CyberKnife for the management of Cushing’s disease: our institutional experience and review of literature

Introduction: Surgery is the primary treatment for Cushing’s disease(CD). In cases with no biochemical remission after surgical resection or when recurrence occurs after a period of remission stereotactic radiosurgery (SRS) is used as alternative/adjuvant treatment. The aim of this study is to demonstrate the effectiveness of SRS and FSRS(Fractionated stereotactic radiosurgery) for the treatment of CD in a long term follow up. Methods: This is a retrospective study in which 41 patient (36 females and 5 males) who underwent surgery for CD from 2009 to 2019 were included. Out of 41 cases, 34 cases had microadenomas while 7 had macroadenomas. These patients had recurrence or persistence of hypercortisolism post-operatively. After multidisciplinary evaluation, these patients were treated by CyberKnife (SRS & FSRS). Results: Remission rate in our study was 60.97% with a median follow up period of 79.03 months. The median time to biochemical remission was 14 months. Tumour growth control was achieved in 95.12%. Hypopituitarism of different axes was seen in 34.14% patients. Secondary hypothyroidism was the most common pituitary insufficiency (34%) followed by secondary hypogonadism in 17%. Conclusion: CyberKnife radiosurgery and hypofractionated radiosurgery can be used as an adjuvant treatment in patient with active disease and no biochemical remission after one or multiple surgical resections. Risk of radiation induced hypopituitarism and other complication is relatively low 34.14% and tumour growth control is significantly higher. © 2021 The Neurosurgical Foundation

Shock wave physics and detonation physics – a stimulus for the emergence of numerous new branches in science and engineering

In the period of the Cold War (1945−1991), Shock Wave Physics and Detonation Physics (SWP&DP) – until the beginning of WWII mostly confined to gas dynamics, high-speed aerodynamics, and military technology (such as aero- and terminal ballistics, armor construction, chemical explosions, supersonic gun, and other firearms developments) – quickly developed into a large interdisciplinary field by its own. This rapid expansion was driven by an enormous financial support and two efficient feedbacks: the Terminal Ballistic Cycle and the Research & Development Cycle. Basic knowledge in SWP&DP, initially gained in the Classic Period (from 1808) and further extended in the Post-Classic Period (from the 1930s to present), is now increasingly used also in other branches of Science and Engineering (S&E). However, also independent S&E branches developed, based upon the fundamentals of SWP&DP, many of those developments will be addressed (see Tab. 2). Thus, shock wave and detonation phenomena are now studied within an enormous range of dimensions, covering microscopic, macroscopic, and cosmic dimensions as well as enormous time spans ranging from nano-/picosecond shock durations (such as produced by ultra-short laser pulses) to shock durations that continue for centuries (such as blast waves emitted from ancient supernova explosions). This paper reviews these developments from a historical perspective