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Related Experiment Video

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Frameless radiosurgical third ventriculostomy: Technical report.

Guillermo Axayacalt Gutierrez-Aceves1, Alejandro Rodriguez-Camacho1, Miguel Angel Celis-Lopez1

  • 1Radio Neurosurgery Unit, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico.

Surgical Neurology International
|December 7, 2020
PubMed
Summary
This summary is machine-generated.

Frameless radiosurgical third ventriculostomy effectively treated a patient with a thalamic-midbrain lesion, relieving symptoms and reducing ventricular dilation without short-term complications.

Keywords:
FramelessLinear acceleratorObstructive hydrocephalusRadiosurgeryThird ventriculostomy

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Medical Imaging

Background:

  • Describes the first image-guided, linear accelerator, frameless radiosurgical third ventriculostomy.
  • Details a case of a 20-year-old male with neurological deficits due to a thalamic-midbrain lesion causing aqueductal compression and hydrocephalus.

Purpose of the Study:

  • To report the technical aspects and outcomes of a novel frameless radiosurgical third ventriculostomy.
  • To evaluate the efficacy and safety of this minimally invasive procedure for treating obstructive hydrocephalus.

Main Methods:

  • Patient presented with diplopia and balance issues; MRI/CT revealed a left thalamic-midbrain pleomorphic xanthoastrocytoma.
  • Frameless radiosurgical third ventriculostomy performed using TrueBeam STX and ExacTrac localization, targeting the floor of the third ventricle.
  • A dose of 120 Gy was delivered via a monoisocentric technique with 15 noncoplanar arcs using a 4 mm cone.

Main Results:

  • Symptomatic and imaging improvements observed within two days post-radiosurgery.
  • Significant reduction in ventricular dilation (Evans index decreased from 0.39 to 0.29).
  • Successful third ventriculostomy confirmed on MRI at 3 months, with no treatment failures or complications.

Conclusions:

  • Frameless radiosurgical third ventriculostomy is an effective procedure.
  • This technique can be performed without significant short-term morbidity.