Changes in neurosurgical practise owing to radiosurgery
Various brain tumours show an increase of incidence owing largely to an elderly growing population. Prominent amongst them are brain metastases and meningioma. The treatment of brain metastases serves the upholding of good quality of life, as survival benefit is mainly determined by the systemic disease status. Out-patient radiosurgery with approximately 2% morbidity is best positioned to do so in case of a limited cranial tumour load. There are no surgical and anaesthesiological complications and no limitations due to multiplicity, location, co-morbidity or high age. Several of these advantages also pertain to benign meningioma. The 5-year survival approaches 85% and compares with outcome of malignancies like breast carcinoma and melanoma. Treatment, particularly in the elderly, exhibits high morbidity as made explicit by 25% of patients over 60 years old that will not return to home after surgery. Contrastingly, radiosurgery provides 10-year progression free survival in over 90% without major, invalidating, complications. Furthermore, in symptomatic, large tumours the availability of radiosurgery does allow surgeons to be more conservative in their approach. These practices lead to an ongoing shift from tumour removal towards tumour control by radiosurgery.