnostic imaging ; Brain/surgery ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Glioma ; Humans ; Magnetic Resonance Imaging ; Male ; Monitoring, Intraoperative ; Neoplasm Recurrence, Local ; Retrospective Studies
Language	English
Publishing date	2021-02-09
Publishing country	Poland
Document type	Journal Article
ZDB-ID	415519-1
ISSN	1897-4260 ; 0028-3843
ISSN (online)	1897-4260
ISSN	0028-3843
DOI	10.5603/PJNNS.a2021.0017
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Article ; Online: Neuro-ophthalmologic outcomes of standard versus hypo-fractionated stereotactic radiotherapy of AVPM.

Zach, Leor / Agami, Amir / Furman, Orit / Attia, Moshe / Cohen, Zvi / Mizrachi, Iris Ben-Bassat / Tam, Guy / Zibly, Zion / Nissim, Ouzi / Spiegelmann, Roberto / Huna-Baron, Ruth

Radiation oncology (London, England)

2021 Volume 16, Issue 1, Page(s) 166

Abstract: Background: Most anterior visual pathway meningiomas (AVPM) are benign and slow-growing, but these tumors may affect visual functions, including visual acuity (VA) and visual field (VF). Due to location, most are treated non-surgically by fractionated ... ...

Abstract	Background: Most anterior visual pathway meningiomas (AVPM) are benign and slow-growing, but these tumors may affect visual functions, including visual acuity (VA) and visual field (VF). Due to location, most are treated non-surgically by fractionated stereotactic radiotherapy (FSRT), aiming to prevent tumor progression and visual functions deterioration. Unfortunately, FSRT in itself may affect visual functions. The current preferred treatment regimen (in terms of safety and effectiveness) is undetermined. While most cases are treated with conventional fractionation (cFSRT)-50.4-54 Gy in 28-30 fractions of 1.8-2 Gy, advances in technology have allowed shortening of total treatment length to hypofractionation (hSRT)-25-27 Gy in 3-5 fractions of 5-9 Gy. Our aim was to evaluate the association of radiotherapy regimen for treating AVPM (cFSRT vs. hSRT) with visual function outcomes (VA, VF) at the last neuro-ophthalmologic evaluation. Methods: We conducted a retrospective cohort study of AVPM cases treated at Sheba Medical Center during 2004-2015. We compared cFSRT and hSRT regimens regarding visual function (VA, VF) outcomes at the last neuro-ophthalmologic evaluation. VA was determined by the logarithm of the minimum angle of resolution (LogMAR). VF was determined by the mean deviation (MD). A clinically relevant change in VA was defined as 0.2 LogMAR. Results: 48 patients (13 receiving hSRT, 35 receiving cFSRT) were included, with a median follow-up of 55 months. No significant difference was evident regarding LogMAR or MD of involved eyes at the last evaluation. Six (17%) patients in the cFSRT group experienced clinically relevant VA deterioration in the involved eye, compared with six (46%) in hSRT (p = 0.06). Conclusion: Our findings, using comprehensive and meticulous investigation of visual outcomes, suggest that hSRT may be associated with higher risk for VA and VF deterioration in AVPM especially in ONSM. We recommend the use of cFSRT for ONSM.
MeSH term(s)	Humans ; Meningeal Neoplasms/diagnostic imaging ; Meningeal Neoplasms/radiotherapy ; Meningioma/diagnostic imaging ; Meningioma/radiotherapy ; Radiation Dose Hypofractionation ; Radiosurgery/adverse effects ; Radiotherapy Dosage ; Retrospective Studies ; Visual Acuity ; Visual Fields ; Visual Pathways
Language	English
Publishing date	2021-08-28
Publishing country	England
Document type	Comparative Study ; Journal Article
ISSN	1748-717X
ISSN (online)	1748-717X
DOI	10.1186/s13014-021-01879-2
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Article ; Online: Comparison of Frame-Based Versus Frameless Image-Guided Intracranial Stereotactic Brain Biopsy: A Retrospective Analysis of Safety and Efficacy.

Ungar, Lior / Nachum, Ortal / Zibly, Zion / Wohl, Anton / Harel, Ran / Attia, Moshe / Spiegelmann, Roberto / Zaubermann, Jacob / Feldman, Zeev / Knoller, Nachshon / Cohen, Zvi R

World neurosurgery

2021 Volume 164, Page(s) e1–e7

Abstract: Background: A definitive diagnosis of brain lesions not amenable to surgery is mainly made by stereotactic needle biopsy. The diagnostic yield and safety of the frameless versus frame-based image-guided stereotactic techniques is unclear. Our objective ... ...

