Avoiding a Collision in Gamma Knife Radiosurgery: A Modified Mask Fixation Method

Abstract

Objective: The latest version of the Leksell Gamma Knife Icon™ allows for mask-and frame-based fixation. Although mask fixation provides fractionated treatment and immobilization using a noninvasive method, it is not free from collision. The authors investigated the collision problem with a modified mask fixation method. Methods: This study presents a case of two meningiomas in the frontal area, where a collision occurs in the occipital area. A modified mask fixation method was introduced to avoid the collision: first, the edges of the head cushion were cut off and polystyrene beads with a diameter of approximately 5 cm were removed. Next, the head cushion was sealed using a stapler. Finally, the head cushion was flattened in the adapter. We compared the shot coordinates, 3-dimensional (3D) error, clearance distance, and vertical depth of the head cushion between the initial and modified mask fixations. Results: When comparing the initial and modified mask fixations, the difference in the shot coordinates was +10.5 mm along the y-axis, the difference in the 3D error was approximately 18 mm, and the difference in clearance was-10.2 mm. The head cushion was approximately 8 mm deeper in the modified mask fixation. Conclusion: Based on these findings, we recommend a modified mask fixation method for gamma knife radiosurgery using ICON with a collision.