Computer-assisted stereotaxic laser resection of intra-axial brain neoplasms

1986 ◽  
Vol 64 (3) ◽  
pp. 427-439 ◽  
Author(s):  
Patrick J. Kelly ◽  
Bruce A. Kall ◽  
Stephan Goerss ◽  
Franklin Earnest
Keyword(s):  
Brain Stem ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Vascular Lesions ◽  
Computer Assisted ◽  
Lower Grade ◽  
Metastatic Tumors ◽  
Content Type ◽  
Contrast Enhanced Ct ◽  
Fine Print

✓ Computer interpolation of stereotaxic computerized tomography (CT) scanning data allows the transposition of a tumor volume in stereotaxic space. A stereotaxically directed and computer-monitored CO2 laser is then utilized to vaporize that volume as the surgeon monitors the position of a cursor representing the laser beam against planar contours of the tumor displayed on an operating room computer monitor. Computer-assisted stereotaxic laser microsurgery provides precise three-dimensional control for aggressive resection of deep-seated tumors from neurologically important areas with acceptable postoperative results. Thus, a significant cytoreduction can be achieved in addition to providing a tissue diagnosis and internal decompression. The authors report 83 computer-assisted stereotaxic laser procedures for tumor excision in 78 patients. The tumors were located in the thalamus/basal ganglia in 15 patients, ventricular system in five, corpus callosum in four, brain stem in three, and deep and centrally in the hemispheres in 51. Histologically, there were 26 glioblastomas, seven grade III astrocytomas, 14 grade II astrocytomas, 14 metastatic tumors, nine vascular lesions, and eight miscellaneous lesions. Resection of these subcortical lesions was confirmed by postoperative contrast-enhanced CT scanning. Neurological examinations performed 1 week after the 83 procedures revealed that 48 patients had improved from their preoperative level and 23 were unchanged (12 were neurologically normal preoperatively). Twelve patients had an increase in a preoperative neurological deficit, three of whom died in the postoperative period: one from infection, one from pulmonary emboli, and one from brain-stem edema. The average survival period (37.6 weeks) of patients having glioblastomas treated by this technique and irradiation was no different from that of patients having glioblastomas in more favorable locations treated by conventional surgery and irradiation. Patients with circumscribed lower-grade astrocytomas did better in terms of morbidity and completeness of resection than those with infiltrative neoplasms. Other circumscribed lesions, such as metastatic tumors, vascular lesions, and intraventricular tumors, were easily resected by the technique described.

A three-dimensional reconstruction of the human brain stem

1982 ◽  
Vol 57 (4) ◽  
pp. 491-495 ◽  
Author(s):  
Farhad Afshar ◽  
Eric Dykes
Keyword(s):  
Human Brain ◽  
Brain Stem ◽  
Computer Technology ◽  
Three Dimensional ◽  
Three Dimensional Reconstruction ◽  
Content Type ◽  
Stereotaxic Surgery ◽  
Stereotaxic Atlas ◽  
Dimensional Reconstruction ◽  
Fine Print

✓ Advances in computer technology and color graphics have been applied to the sections in a stereotaxic atlas of the human brain stem to enable three-dimensional reconstructions of nuclei and tracts. Techniques for viewing the reconstructed brain stem from multiple directions and in stereo have been achieved. The application of these methods and the use of color graphics are discussed with respect to stereotaxic surgery and computer dissection in neuroanatomical studies.

Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage

1999 ◽  
Vol 91 (3) ◽  
pp. 424-431 ◽  
Author(s):  
Yasuo Murai ◽  
Ryo Takagi ◽  
Yukio Ikeda ◽  
Yasuhiro Yamamoto ◽  
Akira Teramoto
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
3D Ct ◽  
Content Type ◽  
Hematoma Enlargement ◽  
3D Ct Angiography ◽  
Fine Print

