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Intramedullary metastases (IMM) lead to severe neurological symptoms. They are extremely rare in clinical practice. Optimal management of such patients is not clearly defined. Surgery, chemo- and radiotherapy are the main options. OBJECTIVE: To study the results of stereotactic high-dose irradiation for IMM considering local control of metastases, neurological status and life expectancy. MATERIAL AND METHODS: Nineteen patients with 29 IMMs underwent high-dose irradiation (Cyber Knife G4 and TrueBeam STx devices) between 2016 and 2022. There were 1-10 fractions, radiation dose 14.0-35.0 Gy with isodose 70-100%. Local control and new spinal cord metastases were assessed using contrast-enhanced MRI. Clinical status and neurological functions were assessed using the Karnofsky and McCormick scales. RESULTS: Local control rates were 91% and 78% after 6 and 12 months, respectively. Overall survival after treatment was 7.3 months, 6- and 12-month overall survival - 58% and 37%, respectively. In addition, 8 patients were available for follow-up. Of these, 6 ones demonstrated improvement or stabilization of neurological function after treatment. The main cause of death was progression of the underlying disease. No significant treatment-related toxic effects were observed. CONCLUSION: High-dose irradiation is a safe, effective and time-saving treatment for IMM. Considering unadvisable surgical methods and chemotherapy for this pathology, we can recommend high-dose irradiation for patients with spinal cord metastases.

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It was not until relatively recently that the method of stereotactic radiosurgery has started to be used for treating trigeminal neuralgia. Being minimally invasive, this method can be considered an attractive alternative to invasive surgical methods. OBJECTIVE: The objective of this study was to analyze the results of treatment in patients with trigeminal neuralgia using the Leksell Gamma Knife system. MATERIAL AND METHODS: The results of stereotactic radiosurgery were analyzed in 52 patients (31 females and 21 males aged 31 to 79 years) who had undergone treatment at the Radiosurgical Center of MIBS (St. Petersburg) in 2009-2016. Forty-four patients were diagnosed with typical trigeminal neuralgia; four patients, with atypical neuralgia; and four patients, with symptomatic neuralgia (accompanying multiple sclerosis). Pain severity was assessed using the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Scale (BNIPS) before and after the surgery, as well as during the follow-up period (mean duration, 3 years). RESULTS: Pain was reduced in 38 (86.4%) patients with type 1 neuralgia. The effect usually was not observed immediately after the surgery but was delayed from several weeks to 12 months (median, 2 months; interquartile range) [1, 4]. The surgery was ineffective in 6 (14%) patients. Eight (18%) patients had a relapse on average after 2 years and 5 months. By the end of the follow-up period, score I according to the BNIPS was achieved in 22 (50%) patients; score II or III was achieved in 7 (16%) patients. Primary reduction of pain was achieved in two patients with type 2 neuralgia; one of them had a relapse after 19 months. Among patients with symptomatic neuralgia, the primary effect was achieved in three patients, but two of them later had a relapse. CONCLUSION: Stereotactic radiosurgery can be used to alleviate pain in most patients with type 1 trigeminal neuralgia, but its results are inferior to those of invasive interventions. According to our findings, 18% of patients had a relapse. For patients with multiple sclerosis accompanied by type 2 and symptomatic trigeminal neuralgia, this method is not sufficiently effective. When both microvascular decompression and stereotactic radiosurgery can be used to treat for type 1 and 2 trigeminal neuralgia, patient's choice is crucial. It is important to inform the patient both about the potential complications of the interventions and about the delayed effect of the surgery and relapse frequency.

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The outcomes of Gamma Knife radiosurgery for 95 patients with melanoma brain metastases were studied. The majority of the patients (82%) presented multiple metastatic brain lesions. Local control was achieved in 94% of cases. The Kaplan-Maier analyses of life expectancy revealed that median survival after radiosurgical treatment was 6.9 months. The median survival by RTOG RPA class was 18,3 months for class I; 6.9 months for class II and 3.9 months for class III. These results demonstrate that Gamma Knife radiosurgery provides a high level of local control for melanoma brain metastases and may increase the life expectancy.

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Gamma-Knife radiosurgery treatment for intracranial metastases of renal-cell cancer results are presented. Treatments were made in 3 Eastern European Centers: in Prague, Moscow and St. Petersburg from 2000 to 2011. 312 patients were treated. Median survival was 8 months (1-91 months). Follow up data were collected for 210 patients. Neurologic state worsening had place at 12% patients, but only 4% of deterioration cases are connected to GKRS. Causes of the rest cases are related to new metastases. Neurologic improvement was found at 29% of patients. Post-RS MRI data were available for 188 patients. Volume enlargement was observed at 10% of cases, but only 5% caused by continued growth. New metastases appeared at 53% of patients. Actuarial analysis didn't detect statistically significant differences in survival for such parameters as patient age, volume and number of metastases. Favorable prognostic factors (p < 0.05) were found to be Karnofsky state equal or more than 70, controlled primary tumor and absence of extracranial metastases, as well as marginal dose for largest metastasis more than 20 Gy. Now RS is one of the basic method of the discussed pathology treatment, that demonstrates high efficacy in relation to the tumor growth and the patient Quality of Life. It is noteworthy that the length of survival is determined by the depth of the complex treatment of primary disease and success of such treatment.

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