The International Radiosurgery Research Foundation consists of academic and clinical centers of excellence where brain Stereotactic Radiosurgery is performed using the Leksell Gamma Knife. All participating centers have a track record of outcomes research and participation in clinical trials.
The primary goal of the IRRF is to facilitate retrospective and prospective clinical trials and outcomes analysis that evaluates the role of Gamma Knife radiosurgery in a wide spectrum of clinical indications.
Because individual centers may evaluate only a small number of patients with rare conditions, pooling of information is critical to evaluate and to improve outcomes. Each center has a professional team consisting of one or more neurological surgeons, radiation oncologists, and medical physicists. Participation is by invitation of the Board of Directors. The IRRF is a non-profit scientific, educational, and research entity incorporated in the state of Pennyslvania.
Chen et al. retrospectively reviewed the International Radiosurgery Research Foundation AVM databases from 1987 to 2018. Patients were categorized into the embolization and SRS (E + SRS) or SRS alone (SRS-only) cohorts. The 2 cohorts were matched in a 1:1 ratio using propensity scores. The primary outcome was defined as AVM obliteration. Secondary outcomes were post-SRS hemorrhage, all-cause mortality, radiologic and symptomatic radiation-induced changes (RIC), and cyst formation.
The matched cohorts each comprised 101 patients. Crude AVM obliteration rates were similar between the matched E + SRS vs SRS-only cohorts (48.5% vs 54.5%; odds ratio = 0.788, P = .399). Cumulative probabilities of obliteration at 3, 4, 5, and 6 yr were also similar between the E + SRS (33.0%, 46.4%, 56.2%, and 60.8%, respectively) and SRS-only (32.9%, 46.2%, 56.0%, and 60.6%, respectively) cohorts (subhazard ratio (SHR) = 1.005, P = .981). Cumulative probabilities of radiologic RIC at 3, 4, 5, and 6 yr were lower in the E + SRS (25.0%, 25.7%, 26.7%, and 26.7%, respectively) vs SRS-only (45.3%, 46.2%, 47.8%, and 47.8%, respectively) cohort (SHR = 0.478, P = .004). Symptomatic and asymptomatic embolization-related complication rates were 8.3% and 18.6%, respectively. Rates of post-SRS hemorrhage, all-cause mortality, symptomatic RIC, and cyst formation were similar between the matched cohorts.
This study refutes the prevalent notion that AVM embolization negatively affects the likelihood of obliteration after SRS 1).
Nidal embolization using Onyx does not appear to differentially impact the outcomes of AVM SRS compared with non-Onyx embolysates. The embolic agent selected for pre-SRS AVM embolization should reflect both the experience of the neurointerventionalist and target of endovascular intervention 2).
Approximately one-quarter of pediatric AVMs that become obliterated after SRS will achieve this radiological endpoint within 24 months of initial SRS. The authors identified multiple factors associated with early obliteration, which may aid in prognostication and management. The overall risks of delayed hemorrhage, RICs, cyst formation, and tumor formation were not statistically different in patients with early versus late obliteration 3).
Publications Books: Intracranial Stereotactic Radiosurgery, (2nd edition), Lunsford LD, Sheehan JP. Thieme, 2015 Articles: 2018
Effect of treatment period on outcomes after stereotactic radiosurgery for brain arteriovenous malformations: an international multicenter study. Patibandla MR, Ding D, Kano H, Starke RM, Lee JYK, Mathieu D, Whitesell J, Pierce JT, Huang PP, Kondziolka D, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Missios S, Barnett GH, Lunsford LD, Sheehan JP. J Neurosurg [Epub ahead of print], 2018.
2017
Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study. Pomeraniec IJ, Kano H, Xu Z, Nguyen B, Siddiqui ZA, Silva D, Sharma M, Radwan H, Cohen JA, Dallapiazza RF, Iorio-Morin C, Wolf A, Jane JA Jr, Grills IS, Mathieu D, Kondziolka D, Lee CC, Wu CC, Cifarelli CP, Chytka T, Barnett GH, Lunsford LD, Sheehan JP. J Neurosurg [Epub ahead of print], 2017.
Outcomes of stereotactic radiosurgery for foramen magnum meningiomas: an international multicenter study. Mehta GU, Zenonos G, Patibandla MR, Lin CJ, Wolf A, Grills I, Mathieu D, McShane B, Lee JY, Blas K, Kondziolka D, Lee CC, Lunsford LD, Sheehan JP. J Neurosurg [Epub ahead of print], 2017.
Stereotactic radiosurgery for jugular foramen schwannomas: an international multicenter study. Kano H, Meola A, Yang HC, Guo WY, Martínez-Alvarez R, Martínez-Moreno N, Urgosik D, Liscak R, Cohen-Inbar O, Sheehan J, Lee JYK, Abbassy M, Barnett GH, Mathieu D, Kondziolka D, Lunsford LD. J Neurosurg [Epub ahead of print], 2017.