Object. The authors confirm the usefulness of extravasation detected on three-dimensional computerized tomography (3D-CT) angiography in the diagnosis of continued hemorrhage and establishment of its cause in patients with acute intracerebral hemorrhage (ICH).Methods. Thirty-one patients with acute ICH in whom noncontrast and 3D-CT angiography had been performed within 12 hours of the onset of hemorrhage and in whom conventional cerebral angiographic studies were obtained during the chronic stage were prospectively studied. Noncontrast CT scanning was repeated within 24 hours of the onset of ICH to evaluate hematoma enlargement.Findings indicating extravasation on 3D-CT angiography, including any abnormal area of high density on helical CT scanning, were observed in five patients; three of these demonstrated hematoma enlargement on follow-up CT studies. Thus, specificity was 60% (three correct predictions among five positives) and sensitivity was 100% (19 correct predictions among 19 negatives). Evidence of extravasation on 3D-CT angiography indicates that there is persistent hemorrhage and correlates with enlargement of the hematoma.Regarding the cause of hemorrhage, five cerebral aneurysms were visualized in four patients, and two diagnoses of moyamoya disease and one of unilateral moyamoya phenomenon were made with the aid of 3D-CT angiography. Emergency surgery was performed without conventional angiography in one patient who had an aneurysm, and it was clipped successfully.Conclusions. Overall, 3D-CT angiography was found to be valuable in the diagnosis of the cause of hemorrhage and in the detection of persistent hemorrhage in patients with acute ICH.

Three-dimensional angiography for radiosurgical treatment planning for arteriovenous malformations

2003 ◽  
Vol 98 (3) ◽  
pp. 536-543 ◽  
Author(s):  
Federico Colombo ◽  
Carlo Cavedon ◽  
Paolo Francescon ◽  
Leopoldo Casentini ◽  
Umberto Fornezza ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Imaging Modality ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Ct Scanning ◽  
New Method ◽  
Rotational Angiography ◽  
Content Type ◽  
3D Rotational Angiography ◽  
Fine Print

Object. Radiosurgical treatment of a cerebral arteriovenous malformation (AVM) requires the precise definition of the nidus of the lesion in stereotactic space. This cannot be accomplished using simple stereotactic angiography, but requires a combination of stereotactic biplanar angiographic images and stereotactic contrast-enhanced computerized tomography (CT) scans. In the present study the authors describe a method in which three-dimensional (3D) rotational angiography is integrated into stereotactic space to aid treatment planning for radiosurgery. Methods. Twenty patients harboring AVMs underwent treatment planning prior to linear accelerator radiosurgery. Planning involved the acquisition of two different data sets, one of which was obtained using the standard method (a combination of biplanar stereotactic angiography with stereotactic CT scanning), and the other, which was procured using a new technique (nonstereotactic 3D rotational angiography combined with stereotactic CT scanning by a procedure of image fusion). The treatment plan that was developed using the new method was compared with that developed using the standard one. For each patient the number of isocenters and the dimension of selected collimators were the same, based on the information supplied in both methods. Target coordinates were modified in only five cases and by a limited amount (mean 0.7 mm, range 0.3–1 mm). Conclusions. The new imaging modality offers an easier and more immediate interpretation of 3D data, while maintaining the same accuracy in target definition as that provided by the standard technique. Moreover, the new method has the advantage of using nonstereotactic 3D angiography, which can be performed at a different site and a different time with respect to the irradiation procedure.

Ruptured cerebral pseudoaneurysm caused by the removal of a ventricular catheter

1999 ◽  
Vol 91 (6) ◽  
pp. 1031-1033 ◽  
Author(s):  
Reizo Shirane ◽  
Takeo Kondo ◽  
Yasuko K. Yoshida ◽  
Susumu Furuta ◽  
Takashi Yoshimoto
Keyword(s):  
Mr Angiography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Content Type ◽  
Pseudoaneurysm Formation ◽  
Left Lateral Ventricle ◽  
Fine Print

✓ A rare case of cerebral pseudoaneurysm located at the internal carotid artery (ICA) was caused by the removal of a ventricular catheter in an infant. This 4-month-old girl underwent ventriculoperitoneal shunt revision, during which the old ventricular catheter was removed from the posterior horn of the left lateral ventricle, but the choroid plexus was pulled out by the tip of the catheter. Intraventricular hemorrhage (IVH) and subarachnoid hemorrhage were observed postoperatively. Magnetic resonance (MR) angiography performed on the 12th postoperative day revealed ICA stenosis and aneurysm formation at the C1 portion of the left ICA. Contrast-enhanced computerized tomography (CT) scans obtained on the 21st postoperative day revealed recurrent IVH and enlargement of the lesion. The patient underwent surgery for treatment of the aneurysm. Operative findings revealed a pseudoaneurysm arising from the left ICA at the proximal end of the anterior choroidal artery (AChA). The aneurysm was removed and the wall of the ICA was reconstructed. Postoperative three-dimensional CT scanning and MR angiography demonstrated disappearance of the aneurysm and preservation of the ICA. The patient was discharged without additional neurological deficits.Many complications, including IVH, are associated with removal of a ventricular catheter. This case shows that pseudoaneurysm formation can occur in a remote region due to avulsion of the AChA from the ICA. In most circumstances a ventricular catheter can be removed without difficulty. However, precision and caution should be exercised when removing a ventricular catheter.

