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Stereotactic radiosurgery--an organized neurosurgery-sanctioned definition.

Since its introduction five decades ago, stereotactic radiosurgery (SRS) has evolved from an investigational concept into a mainstream neurosurgical procedure for the management of a wide variety of brain disorders. Contemporary neurosurgeons routinely use radiosurgery either as a definitive or adjuvant treatment modality in the fields of neurooncology and cerebrovascular and functional neurosurgery. Stereotactic radiosurgery offers the surgical neurooncologist a precise and established treatment that, in combination with fractionated radiotherapy, chemotherapy, and conventional surgery, offers additional management options for the treatment of patients with brain tumors.4,5,12 The role of SRS in the management of vascular malformations is also well established. Furthermore, this modality has had a significant impact on the treatment of patients with brain metastases;4,26,51 in cases in which SRS is possible, these patients more commonly succumb to their uncontrolled extracranial disease than to their intracranial disease. Recently there has been a spate of reports attempting to clarify or to (re)define the terms “stereotactic radiosurgery” and “stereotactic radiotherapy” (SRT).1,48,66 It has become increasingly clear that the evolution of radiosurgery and radiotherapeutic techniques demands a reevaluation of the definition of radiosurgery by organized neurosurgery. These factors led the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) to form the Stereotactic Radiosurgery Task Force under the auspices of the AANS/CNS Washington Committee. Members of the Stereotactic Radiosurgery Task Force were directed to review, clarify, and recommend to their parent organizations a contemporary definition of SRS, which would take into account historical, current, and potential applications of SRS. The purpose of this paper is to express the position of the AANS as well as that of the CNS on the definition of SRS.