Stereotactic radiosurgery for Spetzler-Martin Grade IV and V arteriovenous malformations: an international multicenter study. Patibandla MR, Ding D, Kano H, Xu Z, Lee JYK, Mathieu D, Whitesell J, Pierce JT, Huang PP, Kondziolka D, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Missios S, Barnett GH, Lunsford LD, Sheehan JP. J Neurosurg [Epub ahead of print], 2017.
Relapsed or Refractory Primary Central Nervous System Lymphoma Radiosurgery: Report of the International Gamma Knife Research Foundation. Shin SM, Silverman JS, Bowden G, Mathieu D, Yang H, Cheng-chia L, Tam M, Szelemej P, Kaufmann AM, Cohen-Inbar O, Sheehan J, Niranjan A, Lunsford LD, Kondziolka D. 4(4):247-53, 2017.
Early versus late arteriovenous malformation responders after stereotactic radiosurgery: an international multicenter study. Cohen-Inbar O, Starke RM, Paisan G, Kano H, Huang PP, Rodriguez-Mercado R, Almodovar L, Grills IS, Mathieu D, Silva D, Abbassy M, Missios S, Lee JYK, Barnett GH, Kondziolka D, Lunsford LD, Sheehan JP. J Neurosurg 127(3):503-511, 2017.
Stereotactic radiosurgery for cerebral arteriovenous malformations: evaluation of long-term outcomes in a multicenter cohort. Starke RM, Kano H, Ding D, Lee JY, Mathieu D, Whitesell J, Pierce JT, Huang PP, Kondziolka D, Yen CP, Feliciano C, Rodgriguez-Mercado R, Almodovar L, Pieper DR, Grills IS, Silva D, Abbassy M, Missios S, Barnett GH, Lunsford LD, Sheehan JP. J Neurosurg 126(1):36-44, 2017.
Stereotactic radiosurgery for intracranial hemangiopericytomas: a multi center study. Cohen-Inbar O, Lee CC, Mousavi SH, Kano H, Mathieu D, Meola A, Nakaji P, Honea N, Johnson M, Abbassy M, Mohammadi AM, Silva D, Yang HC, Grills I, Kondziolka D, Barnett GH, Lunsford LD, Sheehan J. J Neurosurg 126(3):744-754, 2017.
Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations: Evaluation of Long-Term Outcomes in a Multicenter Cohort. Starke RM, Kano H, Ding D, Lee JY, Mathieu D, Whitesell J, Pierce JT, Huang PP, Kondziolka D, Yen CP, Feliciano C, Rodgriguez-Mercado R, Almodovar L, Pieper DR, Grills IS, Silva D, Abbassy M, Missios S, Barnett GH, Lunsford LD, Sheehan JP. J Neurosurg 126(1):36-44, 2017.
Stereotactic radiosurgery for cerebellar arteriovenous malformations: an international multicenter study. Cohen-Inbar O, Starke RM, Kano H, Bowden G, Huang P, Rodriguez-Mercado R, Almodovar L, Grills IS, Mathieu D, Silva D, Abbassy M, Missios S, Lee JYK, Barnett GH, Kondziolka D, Lunsford LD, Sheehan JP. J Neurosurg 127(3):512-521, 2017.
Gamma Knife radiosurgery for hemangioma of the cavernous sinus. Lee CC, Sheehan JP, Kano H, Akpinar B, Martinez-Alvarez R, Martinez-Moreno N, Guo WY, Lunsford LD, Liu KD. J Neurosurg 126(5):1498-1505, 2017.
International multicenter cohort study of pediatric brain arteriovenous malformations: Part 1: Predictors of hemorrhagic presentation. Ding D, Starke RM, Kano H, Mathieu D, Huang PP, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Missios S, Kondziolka D, Barnett GH, Dade Lunsford L, Sheehan JP. J Neurosurg Pediatr 19(2):127-135, 2017.
International multicenter cohort study of pediatric brain arteriovenous malformations: Part 2: Outcomes after stereotactic radiosurgery. Starke RM, Ding D, Kano H, Mathieu D, Huang PP, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Missios S, Kondziolka D, Barnett GH, Dade Lunsford L, Sheehan JP. J Neurosurg Pediatr 19(2):136-148, 2017.
Stereotactic radiosurgery for Spetzler-Martin Grade III arteriovenous malformations: an international multicenter study. Ding D, Starke RM, Kano H, Lee JY, Mathieu D, Pierce J, Huang PP, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Missios S, Kondziolka D, Barnett GH, Lunsford LD, Sheehan JP. J Neurosurg 126(3):859-871, 2017.