Surgical treatment of vascular lesions in the brain stem

1975 ◽  
Vol 42 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Shelley N. Chou ◽  
Donald L. Erickson ◽  
Humberto J. Ortiz-Suarez
Keyword(s):  
Surgical Treatment ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Vascular Lesions ◽  
Surgical Removal ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The authors report the total surgical removal of five vascular lesions of the brain stem, three hemangioblastomas and two arteriovenous malformations. One patient died; among the others, the quality of survival is excellent. Factors favoring surgical removal of such lesions are discussed.

Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 120-127 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Junji Ishihara ◽  
Jie Zhang
Keyword(s):  
Tissue Reaction ◽  
Vascular Lesions ◽  
Thalamic Lesion ◽  
Mr Images ◽  
Unsatisfactory Result ◽  
Content Type ◽  
Rhythmic Discharge ◽  
Latent Interval ◽  
Fine Print

Object. The effects of gamma thalamotomy for parkinsonian and other kinds of tremor were evaluated. Methods. Thirty-six thalamotomies were performed in 31 patients by using a 4-mm collimator. The maximum dose was 150 Gy in the initial six cases, which was reduced to 130 Gy thereafter. The longest follow-up period was 6 years. The target was determined on T2-weighted and proton magnetic resonance (MR) images. The point chosen was in the lateral-most part of the thalamic ventralis intermedius nucleus. This is in keeping with open thalamotomy as practiced at the authors' institution. In 15 cases, gamma thalamotomy was the first surgical procedure. In other cases, previous therapeutic or vascular lesions were visible to facilitate targeting. Two types of tissue reaction were onserved on MR imaging: a simple oval shape and a complex irregular shape. Neither of these changes affected the clinical course. In the majority of cases, the tremor subsided after a latent interval of approximately 1 year after irradiation. The earliest response was demonstrated at 3 months. In five cases the tremor remained. In four of these cases, a second radiation session was administered. One of these four patients as well as another patient with an unsatisfactory result underwent open thalamotomy with microrecording. In both cases, depth recording adjacent to the necrotic area revealed normal neuronal activity, including the rhythmic discharge of tremor. Minor coagulation was performed and resulted in immediate and complete arrest of the remaining tremor. Conclusions. Gamma thalamotomy for Parkinson's disease seems to be an alternative useful method in selected cases.

Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 90-92 ◽  
Author(s):  
Mark E. Linskey
Keyword(s):  
Gamma Knife ◽  
Stereotactic Radiotherapy ◽  
Three Dimensional ◽  
Late Recurrence ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Complication Rates ◽  
Content Type ◽  
Single Fraction ◽  
Fine Print

✓ By definition, the term “radiosurgery” refers to the delivery of a therapeutic radiation dose in a single fraction, not simply the use of stereotaxy. Multiple-fraction delivery is better termed “stereotactic radiotherapy.” There are compelling radiobiological principles supporting the biological superiority of single-fraction radiation for achieving an optimal therapeutic response for the slowly proliferating, late-responding, tissue of a schwannoma. It is axiomatic that complication avoidance requires precise three-dimensional conformality between treatment and tumor volumes. This degree of conformality can only be achieved through complex multiisocenter planning. Alternative radiosurgery devices are generally limited to delivering one to four isocenters in a single treatment session. Although they can reproduce dose plans similar in conformality to early gamma knife dose plans by using a similar number of isocenters, they cannot reproduce the conformality of modern gamma knife plans based on magnetic resonance image—targeted localization and five to 30 isocenters. A disturbing trend is developing in which institutions without nongamma knife radiosurgery (GKS) centers are championing and/or shifting to hypofractionated stereotactic radiotherapy for vestibular schwannomas. This trend appears to be driven by a desire to reduce complication rates to compete with modern GKS results by using complex multiisocenter planning. Aggressive advertising and marketing from some of these centers even paradoxically suggests biological superiority of hypofractionation approaches over single-dose radiosurgery for vestibular schwannomas. At the same time these centers continue to use the term radiosurgery to describe their hypofractionated radiotherapy approach in an apparent effort to benefit from a GKS “halo effect.” It must be reemphasized that as neurosurgeons our primary duty is to achieve permanent tumor control for our patients and not to eliminate complications at the expense of potential late recurrence. The answer to minimizing complications while maintaining maximum tumor control is improved conformality of radiosurgery dose planning and not resorting to homeopathic radiosurgery doses or hypofractionation radiotherapy schemes.

