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.

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.

Significance of a small bulge on the basilar artery in patients with perimesencephalic nonaneurysmal subarachnoid hemorrhage

2003 ◽  
Vol 98 (2) ◽  
pp. 426-429 ◽  
Author(s):  
Yuji Matsumaru ◽  
Kiyoyuki Yanaka ◽  
Ai Muroi ◽  
Hiroaki Sato ◽  
Takao Kamezaki ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Basilar Artery ◽  
Three Dimensional ◽  
Distinct Type ◽  
Rotational Angiography ◽  
Bleeding Pattern ◽  
Content Type ◽  
Nonaneurysmal Subarachnoid Hemorrhage ◽  
Excellent Clinical Outcome ◽  
Fine Print

✓ Perimesencephalic nonaneurysmal subarachnoid hemorrhage (SAH) is a distinct type of hemorrhage with a characteristic bleeding pattern and an excellent clinical outcome. The cause of this benign form of SAH remains unknown. The authors report on two cases of perimesencephalic nonaneurysmal SAH in which a small bulge on the basilar artery (BA) was demonstrated on three-dimensional rotational angiography studies. Based on data from these cases, one may infer that the lesion on the BA is responsible for the SAH. The possible pathogenesis is discussed.

A comparison of radiographic methods of diagnosing constrictive lesions of the spinal canal

1978 ◽  
Vol 48 (3) ◽  
pp. 360-368 ◽  
Author(s):  
M. Judith Donovan Post ◽  
Fredie P. Gargano ◽  
Donald Q. Vining ◽  
Hubert L. Rosomoff
Keyword(s):  
Computerized Tomography ◽  
Cross Section ◽  
Spinal Canal ◽  
Relative Effectiveness ◽  
Ct Scanning ◽  
New Method ◽  
Cross Sectional ◽  
Content Type ◽  
Sectional Anatomy ◽  
Fine Print

✓ With the advent of computerized tomography (CT), a new method of visualizing the spinal canal in cross-section has been created. Before the introduction of CT scanning, evaluation of the cross-sectional anatomy of the spinal canal was accomplished chiefly by the Toshiba unit. This study compares these two forms of tomography and discusses their relative effectiveness in diagnosing constrictive lesions of the spinal canal.

Three-dimensional helical computerized tomography angiography in the diagnosis, characterization, and management of middle cerebral artery aneurysms: comparison with conventional angiography and intraoperative findings

2002 ◽  
Vol 97 (6) ◽  
pp. 1322-1332 ◽  
Author(s):  
J. Pablo Villablanca ◽  
Parizad Hooshi ◽  
Neil Martin ◽  
Reza Jahan ◽  
Gary Duckwiler ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Treatment Planning ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Fine Print

Object. Middle cerebral artery (MCA) aneurysms can be difficult to detect and characterize. The authors describe the utility and impact of helical computerized tomography (CT) angiography for the evaluation of aneurysms in this location, and compare this modality with digital subtraction (DS) angiography and intraoperative findings. Methods. Two hundred fifty-one patients with suspected cerebral aneurysms underwent CT angiography. Two-dimensional multiplanar reformatted images and three-dimensional CT angiograms were examined by two independent readers in a blinded fashion. Results were compared with findings on DS angiograms to determine the relative efficacy of these modalities in the detection and characterization of aneurysms. Questionnaires completed by neurosurgeons and endovascular therapists were used to determine the impact of CT angiograms on aneurysm management. Twenty-eight patients harboring 31 MCA aneurysms and 26 patients without aneurysms were identified using CT angiography. The sensitivity of CT angiography and DS angiography for MCA aneurysms was 97%; both techniques showed 100% specificity. In 76% of evaluations, the CT angiography studies provided information not available on DS angiography examinations. For the characterization of aneurysms, CT angiography was rated superior (72%) or equal (20%) to DS angiography in 92% of cases evaluated (p < 0.001). Computerized tomography angiography was evaluated as the only study needed for patient triage in 82% of cases (p < 0.001), and as the only study needed for treatment planning in 89% of surgically treated (p < 0.001) and in 63% of endovascularly treated cases (p < 0.001). The information acquired on CT angiograms changed the initial treatment plan in 24 (67%) of these 36 complex lesions (p < 0.01). The aneurysm appearance intraoperatively was identical or nearly identical to that seen on CT angiograms in 17 (89%) of 19 of the surgically treated cases. Conclusions. Computerized tomography angiography has unique advantages over DS angiography and is a viable alternative to the latter modality in the diagnosis, triage, and treatment planning in patients with MCA aneurysms.

