Gutierrez-Aceves Guillermo Axayacalt, Rodriguez-Camacho Alejandro, Celis-Lopez Miguel Angel, Moreno-Jimenez Sergio, Herrera-Gonzalez Jose Alfredo
Radio Neurosurgery Unit, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico.
Surg Neurol Int. 2020 Nov 18;11:398. doi: 10.25259/SNI_247_2020. eCollection 2020.
We describe the technical report and results of the first image-guided, linear accelerator, frameless radiosurgical third ventriculostomy.
We report a 20 years old man, with diplopia, balance disturbances, and limitation for gaze supraversion. Magnetic resonance imaging resonance imaging of the brain and cranial computed tomography showed showed a left thalamic-midbrain lesion that caused partial compression of the Silvio aqueduct and mild ventricular dilatation. The biopsy revealed the diagnosis of pleomorphic xanthoastrocytoma. Before radical treatment of the tumor with fractionated stereotactic radiotherapy, the patient underwent to frameless radiosurgical third ventriculostomy, on the TrueBeam STX® platform with the ExacTrac localization system. The target used was the one defined on the floor of the third ventricle, at the midpoint between the mammillary bodies and the infundibular recess. The prescription dose was 120 Gy, given using a monoisocentric technique of multiple noncoplanar circular arches. The geometric arrangement of the plan consisted of 15 arches, with a 4 mm cone, distributed over a 110° table.
There was symptomatic and image improvement two days after radiosurgery. On CT, a reduction in ventricular dilation was observed with a reduction in the Evans index from 0.39 (initial CT) to 0.29 (CT at 15 days). In 3.0T magnetic resonance image at 3 months, we showed the third ventriculostomy. There have been no treatment failures or complications.
It is possible to effectively perform the frameless radiosurgical third ventriculostomy without associated morbidity in the short term.
我们描述了首例影像引导下的直线加速器无框架放射外科第三脑室造瘘术的技术报告及结果。
我们报告了一名20岁男性，有复视、平衡障碍及上视受限症状。脑部磁共振成像和头颅计算机断层扫描显示左丘脑 - 中脑病变，导致西尔维奥导水管部分受压及轻度脑室扩张。活检确诊为多形性黄色星形细胞瘤。在对肿瘤进行分次立体定向放射治疗的根治性治疗前，患者在TrueBeam STX®平台上使用ExacTrac定位系统接受了无框架放射外科第三脑室造瘘术。所用靶点为第三脑室底部，乳头体与漏斗隐窝中点处确定的靶点。处方剂量为120 Gy，采用单等中心技术的多个非共面圆形弧给予。计划的几何布局由15个弧组成，使用4毫米准直器，分布在110°的治疗床角度范围内。
放射外科手术后两天症状及影像学表现有所改善。CT显示脑室扩张减轻，埃文斯指数从0.39（初始CT）降至0.29（第15天CT）。3个月时的3.0T磁共振成像显示了第三脑室造瘘情况。未出现治疗失败或并发症。
短期内可有效实施无框架放射外科第三脑室造瘘术且无相关并发症。
