The Most Challenging Case Yet Phantom limb pain: Everything tried over the years at the local and peripheral levels has failed, including active treatment by algology and neuropsychology. Treatments have included an L2-L5 radiosurgical rhizotomy and—as you can see in the images—our most powerful approach: bilateral thalamotomy (120 Gy) and bilateral cingulotomy (90 Gy). We are one year out, and pain intensity is 8 to 10 out of 10.
What to do? This patient—as with so many out there—goes beyond the limits of what is known to medical science. Invasive alternatives are always available, such as attempts at DBS or cortical stimulation (rTMS has failed as well on her), but I believe—and the literature could demonstrate—that they are inferior or at least not superior to radiosurgery, in addition to this they are currently not available.
What’s new? Connectomic-based radiosurgery with Brianlab Elemnts. The approach is bilateral irradiation (50 Gy DMax) of the thalamus, but now to the VPL (previously, we used our classic CM-PFc target), and now a subgenual cingulotomy guided by connections to the hypothalamus and amygdala (90 Gy DMax).
What’s with the low doses? Recently, our published data showed how 90 Gy can be necrotic; this patient has contrast enhancement as well where we delivered 90 Gy to the right cingulum at a more traditional “surgical” targeting technique above the corpus callosum. 50 Gy might not be necrotic, but hopefully the 20 Gy isodose line can be modulatory, and this encompasses both the VPL and the VPM.
We shall keep our fingers crossed, hoping we can alleviate this wonderful lady. I'll keep you posted in the upcoming months.
Big News! 🎉 We are excited to announce that the Brainlab Novalis Circle 10th International Conference is happening on September 17-19, 2026, in the vibrant city of Munich, Germany!
Mark your calendars and get ready for two full days of cutting-edge scientific talks and thought-provoking discussions, featuring some of the most brilliant minds in the world of stereotactic radiosurgery and stereotactic body radiation therapy.
It’s going to be an unforgettable event, and we can’t wait to see you there!
You can find more information here: Novalis Circle Conference 2026 | Brainlab
Novalis Circle is proud to partner with ISRS for two engaging sessions at the CNS Summit. In the plenary session, Dheerendra Prasad, MD, will present on how advanced software tools can enhance outcomes for a Gamma Knife practice. The Novalis Circle Symposium will explore cutting-edge approaches and provide valuable insights into the evolving role of radiosurgery in managing chronic pain, obsessive-compulsive disorder, and movement disorders. We are excited to welcome esteemed speakers to both the plenary session and the Novalis Circle Symposium.
Plenary Session
Wednesday, June 4, 2025 – 3.00–3.30 PM
Improving Outcomes via Longitudinal Patient Management Utilizing Advanced Software Tools in a Gamma Knife Practice
Dheerendra Prasad, MD, Roswell Park Cancer Institute, Buffalo, NY, US
Novalis Circle Symposium: Advancements in Functional Radiosurgery
Wednesday, June 4, 2025 – 3.45–4.45 PM (Room: A1)
- Radiosurgery to the Medial Thalamus for Chronic Pain: A Single Group Experience
Eduardo Lovo, MD, Instituto de Neurociencias de El Salvador, San Salvador, El Salvador
- Outcome Improvements in Obsessive-Compulsive Disorder Capsulomoty
Selçuk Peker, MD, Koç University School of Medicine, Istanbul, Turkey
- Standardization of Thalamotomy Targeting for Movement Disorders
Alfredo Conti, MD PhD, Ospedale Bellaria, Bologna, Italy
We’re looking forward to seeing you in Geneva in June!
Join the Symposium!
The Brainlab UK & Ireland Radiotherapy Symposium 2024 will focus on precision, personalization and evolution in radiotherapy and radiosurgery.
Led by the Charing Cross Hospital team, this meeting is an opportunity for clinicians, medical physicists and radiation oncologists to share insights on clinical techniques, exchange management approaches, tools and the use of big data in radiotherapy and radiosurgery treatments.
Attendees have the opportunity to take part in scientific talks, live demonstrations and informative discussions.
We look forward to seeing you all in London!
To register click here
Together with our partner Varay, we are pleased to invite you to our Israel User Meeting in HERZLIYA ON SEA in Tel Aviv.
This meeting is an opportunity for clinicians, medical physicists and radiation oncologists to share clinical techniques and discuss management approaches, tools and Big Data insights in primary and metastatic oncological radiotherapy treatment.
We are thrilled to have the chance to reconnect with you in person.
