{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:30:59Z","timestamp":1786728659231,"version":"build-2736575974"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3]]},"abstract":"\n Background:<\/jats:title>\n Single-session stereotactic radiosurgery (SRS) is a proven and effective treatment modality for various benign, malignant, and functional intra-cranial pathologies. In certain situations, single-fraction SRS is limited because of lesion size and location. Hypo-fractionated gamma knife radiosurgery (hfGKRS) is an alternative approach for such unconventional indications.<\/jats:p>\n <\/jats:sec>\n \n Objective:<\/jats:title>\n To evaluate the feasibility, efficacy, safety, and complication profile of hfGKRS with evaluation of different fractionation schemes and dosing patterns.<\/jats:p>\n <\/jats:sec>\n \n Methodology:<\/jats:title>\n The authors prospectively evaluated 202 patients treated with frame-based hfGKRS over a 9-year period. GKRS was administered fractionated because of either a large volume (>14 cc) or an inability to spare neighboring organs at risk from permissible radiation in single-session GKRS. The inter-fraction interval was kept at 24 hours, and the dose calculation was performed with linear quadratic equations. Patients with more than 3 years of clinical and radiological follow-up were included in prospective analysis. At pre-decided follow-up criteria, treatment effects and side effects were documented on objective scales.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n A total of 169\/202 patients met inclusion criteria. 41% patients received treatment in three fractions, whereas 59% received two-fraction GKRS. Two patients of giant cavernous sinus hemangiomas were treated with 5 Gy in the five-fraction regimen. In patients with more than 3 years of follow-up, the obliteration rate was 88% for complex arteriovenous malformations (AVMs) treated with hfGKRS because of eloquent locations, whereas it was 62% for Spetzler\u2013Martin grade 4-5 AVMs. For non-AVM pathologies (meningiomas, schwannomas, pituitary adenomas, paragangliomas, hypothalamic hamartomas, etc.), the 5-year progression free survival was 95%. Tumor failure was noted in 0.05% patient population. Radiation necrosis developed in 8.1% patients, and radiation-induced brain edema developed in 12% patients. It was resistant to treatment in 4% patients. No patient developed radiation-induced malignancy. Hypo-fractionation did not provide any hearing improvement in giant vestibular schwannomas.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n hfGKRS is a valuable standalone treatment option for candidates unsuitable for single-session GKRS. The dosing parameters need to be tailored as per the pathology and neighboring structures. It provides comparable results to single-session GKRS with an acceptable safety and complication profile.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/0028-3886.373638","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T04:30:03Z","timestamp":1692851403000},"page":"S189-S197","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Hypo-fractionated Gamma Knife Radiosurgery for Intra-cranial Pathologies"],"prefix":"10.4103","volume":"71","author":[{"given":"Manjul","family":"Tripathi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narendra","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev A","family":"Sreenivasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirag K","family":"Ahuja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parth","family":"Jani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajkumar","family":"Bhatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupinder","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Mohindra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeev","family":"Chauhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-27-20240907","doi-asserted-by":"crossref","first-page":"415","DOI":"10.3340\/jkns.2020.0008","article-title":"Radiosurgery for cerebral arteriovenous malformation (AVM): Current treatment strategy and radiosurgical technique for large cerebral AVM","volume":"63","author":"Byun","year":"2020","journal-title":"J Korean Neurosurg Soc"},{"key":"R2-27-20240907","doi-asserted-by":"crossref","first-page":"826","DOI":"10.4103\/neuroindia.NI_220_17","article-title":"Dose fractionated gamma knife radiosurgery for large arteriovenous malformations on daily or alternate day schedule outside the linear quadratic model: Proof of concept and early results. A substitute to volume fractionation","volume":"65","author":"Mukherjee","year":"2017","journal-title":"Neurol India"},{"key":"R3-27-20240907","doi-asserted-by":"crossref","first-page":"e136","DOI":"10.1016\/j.wneu.2019.07.090","article-title":"Safety and efficacy of primary multisession dose fractionated gamma knife radiosurgery for jugular paragangliomas","volume":"131","author":"Tripathi","year":"2019","journal-title":"World Neurosurg"},{"key":"R4-27-20240907","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1186\/s13014-019-1390-1","article-title":"Hearing loss after radiosurgery-blame it on Cochlear dose or the radiation tool!","volume":"14","author":"Deora","year":"2019","journal-title":"Radiat Oncol"},{"key":"R5-27-20240907","doi-asserted-by":"crossref","first-page":"S219","DOI":"10.4103\/IJNO.IJNO_431_21","article-title":"Complications of stereotactic radiosurgery: Avoidable or inevitable?","volume":"4","author":"Tripathi","year":"2021","journal-title":"Int J Neurooncol"},{"key":"R6-27-20240907","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.3171\/2018.5.JNS181361","article-title":"Letter to the editor. 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