Stereotactic Radiosurgery for Brainstem Arteriovenous Malformations: A Multicenter Study. Cohen-Inbar O, Starke RM, Lee CC, Kano H, Huang P, Kondziolka D, Grills IS, Silva D, Abbassy M, Missios S, Barnett GH, Lunsford LD, Sheehan JP. Neurosurgery 81(6):910-920, 2017.
Radiosurgery for Unruptured Brain Arteriovenous Malformations: An International Multicenter Retrospective Cohort Study. Ding D, Starke RM, Kano H, Lee JYK, Mathieu D, Pierce J, Huang P, Missios S, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Kondziolka D, Barnett GH, Lunsford LD, Sheehan JP. Neurosurgery 80(6):888-898, 2017.
Histology-Stratified Tumor Control and Patient Survival After Stereotactic Radiosurgery for Pineal Region Tumors: A Report From the International Gamma Knife Research Foundation. Iorio-Morin C, Kano H, Huang M, Lunsford LD, Simonová G, Liscak R, Cohen-Inbar O, Sheehan J, Lee CC, Wu HM, Mathieu D. World Neurosurg 107:974-982, 2017.
Prognostic significance of corticotroph staining in radiosurgery for Non-Functioning Pituitary Neuroendocrine Tumors: a multicenter study. Cohen-Inbar O, Xu Z, Lee CC, Wu CC, Chytka T, Silva D, Sharma M, Radwan H, Grills IS, Nguyen B, Siddiqui Z, Mathieu D, Iorio-Morin C, Wolf A, Cifarelli CP, Cifarelli DT, Lunsford LD, Kondziolka D, Sheehan JP. J Neurooncol 135(1):67-74, 2017.
Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study. Mehta GU, Ding D, Patibandla MR, Kano H, Sisterson N, Su YH, Krsek M, Nabeel AM, El-Shehaby A, Kareem KA, Martinez-Moreno N, Mathieu D, McShane B10, Blas K, Kondziolka D, Grills I, Lee JY, Martinez-Alvarez R, Reda WA, Liscak R, Lee CC, Lunsford LD, Vance ML, Sheehan JP. J Clin Endocrinol Metab 102(11):4284-4291, 2017.
2016
Radiosurgery for Cerebral Arteriovenous Malformations in A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA)-Eligible Patients: A Mulicenter Study. Ding D, Starke RM, Kano H, Mathieu D, Huang P, Kondziolka D, Feliciano C, Rodriguez-Mercado R, Almodovar L, Grills IS, Silva D, Abbassy M, Missios S, Barnett GH, Lunsford LD, Sheehan JP. Stroke 47(2):342-9, 2016.
Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity. Trifiletti DM, Lee CC, Kano H, Cohen J, Janopaul-Naylor J, Alonso-Basanta M, Lee JYK, Simonova G, Liscak R, Wolf A, Kvint S, Grills IS, Johnson M, Liu KD, Lin CJ, Mathieu D, Héroux F, Silva D, Sharma M, Cifarelli CP, Watson CN, Hack JD, Golfinos JG, Kondziolka D, Barnett G, Lunsford LD, Sheehan J. Int J Radiat Oncol Biol Phys 96(2):280-288, 2016.
Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: an international multicenter study. Kano H, Urgosik D, Liscak R, Pollock BE, Cohen-Inbar O, Sheehan JP, Sharma M, Silva D, Barnett GH, Mathieu D, Sisterson ND, Lunsford LD. J Neurosurg 125(Suppl 1):147-153, 2016.
Using a Machine Learning Approach to Predict Outcomes after Radiosurgery for Cerbral Arteriovenous Malformations. Oermann EK, Rubinsteyn A, Ding D, Mascitelli J, Starke RM, Bederson JB, Kano H, Lunsford LD, Sheehan JP, Hammerbacher J, Kondziolka D. Sci Rep 6:21161, 2016.
2015
The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia. Tempel ZJ, Chivukula S, Monaco EA 3rd, Bowden G, Kano H, Niranjan A, Chang EF, Sneed PK, Kaufmann AM, Sheehan J, Mathieu D, Lunsford LD. J Neurosurg 122(1):169-79, 2015. Stereotactic radiosurgery for intracranial hemangioblastomas: A retrospective international outcome study. Kano H, Shuto T, Iwai Y, Sheehan J, Yamamoto M, McBride HL, Sato M7, Serizawa T, Yomo S, Moriki A, Kohda Y, Young B, Suzuki S, Kenai H, Duma C, Kikuchi Y, Mathieu D, Akabane A, Nagano O, Kondziolka D, Lunsford LD. J Neurosurg 122(6):1469-78, 2015.