Abstract	Background: A definitive diagnosis of brain lesions not amenable to surgery is mainly made by stereotactic needle biopsy. The diagnostic yield and safety of the frameless versus frame-based image-guided stereotactic techniques is unclear. Our objective was to evaluate the safety and accuracy of frameless versus frame-based stereotactic brain biopsy techniques. Methods: A total of 278 patients (153 men; mean age: 65.5 years) with intra-axial brain lesions underwent frame-based (n = 148) or frameless image-guided stereotactic brain biopsy (n = 130) using a minimally invasive twist drill technique during 2010-2016 at Sheba Medical Center. Demographic, imaging, and clinical data were retrospectively analyzed. Results: The diagnostic yield (>90%) did not differ significantly between groups. Overall morbidity (6.8% vs. 8.5%), incidence of permanent neurologic deficits (2.1% vs. 1.6%), mortality rate (0.7% vs. 0.8%), and postoperative computed tomography-detected asymptomatic (14.2% vs. 16.1%) and symptomatic (2.0% vs. 1.6%) bleeding also did not differ significantly between the frame-based and frameless cohorts, respectively. The diagnostic yield and complication rates related to the biopsy technique were not significantly associated with sex, age, entry angle to the skull and skull thickness, lesion location or depth, or radiologic characteristics. Diagnostic yield was significantly associated with the mean lesion volume. Smaller lesions were less diagnostic than larger lesions in both techniques (P = 0.043 frame-based and P = 0.048 frameless). Conclusions: The frameless biopsy technique is as efficient as the frame-based brain biopsy technique with a low complication rate. Lesion volume was the only predictive factor of diagnostic yield. The minimally invasive twist drill technique is safe and efficient.
MeSH term(s)	Aged ; Biopsy/adverse effects ; Biopsy/methods ; Brain/diagnostic imaging ; Brain/pathology ; Brain/surgery ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Humans ; Image-Guided Biopsy ; Male ; Neuronavigation/methods ; Retrospective Studies ; Stereotaxic Techniques
Language	English
Publishing date	2021-07-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2021.07.063
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Article ; Online: Radiosurgery for brain metastases and cerebral edema.

Gazit, Inbal / Har-Nof, Sagi / Cohen, Zvi R / Zibly, Zion / Nissim, Uzi / Spiegelmann, Roberto

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2015 Volume 22, Issue 3, Page(s) 535–538

Abstract: The objective of this study was to assess reduction in cerebral edema following linear accelerator radiosurgery (LINAC) as first line therapy for brain metastasis. We reviewed the medical records of all patients who underwent LINAC radiosurgery for brain ...

Abstract	The objective of this study was to assess reduction in cerebral edema following linear accelerator radiosurgery (LINAC) as first line therapy for brain metastasis. We reviewed the medical records of all patients who underwent LINAC radiosurgery for brain metastasis at our institution during 2010-2012, and who had not previously undergone either surgery or whole brain radiotherapy. Data were analyzed for 55 brain metastases from 46 patients (24 males), mean age 59.9 years. During the 2 months following LINAC radiosurgery, the mean steroid dose decreased from 4.8 to 2.6 mg/day, the mean metastasis volume decreased from 3.79±4.12 cc to 2.8±4.48 cc (p=0.001), and the mean edema volume decreased from 16.91±30.15 cc to 12.85±24.47 cc (p=0.23). The 17 patients with reductions of more than 50% in brain edema volume had single metastases. Edema volume in the nine patients with two brain metastases remained stable in five patients (volume change <10%, 0-2 cc) and increased in four patients (by >10%, 2-14 cc). In a subanalysis of eight metastases with baseline edema volume greater than 40 cc, edema volume decreased from 77.27±37.21 cc to 24.84±35.6 cc (p=0.034). Reductions in brain edema were greater in metastases for which non-small-cell lung carcinoma and breast cancers were the primary diseases. Overall, symptoms improved in most patients. No patients who were without symptoms or who had no signs of increased intracranial pressure at baseline developed signs of intracranial pressure following LINAC radiosurgery. In this series, LINAC stereotactic radiosurgery for metastatic brain lesions resulted in early reduction in brain edema volume in single metastasis patients and those with large edema volumes, and reduced the need for steroids.
MeSH term(s)	Adult ; Aged ; Brain Edema/etiology ; Brain Neoplasms/secondary ; Brain Neoplasms/surgery ; Breast Neoplasms/pathology ; Carcinoma, Non-Small-Cell Lung/secondary ; Carcinoma, Non-Small-Cell Lung/surgery ; Female ; Humans ; Intracranial Hypertension/complications ; Intracranial Pressure ; Lung Neoplasms/pathology ; Male ; Middle Aged ; Radiosurgery/adverse effects ; Treatment Outcome
Language	English
Publishing date	2015-03
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2014.08.025
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