Radiosurgery with a linear accelerator. Methodological aspects.

Based on the concepts of Leksell and on recommendations of different Swedish physicists on the use of linear accelerator for radiosurgical use, we developed a new methodology coupling the Talairach stereotactic system with a commercial linac. Anatomical facts encouraged us to use coronal angles of irradiation employing the angular displacement of the linac above the horizontal plane. Different coronal planes are obtained by rotation of the stereotactic frame. The center of the irradiated target coincides with the irradiation and rotation center of the linear accelerator. Multiple targets can be irradiated in the same session. We use as recommended a secondary collimator in heavy alloy. Special software was prepared after different dosimetric controls. The use of a PC allows us to employ 1-6 targets and different collimators to displace the isocenters in order to obtain geometrical isodose modification, and to change the value of each irradiation arc or portions of each arc in some minutes. Simple or sophisticated neurosurgical strategies can be applied in the treatment of frequently irregular shape and volume AVMs.