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Hypofractionated radiosurgery for brain metastases. 

In a new article, USCD Brain Tumor Center Radisurgery Program Director, Dr. Clark Chen highlights the safety and efficacy of hypofractionation of radiosurgery to the resection margins in patients with large brain metastases.  With increasing interest, in treating the margins of disease after resection of brain metastases without resorting to whole brain radiation, this article highlights the outcomes using the Cyberknife hypofractionated approach.  

From the article....

Development of hypofractionated stereotactic radiosurgery (HSRS) has expanded the size of lesion that can be safely treated by focused radiation in a limited number of treatment sessions. However, clinical data regarding the efficacy and morbidity of HSRS in the treatment of cerebral metastasis is lacking. Here, we review our experience with CyberKnife(®) HSRS for this indication. From 2005 to 2010, we identified 37 patients with large (>3 cm in diameter) cerebral metastases resection cavity that was treated with HSRS. This constituted approximately 8% of all treated resection cavities. We reviewed dose regimens, local control, distal control, and treatment associated morbidities. Primary sites for the metastatic lesions included: lung (n = 10), melanoma (n = 12), breast (n = 9), kidney (n = 4), and colon (n = 2). All patients underwent resection of the cerebral metastasis and received 800 cGy × 3 daily fractions to the resection cavity. Of the 37 patients treated, one-year follow-up data was available for 35 patients. The median survival was 5.5 months. Actuarial local control rate at 6 months was 80%. Local failures did not correlate with prior WBRT, or tumor histology. Distant recurrence occurred in 7 of the 35 patients. Morbidities associated with HSRS totaled 9%, including radiation necrosis (n = 1, 2.9%), prolonged steroid use (n = 1, 2.9%), and new-onset seizures (n = 1, 2.9%). This study demonstrates the safety and efficacy of an 800 cGy × 3 daily fractions CyberKnife(®) HSRS regimen for irradiation of large resection cavity. The efficacy compares favorably to historical data derived from patients undergoing WBRT, SRS, or brachytherapy.


UCSD Neurosurgeons present at International Stroke Conference in Los Angeles

Dr. Sean Pakbaz and Dr. Bob Carter presented at the February 2011 International Stroke Conference and Annual Joint Section meeting of the Cerebrovascular Section.  Dr. Carter discussed microsurgical management of posterior communicating, internal carotid artery bifurcation, and anterior choroidal artery aneurysms.  

Dr. Pakbaz reviewed his experience with endovascular management of cerebral vasospasm.  In addition, Ben Newman, 6th year resident in Neurosurgery, discussed the topic of central venous stenosis.  

Drs. Pakbaz, Carter, and Newman are part of a multidisciplinary team at the University of California, San Diego involved in the care of patients with cerebrovascular disorders including brain aneurysms, arteriovenous malformations, stroke, and intracerebral hemorrhage.  


UCSD Neurosurgery Residency to Expand

Dr. Joseph Ciacci and Dr. Bob Carter are pleased to announce that the UCSD Neurosurgery Residency will expand to a two resident per year training program. 

Dr. Carter notes, "This expansion will be important in allowing us to continue to offer cutting edge training for our neurosurgery residents.  With new programmatic developments in endovascular neurosurgery and radiosurgery, residents will have a better opportunity to be exposed to the full gamut of neurosurgical practice.  We appreciate the thoughtful review by the Neurosurgery Residency Review Committee in consideration of our application."

The expanded residency will permit two chief residents each year in the program and will also afford residents increased exposure to surgical techniques in the Center for the Future of Surgery, a new procedure based educational facility that will open in the fall of 2011 with 20 dedicated stations for microsurgery learning and 22 stations for macrosurgery learning.



Dr. Sean Pakbaz to lead endovascular program

The Division of Neurosurgery is pleased to announce that as of November 1st, 2010, Dr. Sean Pakbaz will join the Division to lead the effort in Endovascular Neurosurgery.  Dr. Pakbaz joins the division in joint appointment in the Department of Radiology.  Dr. Bob Carter, Division Chair, noted, "Dr. Pakbaz has world class skills in minimally invasive techniques for treating brain aneurysms, arteriovenous malformations, and stroke.  We are delighted to have a faculty member with Dr. Pakbaz's demonstrated leadership in endovascular techniques join our faculty."

Dr. Pakbaz's practice is focused on endovascular management of neurovascular disease.  He has been part of advanced trials of the use of embolic agents such as Onxy HD-500 in the treatment of brain aneurysms.  Dr. Pakbaz will also lead a new rotation in endovascular neurosurgery for residents in the UCSD Neurosurgery Residency program.

Dr. Pakbaz is supported by nurse practitioner Marissa Manuel, who comes to UCSD with over a decade of experience in neurovascular disease management.

To contact the endovascular program, please dial 1-888-9Neuro1 for urgent referrals or 619-543-5540 for routine office consultation. 


UCSD Pediatric Neurosurgery Gains New Operating Home

UCSD Pediatric Neurosurgery is set for an additional expansion as Rady Children's hospital opens it's new tower on 10-10-2010.  The new tower, profiled in the San Diego Union Tribune, will make Rady Children's the largest acute care pediatric hospital in the State of California. 

Pediatric neurousurgeons Mike Levy, MD PhD and Hal Meltzer, MD share one of the nation's busiest practices in pediatric brain tumors, developmental skull and brain disorders, Chiari malformations and other conditions which affect children. The new tower at Rady Children's will provide state of the art neurosurgical operating rooms, ICU's and floors for the care of neurosurgery patients. 

The Pediatric Neurosurgery division provides a pediatric neurosurgery fellowship and residency training in the UCSD Neurosurgery residency

The pediatric neurosurgery program can be reached at 619-543-5540.