Radiosurgical research: What has it told us? What do we still need to know?

Radiosurgery has become a preferred management modality for many intracranial tumors such as schwannomas, menigiomas and metastatic tumors. Radiosurgery, in contrast to conventional radiotherapy, entails the use of a high dose of focused radiation delivered in a single session. The effects and the pathogenesis of biologic effects following radiosurgery may be unique. The need for basic research concerning the radiobiology of high-dose single-fraction ionizing radiation on nervous system tissue is crucial. Information from those studies would be useful in devising strategies to avoid, prevent, or ameliorate damage to normal tissue without compromising treatment efficacy. The development of future applications of radiosurgery will depend upon an increase in our understanding of radiobiology of radiosurgery that can impact the efficacy of treatment. The present review examines the current state of radiosurgery research with regard to, the nature of central nervous system (CNS) effects, the techniques developed for increasing therapeutic efficacy, investigations into the use of radiosurgery for functional disorders, radiosurgery as a tool for investigations into basic CNS biology, and the additional areas that require further investigation.