{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:11:56Z","timestamp":1779527516999,"version":"3.53.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,8]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Increased survival time after diagnosis of neoplastic disease has resulted in a gradual increase in spine tumor incidence. Radiosurgery is frequently a viable alternative to operative management in a population with severe medical comorbidities. The authors sought to assess the histopathological consequences of radiosurgery in the subset of patients progressing to operative intervention.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Eighteen patients who underwent radiosurgery for spine tumors between 2008 and 2014 subsequently progressed to surgical treatment. A histopathological examination of these cases was performed. Indications for surgery included symptomatic compression fractures, radiographic instability, and symptoms of cord or cauda equina compression. Biopsy samples were obtained from the tumor within the radiosurgical zone in all cases and were permanently fixated. Viable tumor samples were stained for Ki 67.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Fifteen patients had metastatic lesions and 3 patients had neurofibromas. The mean patient age was 57 years. The operative indication was symptomatic compression in 10 cases (67%). The most frequent metastatic lesions were breast cancer (4 cases), renal cell carcinoma (3), prostate cancer (2), and endometrial cancer (2). In 9 (60%) of the 15 metastatic cases, histological examination of the lesions showed minimal evidence of inflammation. Viable tumor at the margins of the radiosurgery was seen in 9 (60%) of the metastatic cases. Necrosis in the tumor bed was frequent, as was fibrotic bone marrow. Vascular ectasia was seen in 2 of 15 metastatic cases, but sclerosis with ectasia was frequent. No evidence of malignant conversion was seen in the periphery of the lesions in the 3 neurofibroma cases. In 1 case of neurofibroma, the lesion demonstrated some small areas of remnant tumor in the radiosurgical target zone.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This case series demonstrates important histopathological characteristics of spinal lesions treated by SRS. Regions with the highest exposure to radiation appear to be densely necrotic and show little evidence of tumor growth, whereas peripheral regions distant from the radiation dosage are more likely to demonstrate viable tumor in malignant and benign neoplasms. Physiological tissue appears to be similarly affected. With additional investigation, a more homogenized field of hypofractionated radiation exposure may allow for tumor obliteration with relative preservation of critical anatomical structures.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.5.focus16119","type":"journal-article","created":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T03:37:36Z","timestamp":1470022656000},"page":"E14","source":"Crossref","is-referenced-by-count":3,"title":["Histopathological examination of spine tumors after treatment with radiosurgery"],"prefix":"10.3171","volume":"41","author":[{"given":"Nathan T.","family":"Zwagerman","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"McDowell","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald L.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Division of Neuropathology, University of Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward A.","family":"Monaco","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Radiation Oncology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Gerszten","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16119","series-title":"J Neurosurg Spine","first-page":"430","article-title":"Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation","volume":"18","author":"Al-Omair","year":"2013"},{"key":"b2-focus16119","series-title":"Neurology","first-page":"91","article-title":"Experiences with metastatic neoplasms involving the spinal cord","volume":"9","author":"Barron","year":"1959"},{"key":"b3-focus16119","series-title":"Neurosurgery","first-page":"726","article-title":"Spinal metastasis: current status and recommended guidelines for management","volume":"5","author":"Black","year":"1979"},{"key":"b4-focus16119","series-title":"J Neurosurg Spine","first-page":"379","article-title":"Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases","volume":"16","author":"Boehling","year":"2012"},{"key":"b5-focus16119","series-title":"Diagnostic Immunohistochemistry","author":"Dabbs","year":"2002"},{"key":"b6-focus16119","series-title":"Radiology","first-page":"629","article-title":"Radiation-induced telangiectasia in the brain simulates cryptic vascular malformations at MR imaging","volume":"193","author":"Gaensler","year":"1994"},{"key":"b7-focus16119","series-title":"J Neurosurg","first-page":"599","article-title":"Transthoracic vertebrectomy for metastatic spinal tumors","volume":"89","author":"Gokaslan","year":"1998"},{"key":"b8-focus16119","series-title":"J Clin Oncol","first-page":"5075","article-title":"Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases","volume":"27","author":"Rose","year":"2009"},{"key":"b9-focus16119","series-title":"Radiother Oncol","first-page":"51","article-title":"Disruption of the blood-brain barrier as the primary effect of CNS irradiation","volume":"31","author":"Rubin","year":"1994"},{"key":"b10-focus16119","series-title":"AJNR Am J Neuroradiol","first-page":"45","article-title":"Radiation injury of the brain","volume":"12","author":"Valk","year":"1991"},{"key":"b11-focus16119","series-title":"Ann Thorac Surg","first-page":"1611","article-title":"Anterior approaches to the thoracic spine in patients with cancer: indications and results","volume":"64","author":"Walsh","year":"1997"},{"key":"b12-focus16119","series-title":"Neurosurgery","first-page":"226","article-title":"A review of image-guided intensity-modulated radiotherapy for spinal tumors","volume":"61","author":"Yamada","year":"2007"},{"key":"b1-focus16119","series-title":"J Neurosurg Spine","first-page":"430","article-title":"Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation","volume":"18","author":"Al-Omair","year":"2013"},{"key":"b2-focus16119","series-title":"Neurology","first-page":"91","article-title":"Experiences with metastatic neoplasms involving the spinal cord","volume":"9","author":"Barron","year":"1959"},{"key":"b3-focus16119","series-title":"Neurosurgery","first-page":"726","article-title":"Spinal metastasis: current status and recommended guidelines for management","volume":"5","author":"Black","year":"1979"},{"key":"b4-focus16119","series-title":"J Neurosurg Spine","first-page":"379","article-title":"Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases","volume":"16","author":"Boehling","year":"2012"},{"key":"b5-focus16119","series-title":"Diagnostic Immunohistochemistry","author":"Dabbs","year":"2002"},{"key":"b6-focus16119","series-title":"Radiology","first-page":"629","article-title":"Radiation-induced telangiectasia in the brain simulates cryptic vascular malformations at MR imaging","volume":"193","author":"Gaensler","year":"1994"},{"key":"b7-focus16119","series-title":"J Neurosurg","first-page":"599","article-title":"Transthoracic vertebrectomy for metastatic spinal tumors","volume":"89","author":"Gokaslan","year":"1998"},{"key":"b8-focus16119","series-title":"J Clin Oncol","first-page":"5075","article-title":"Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases","volume":"27","author":"Rose","year":"2009"},{"key":"b9-focus16119","series-title":"Radiother Oncol","first-page":"51","article-title":"Disruption of the blood-brain barrier as the primary effect of CNS irradiation","volume":"31","author":"Rubin","year":"1994"},{"key":"b10-focus16119","series-title":"AJNR Am J Neuroradiol","first-page":"45","article-title":"Radiation injury of the brain","volume":"12","author":"Valk","year":"1991"},{"key":"b11-focus16119","series-title":"Ann Thorac Surg","first-page":"1611","article-title":"Anterior approaches to the thoracic spine in patients with cancer: indications and results","volume":"64","author":"Walsh","year":"1997"},{"key":"b12-focus16119","series-title":"Neurosurgery","first-page":"226","article-title":"A review of image-guided intensity-modulated radiotherapy for spinal tumors","volume":"61","author":"Yamada","year":"2007"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/2\/article-pE14.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/2\/article-pE14.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/2\/article-pE14.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:00:04Z","timestamp":1779526804000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/2\/article-pE14.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8]]},"references-count":24,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2016.5.focus16119","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8]]}}}