Clinical Evaluation of Shot-Within-Shot Optimization for Gamma Knife Radiosurgery Planning and Delivery.


OBJECTIVE:Shot-within-shot (SWS) optimization is a new planning technique that relies on various combinations of shot weighting and prescription isodose line (IDL) to reduce beam-on time. The method differs from other planning techniques that incorporate mixed collimation, multiple stereotactic coordinates, and traditionally low prescription IDLs (<60%). In this work, we evaluate the percentage of brain metastasis for which the method can be applied, the magnitude of the resultant time savings, and the possible tradeoffs in plan quality. METHODS:A retrospective analysis was performed on 75 patients treated for 241 metastatic lesions in the brain. For each lesion, the original planning metrics related to target coverage, conformity, gradient, and beam-on time were recorded. A subset of lesions were selected for replanning using the SWS technique based on size, shape, and proximity to critical structures. Two replans were done, a reference plan was prescribed at the 50% IDL, and an optimized plan was prescribed at an IDL typically >50%. Planning metrics were then compared among the original plan and the 2 replans. RESULTS:More than a third (39%) of the brain metastases were eligible for the SWS technique. For these lesions, the differences between the original plan and reference SWS plan were as follows: ΔV12Gy < 0.5 cc in 93% of cases, ΔV12Gy < 0.5 cc in 100% of cases, Δselectivity < 0.1 in 79% of cases. Negligible differences were seen between the 2 replans in terms of Δselectivity and ΔV12Gy; ΔGI < 5% in 99% of cases. After optimization, beam-on time was reduced by 25%-30% in approximately 40%-50% of eligible lesions when compared with the reference SWS plan (ΔTmax = 42%). In comparison with the original plan, beam-on time was reduced even further, ΔT > 50% in 20% of cases (ΔTmax = 70%). CONCLUSIONS:This work demonstrates clinically that optimization using the shot-within-shot technique can reduce beam-on time without degrading treatment plan quality.


World Neurosurg


World neurosurgery


Johnson PB,Monterroso MI,Yang F,Bossart E,Keyvanloo A,Mellon EA




Has Abstract


2019-03-01 00:00:00












  • Third Ventriculocisternostomy for Shunt Failure.

    abstract:BACKGROUND:Our objective was to analyze the relevance, potential prognostic factors, and complications of endoscopic third ventriculostomy (ETV) in patients with shunt failures. METHODS:Among 721 ETVs performed between 1999 and 2013, we studied 53 patients with shunts (31 men, 21 less than 18 years of age) who had an ...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Chhun V,Sacko O,Boetto S,Roux FE

    更新日期:2015-06-01 00:00:00

  • A large calvarial bone defect in a child: osteointegration of an implant.

    abstract:BACKGROUND:This is an original report describing the long-term follow-up outcome of a cranioplasty. A large calvarial bone defect of a child was reconstructed with a bioactive and biostable non-metallic implant. CASE DESCRIPTION:This is a case study of a young child with an infantile fibrosarcoma of occipital bone. Th...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Piitulainen JM,Posti JP,Vallittu PK,Aitasalo KM,Serlo W

    更新日期:2019-01-23 00:00:00

  • Anatomic Analysis of the Internal and External Aspects of the Pterion.

    abstract:OBJECTIVE:The pterion is an H-shaped suture complex. This study's goal was to determine the location of its external and internal surfaces and extension and emphasize and discuss its surgical importance. METHODS:Fifty dried adult human skulls were obtained from the Department of Anatomy. A 2-mm drill bit was placed ex...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Uz A,Korkmaz AC,Filgueira L,Guner MA,Tubbs RS,Demirciler AK

    更新日期:2020-05-01 00:00:00

  • Auditory Monitoring in Vestibular Schwannoma Surgery: Intraoperative Development and Outcome.

    abstract:OBJECTIVE:The auditory brainstem response (ABR) may be a predictor of postoperative cochlear nerve function. In this study, the course of intraoperative ABR monitoring was analyzed to find predictive markers for postoperative hearing function. PATIENTS AND METHODS:From 2010 to 2012, 46 patients who had had vestibular ...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Hummel M,Perez J,Hagen R,Gelbrich G,Ernestus RI,Matthies C

    更新日期:2016-12-01 00:00:00

  • Extensive Spinal Adhesive Arachnoiditis After Extradural Spinal Infection-Spinal Dura Mater Is No Barrier to Inflammation.

    abstract:BACKGROUND:Spinal adhesive arachnoiditis (SAA) is an inflammatory process of the meninges. Cystic changes and cicatrization may lead to neurologic deficits and immobilization. Therapy is difficult and often unsatisfactory. We describe 8 cases of extensive SAA after extradural spinal infection. METHODS:A total of 238 p...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Krätzig T,Dreimann M,Mende KC,Königs I,Westphal M,Eicker SO