Integration of three-dimensional corticospinal tractography into treatment planning for gamma knife surgery

2005 ◽  
Vol 102 (4) ◽  
pp. 673-677 ◽  
Author(s):  
Keisuke Maruyama ◽  
Kyousuke Kamada ◽  
Masahiro Shin ◽  
Daisuke Itoh ◽  
Shigeki Aoki ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Gamma Knife ◽  
Diffusion Tensor ◽  
Three Dimensional ◽  
Spatial Relationship ◽  
Gamma Knife Surgery ◽  
Univariate Logistic Regression Analysis ◽  
Content Type ◽  
Combined Images ◽  
Fine Print

Object. In the radiosurgical treatment of critically located lesions, the effort to minimize the risk of complication is essential. In this study the integration of diffusion-tensor (DT) imaging—based tractography was clinically applied to treatment planning for gamma knife surgery (GKS). Methods. Seven patients with cerebral arteriovenous malformations located adjacent to the corticospinal tract (CST) underwent this technique. Data provided by DT imaging were acquired before the frame was affixed to the patient's head and the CST of the DT tractography was created using our original software. Stereotactic three-dimensional imaging studies were obtained after frame fixation and then coregistered with the data from DT tractography. After image fusion of the two studies, the combined images were transported to a GKS treatment-planning workstation. The spatial relationship between the dose distribution and the CST was clearly demonstrated within the 2 hours it took to complete the entire imaging process. The univariate logistic regression analysis of transient or permanent motor complications revealed a significant independent correlation with the volume of the CST that received 25 Gy or more and with a maximum dose to the CST (p < 0.05). Conclusions. The integration of DT tractography into the GKS treatment planning was highly useful in confirming the dose to the CST during treatment planning.

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.

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.

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.

Functional stereotactic radiosurgery involving a dedicated linear accelerator and gamma unit: a comparison study

2004 ◽  
pp. 373-380 ◽  
Author(s):  
Timothy D. Solberg ◽  
Steven J. Goetsch ◽  
Michael T. Selch ◽  
William Melega ◽  
Goran Lacan ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Treatment Plan ◽  
Single Shot ◽  
Submillimeter Range ◽  
Primate Model ◽  
Content Type ◽  
Stereotactic Frame ◽  
Targeting Ability ◽  
Fine Print

Object. The purpose of this work was to investigate the targeting and dosimetric characteristics of a linear accelerator (LINAC) system dedicated for stereotactic radiosurgery compared with those of a commercial gamma knife (GK) unit. Methods. A phantom was rigidly affixed within a Leksell stereotactic frame and axial computerized tomography scans were obtained using an appropriate stereotactic localization device. Treatment plans were performed, film was inserted into a recessed area, and the phantom was positioned and treated according to each treatment plan. In the case of the LINAC system, four 140° arcs, spanning ± 60° of couch rotation, were used. In the case of the GK unit, all 201 sources were left unplugged. Radiation was delivered using 3- and 8-mm LINAC collimators and 4- and 8-mm collimators of the GK unit. Targeting ability was investigated independently on the dedicated LINAC by using a primate model. Measured 50% spot widths for multisource, single-shot radiation exceeded nominal values in all cases by 38 to 70% for the GK unit and 11 to 33% for the LINAC system. Measured offsets were indicative of submillimeter targeting precision on both devices. In primate studies, the appearance of an magnetic resonance imaging—enhancing lesion coincided with the intended target. Conclusions. Radiosurgery performed using the 3-mm collimator of the dedicated LINAC exhibited characteristics that compared favorably with those of a dedicated GK unit. Overall targeting accuracy in the submillimeter range can be achieved, and dose distributions with sharp falloff can be expected for both devices.

The integration of metabolic imaging in stereotactic procedures including radiosurgery: a review

2002 ◽  
Vol 97 ◽  
pp. 542-550 ◽  
Author(s):  
Marc Levivier ◽  
David Wikler ◽  
Nicolas Massager ◽  
Philippe David ◽  
Daniel Devriendt ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Brain Tumors ◽  
Treatment Planning ◽  
Target Volume ◽  
Emission Tomography ◽  
Low Grade ◽  
Content Type ◽  
Positron Emission ◽  
Pet Scanning ◽  
Fine Print

Object. The authors review their experience with the clinical development and routine use of positron emission tomography (PET) during stereotactic procedures, including the use of PET-guided gamma knife radiosurgery (GKS). Methods. Techniques have been developed for the routine use of stereotactic PET, and accumulated experience using PET-guided stereotactic procedures over the past 10 years includes more than 150 stereotactic biopsies, 43 neuronavigation procedures, and 34 cases treated with GKS. Positron emission tomography—guided GKS was performed in 24 patients with primary brain tumors (four pilocytic astrocytomas, five low-grade astrocytomas or oligodendrogliomas, seven anaplastic astrocytomas or ependymomas, five glioblastomas, and three neurocytomas), five patients with metastases (single or multiple lesions), and five patients with pituitary adenomas. Conclusions. Data obtained with PET scanning can be integrated with GKS treatment planning, enabling access to metabolic information with high spatial accuracy. Positron emission tomography data can be successfully combined with magnetic resonance imaging data to provide specific information for defining the target volume for the radiosurgical treatment in patients with recurrent brain tumors, such as glioma, metastasis, and pituitary adenoma. This approach is particularly useful for optimizing target selection for infiltrating or ill-defined brain lesions. The use of PET scanning contributed data in 31 cases (93%) and information that was specifically utilized to adapt the target volume in 25 cases (74%). It would seem that the integration of PET data into GKS treatment planning may represent an important step toward further developments in radiosurgery: this approach provides additional information that may open new perspectives for the optimization of the treatment of brain tumors.

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