Malignant transformation of a dysembryoplastic neuroepithelial tumor

2000 ◽  
Vol 92 (4) ◽  
pp. 722-725 ◽  
Author(s):  
Robert R. Hammond ◽  
Neil Duggal ◽  
John M. J. Woulfe ◽  
John P. Girvin
Keyword(s):  
Malignant Transformation ◽  
Complex Form ◽  
Ct Scanning ◽  
Subtotal Resection ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Content Type ◽  
Recent Onset ◽  
Fibrillary Astrocytoma ◽  
Fine Print ◽  
Glial Nodules

✓ A 29-year-old man presented in 1984 with a recent onset of partial seizures marked by speech arrest. Electroencephalography identified a left frontotemporal dysrhythmia. Computerized tomography (CT) scanning revealed a superficial hypodense nonenhancing lesion in the midleft frontal convexity, with some remodeling of the overlying skull. The patient was transferred to the London Health Sciences Centre for subtotal resection of what was diagnosed as a “fibrillary astrocytoma (microcystic).” He received no chemotherapy or radiation therapy and remained well for 11 years.The patient presented again in late 1995 with progressive seizure activity. Both CT and magnetic resonance imaging demonstrated a recurrent enhancing partly cystic lesion. A Grade IV astrocytoma was resected, and within the malignant tumor was a superficial area reminiscent of a dysembryoplastic neuroepithelial tumor (DNT). Data on the lesion that had been resected in 1984 were reviewed, and in retrospect the lesion was identified as a DNT of the complex form. It was bordered by cortical dysplasia and contained glial nodules, in addition to the specific glioneuronal element. The glial nodules were significant for moderate pleomorphism and rare mitotic figures. The Ki67 labeling index averaged 0.3% in the glial nodules and up to 4% focally. Cells were rarely Ki67 positive within the glioneuronal component. This case is the first documented example of malignant transformation of a DNT. It serves as a warning of the potential for malignant transformation in this entity, which has been traditionally accepted as benign. This warning may be especially warranted when confronted with complex forms of DNT. The completeness of resection in the benign state is of paramount importance.

Progressive neurological deficits with benign intracerebral cysts

1986 ◽  
Vol 65 (5) ◽  
pp. 706-709 ◽  
Author(s):  
Yoko Nakasu ◽  
Jyoji Handa ◽  
Kazuyoshi Watanabe
Keyword(s):  
Histological Examination ◽  
Computerized Tomography ◽  
Cyst Wall ◽  
Benign Lesion ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Review Of The Literature ◽  
Content Type ◽  
Ct Findings ◽  
Fine Print

✓ Two patients with benign intracerebral cysts are reported and a brief review of the literature is given. Although computerized tomography (CT) scanning is useful in detecting a variety of intracerebral cysts, the CT findings are not specific for any lesion. An exploratory operation with establishment of an adequate route of drainage and a histological examination of the cyst wall are mandatory in the management of patients with a progressive but benign lesion.

Giant aneurysm of anterior ethmoidal artery presenting with intracranial hemorrhage

1994 ◽  
Vol 81 (6) ◽  
pp. 934-936 ◽  
Author(s):  
Alok Ranjan ◽  
Thomas Joseph
Keyword(s):  
Intracranial Hemorrhage ◽  
Giant Aneurysm ◽  
Postoperative Recovery ◽  
Vascular Lesions ◽  
Feeding Artery ◽  
Neck Stiffness ◽  
Content Type ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Fine Print

✓ This forty-five-year-old woman presented with a history suggestive of an intracranial hemorrhage. Clinical examination indicated mild right pyramidal signs and neck stiffness. Computerized tomography demonstrated contrast enhancement in the region of a left frontal intraparenchymal hematoma with an adjacent subdural hematoma. Angiography revealed the presence of a giant aneurysm on the left anterior ethmoidal artery. Surgical evacuation of the hematoma with excision of the aneurysm and coagulation of the feeding artery was achieved. Postoperative recovery was uneventful. Vascular lesions of the anterior ethmoidal artery and the rarity of a giant aneurysm at this site are discussed.

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