Gamma Knife radiosurgery for posterior fossa meningiomas: A multicenter study. Sheehan JP, Starke RM, Kano H, Barnett GH, Mathieu D, Chiang V, Yu JB, Hess J, McBride HL, Honea N, Nakaji P, Lee JY, Rahmathulla G, Evanoff WA, Alonso-Basanta M, Lunsford LD. J Neurosurg 122(6):1479-89, 2015.
Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study. Sheehan JP, Kano H, Xu Z, Chiang V, Mathieu D, Chao S, Akpinar B, Lee JY, Yu JB, Hess J, Wu HM, Chung WY, Pierce J, Missios S, Kondziolka D, Alonso-Basanta M, Barnett GH, Lunsford LD. J Neurosurg 123:387-394, 2015.
Skull base chondrosarcoma radiosurgery: report of the North American Gamma Knife Consortium. Kano H, Sheehan J, Sneed PK, McBride HL, Young B, Duma C, Mathieu D, Seymour Z, McDermott MW, Kondziolka D, Iyer A, Lunsford LD. J Neurosurg 123(5):1268-75, 2015.
Post-radiosurgical edema associated with parasagittal and parafalcine meningiomas: a multicenter study. Sheehan JP, Cohen-Inbar O, Ruangkanchanasetr R, Bulent Omay S, Hess J, Chiang V, Iorio-Morin C, Alonso-Basanta M, Mathieu D, Grills IS, Lee JY, Lee CC, Dade Lunsford L. J Neurooncol 125(2):317-24.
2014
Gamma Knife radiosurgery for cellar and parasellar meningiomas: a multicenter study. Sheehan JP, Starke RM, Kano H, Kaufmann AM, Mathieu D, Zeiler FA, West M, Chao ST, Varma G, Chiang VL, Yu JB, McBride HL, Nakaji P, Youssef E, Honea N, Rush S, Kondziolka D, Lee JY, Bailey RL, Kunwar S, Petti P, Lunsford LD. J Neurosurg 120(6):1268-77, 2014.
Radiosurgery is an effective treatment for recurrent esthesioneuroblastoma: A multicenter study. Van Gompel JJ, Link MJ, Sheehan JP, Xu Z, Mathieu D, Kano H, Lunsford LD. J Neurol Surg B Skull Base 75(6):409-14, 2014.
Gamma Knife Radiosurgery for Cerebellopontine Angle Meningiomas: A Multicenter Study.Ding D, Starke RM, Kano H, Nakaji P, Barnett GH, Mathieu D, Chiang V, Omay SB, Hess J, McBride HL, Honea N, Lee JY, Rahmathulla G, Evanoff WA, Alonso-Basanta M, Lunsford LD, Sheehan JP. Neurosurgery 75(4):398-408, 2014.
Stereotactic radiosurgery of petroclival meningiomas: a multicenter study. Starke R, Kano H, Ding D, Nakaji P, Barnett GH, Mathieu D, Chiang V, Yu JB, Hess J, McBride HL, Honea N, Lee JY, Rahmathulla G, Evanoff WA, Alonso-Basanta M, Lunsford LD, Sheehan JP. J Neurooncol 119(1):169-76, 2014.
2013
Gamma Knife radiosurgery for the management of nonfunctioning pituitary neuroendocrine tumors: a multicenter study. Sheehan JP, Starke RM, Mathieu D, Young B, Sneed PK, Chiang VL, Lee JY, Kano H, Park KJ, Niranjan A, Kondziolka D, Barnett GH, Rush S, Golfinos JG, Lunsford LD. J Neurosurg 119(2):446-56, 2013.
2012
Gamma Knife surgery for the management of glomus tumors: a multicenter study. Sheehan JP, Tanaka S, Link MJ, Pollock BE, Kondziolka D, Mathieu D, Duma C, Young AB, Kaufmann AM, McBride H, Weisskopf PA, Xu Z, Kano H, Yang HC, Lunsford LD. J Neurosurg 117(2):246-54, 2012.
2011
Stereotactic radiosurgery for chordoma: a report from the North American Gamma Knife Consortium. Kano H, Iqbal FO, Sheehan J, Mathieu D, Seymour ZA, Niranjan A, Flickinger JC, Kondziolka D, Pollock BE, Rosseau G, Sneed PK, McDermott MW, Lunsford LD. Neurosurgery 68(2):379-89, 2011.
Stereotactic radiosurgery for intractable cluster headache: an initial report from the North American Gamma Knife Consortium. Kano H, Kondziolka D, Mathieu D, Stafford SL, Flannery TJ, Niranjan A, Pollock BE, Kaufmann AM, Flickinger JC, Lunsford LD. J Neurosurg 114(6):1736-43, 2011.