    更新日期:2018-08-01 00:00:00

  • Autologous Bone Harvest in Anterior Cervical Spine Surgery: A Quantitative and Qualitative In Vitro Analysis of Cadaveric Tissue.

    abstract:BACKGROUND:The cervical spine may be used as a harvesting site of local autograft material during anterior cervical discectomy and fusion procedures. We analyzed the quality and composition of bone grafts obtained from different parts of the cervical vertebrae in a cadaveric model. METHODS:Five fresh adult human cadav...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Rustagi T,Alonso F,Drazin D,Schmidt C,Rostad S,Yilmaz E,Oskouian RJ,Tubbs RS,Chapman JR,Fisahn C

    更新日期:2018-04-01 00:00:00

  • Novel Technique for Detection of Actual Position of Clot During Endovascular Clot Retrieval: Assessment of Microcatheter Withdrawing Angiography.

    abstract:BACKGROUND:When endovascular clot retrievals are performed using a stent retriever and/or an aspiration catheter, identifying the accurate position of a clot is extremely important for a successful immediate recanalization. Herein, we report a new technique called microcatheter withdrawing angiography, which facilitate...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Ohshima T,Niwa A,Kawaguchi R,Matsuo N,Miyachi S

    更新日期:2020-05-01 00:00:00

  • Carotid Endarterectomy for Medical Therapy-Resistant Symptomatic Low-Grade Stenosis.

    abstract:BACKGROUND:Plaque characteristics play pivotal roles in ischemic events, but stenosis severity does not accurately reflect carotid plaque volume due to expansive remodeling in some patients with low-grade stenosis (LGS). This study aimed to assess the safety, efficacy, and durability of carotid endarterectomy (CEA) for...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Yoshida K,Fukumitsu R,Kurosaki Y,Nagata M,Tao Y,Suzuki M,Yamamoto Y,Funaki T,Kikuchi T,Ishii A,Miyamoto S

    更新日期:2019-03-01 00:00:00

  • Pharyngo-Esophageal Perforations After Anterior Cervical Spine Surgery: Management and Outcomes.

    abstract:OBJECTIVE:To report about the diagnosis, surgical treatment, and postoperative management of pharyngo-esophageal perforations (PEPs) after anterior cervical spine (ACS) surgery in 17 patients. METHODS:A retrospective multicenter case series of patients surgically treated for PEP after ACS surgery was performed. Data r...

    journal_title:World neurosurgery

    pub_type: 杂志文章,多中心研究


    authors: Ghirelli M,Molinari G,Rosini M,De Iure F,Gasbarrini A,Mattioli F,Alicandri-Ciufelli M,Presutti L

    更新日期:2020-07-01 00:00:00

  • Reliability of Tokuhashi Score to Predict Prognosis: Comparison of 117 Patients.

    abstract:BACKGROUND:Spinal metastatic disease compromises the quality of life and prognosis of the patients. Prognosis is an important factor for the decision-making process and needs to be precise in order to adjust the intensity of therapy. The Tokuhashi score is a universal instrument to determine the prognosis. The objectiv...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Pelegrini de Almeida L,Vidaletti T,Martins de Lima Cecchini A,Sfreddo E,Martins de Lima Cecchini F,Falavigna A

    更新日期:2018-03-01 00:00:00

  • "Stent view" flat-detector CT and stent-assisted treatment strategies for complex intracranial aneurysms.

    abstract:BACKGROUND:Complex intracranial aneurysms are often treated with endovascular stent-assisted coiling. Intracranial stents are difficult to visualize with conventional computed tomography (CT) or fluoroscopy. "Stent view" flat-detector CT can be used to visualize intracranial stents during endovascular treatment. METHO...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Levitt MR,Cooke DL,Ghodke BV,Kim LJ,Hallam DK,Sekhar LN

    更新日期:2011-02-01 00:00:00

  • Contralateral Transcingulate Resection of Midcingulate Cavernous Malformation.

    abstract::This case video demonstrates the surgical technique for resection of a cavernous malformation in the midleft cingulate gyrus using a contralateral transcingulate approach (Video 1). The indications for operating on a cavernoma such as this are seizures, recurrent hemorrhages, and a surgically resectable target. This v...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Glauser G,Abdullah KG,Choudhri OA

    更新日期:2019-09-01 00:00:00

  • Mechanical Thrombectomy with Stent Retriever 29 Days After Onset of Ischemic Stroke.

    abstract::A patient presented with progressive ischemic stroke and received mechanical thrombectomy with a Solitaire FR device 29 days after stroke onset. The occluded V4 segment of the left vertebral artery showed a double rail sign on angiography, which indicated that the occlusion might have been caused by embolism instead o...

    journal_title:World neurosurgery



    authors: Fu X,Yuan Y,Xu H

    更新日期:2020-09-01 00:00:00

  • The Assassination of Abraham Lincoln and the Evolution of Neuro-Trauma Care: Would the 16th President Have Survived in the Modern Era?

