Gamma knife stereotactic radiosurgery for brain metastases using only 3 pins

Jennifer C. Ho, Dershan Luo, Nandita Guha-Thakurta, Sherise D. Ferguson, Amol J. Ghia, James N. Yang, Paul D. Brown, Khinh Ranh Voong

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Removal of a pin during Gamma Knife stereotactic radiosurgery (GK-SRS) may be necessary to prevent collision and allow treatment. OBJECTIVE: To investigate outcomes after GK-SRS for treatment of brain metastases using a head frame immobilized to the skull with only 3 pins. METHODS: Between 2009 and 2014, we retrospectively reviewed the records of 1971 patients and identified 20 patients with multiple brain metastases treated with GK-SRS in which 1 anterior pin was removed immediately before treatment of a single posterior lesion. GK-SRS was also delivered to 116 other lesions in these 20 patients using the standard 4 pins during the same session, serving as an internal control for comparison. Endpoints included local control, dosimetric parameters, toxicity, and overall survival. RESULTS: The median number of lesions treated per session was 6 (range, 2-14). The lesions treated using 3 pins were located in the occipital lobe (n 14) or the cerebellum (n 6). Median follow-up was 12.3 months. There was 1 local failure involving a control lesion. Lesions treated using 3 pins had a lower prescription isodose line. GK-SRS of a lesion using 3 pins did not cause any clinical toxicities or increase in radiographic edema or hemorrhage. CONCLUSION: Treating posteriorly located brain metastases with GK-SRS using only 3 pins provided excellent local control and no difference in treatment toxicity, which may make it a safe and reasonable option for lesions that may otherwise be difficult to treat.

Original languageEnglish (US)
Pages (from-to)877-882
Number of pages6
Issue number6
StatePublished - Jun 1 2016
Externally publishedYes


  • 3-Pins
  • Brain metastases
  • Gamma knife
  • Headframe
  • Radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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