    abstract::Abraham Lincoln was the 16(th) President of the United States of America. On April 14, 1865, shortly after his re-election and the conclusion of the Civil War, Lincoln was shot and killed by John Wilkes Booth. Although numerous physicians tended to the President shortly after his injury, he passed away the next mornin...

    journal_title:World neurosurgery

    pub_type: 传,历史文章,杂志文章,评审


    authors: Yan SC,Smith TR,Bi WL,Brewster R,Gormley WB,Dunn IF,Laws ER Jr

    更新日期:2015-11-01 00:00:00

  • Nerve Transfers in Patients with Brown-Séquard Pattern of Spinal Cord Injury: Report of 2 Cases.

    abstract:BACKGROUND:Use of distal nerve transfer for improving upper limb function has been well described for patients with tetraplegic spinal cord injury and brachial plexus injuries but has not previously been described for Brown-Séquard type spinal cord injury. We describe our experience with 2 cases of combined Brown-Séqua...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Loch-Wilkinson T,McNeil S,White C,Schrag C,Midha R

    更新日期:2018-02-01 00:00:00

  • Challenges to Neurosurgery During the Coronavirus Disease 2019 (COVID-19) Pandemic.

    abstract::The coronavirus disease 2019 pandemic has presented a massive burden to most health care systems across the globe. The demand for intensive care unit capacity in particular has increased significantly, and hospitals in most affected regions have struggled to cope. The focus of health care activity has shifted to the p...

    journal_title:World neurosurgery

    pub_type: 杂志文章,评审


    authors: Tsermoulas G,Zisakis A,Flint G,Belli A

    更新日期:2020-07-01 00:00:00

  • Tumor Volume Changes During and After Temozolomide Treatment for Newly Diagnosed Higher-Grade Glioma (III and IV).

    abstract:BACKGROUND:A standard post-concomitant radiochemotherapy involving adjuvant temozolomide (TMZ) was stopped after 6 cycles for high-grade gliomas (HGG). Several studies demonstrated that prolonged TMZ treatment increased survival for these patients. METHODS:This retrospective study aimed to compare changes in tumor vol...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Wang HC,Lin YT,Lin WC,Ho RW,Lin YJ,Tsai NW,Ho JT,Lu CH

    更新日期:2018-06-01 00:00:00

  • Novel Software-Derived Workflow in Extracranial-Intracranial Bypass Surgery Validated by Transdural Indocyanine Green Videoangiography.

    abstract:BACKGROUND:The introduction of image-guided methods to bypass surgery has resulted in optimized preoperative identification of the recipients and excellent patency rates. However, the recently presented methods have also been resource-consuming. In the present study, we have reported a cost-efficient planning workflow ...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Dodier P,Auzinger T,Mistelbauer G,Wang WT,Ferraz-Leite H,Gruber A,Marik W,Winter F,Fischer G,Frischer JM,Bavinzski G

    更新日期:2020-02-01 00:00:00

  • Recovery of Visual and Ophthalmologic Symptoms After Treating Large or Giant Internal Carotid Artery Aneurysm by High-Flow Bypass with Cervical Ligation.

    abstract:OBJECTIVE:Large or giant internal carotid artery (ICA) aneurysms often cause visual deficits and cranial nerve palsy. The aim of this study was to investigate the efficacy of ligation of the ICA with high-flow bypass. METHODS:We retrospectively analyzed the findings from patients with visual deficit and ophthalmologic...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Matano F,Murai Y,Mizunari T,Tamaki T,Tateyama K,Koketsu K,Tanikawa R,Kamiyama H,Kobayashi S,Morita A

    更新日期:2017-02-01 00:00:00

  • Does Heterotopic Ossification in Cervical Arthroplasty Affect Clinical Outcome?

    abstract:OBJECTIVE:To investigate the occurrence and progression of heterotopic ossification (HO) in patients treated by anterior cervical discectomy with arthroplasty. It was evaluated if HO affects clinical outcome and range of motion (ROM). Risk factors of HO was studied as well. METHODS:Patients who underwent anterior cerv...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Yang X,Bartels RHMA,Donk R,Depreitere B,Walraevens J,Zhai Z,Vleggeert-Lankamp CLA

    更新日期:2019-11-01 00:00:00

  • Limb Undergrowth in Intraneural Perineuriomas: An Under-Recognized Association.

    abstract:BACKGROUND:Intraneural (IN) perineuriomas are a rare benign hypertrophic nerve tumor, most frequently occurring in young patients. Patients with IN perineurioma have been anecdotally found to have limb undergrowth; however, this has not been systematically evaluated. METHODS:Archived electronic records from 1990 to 20...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Pendleton C,Lenartowicz KA,Howe BM,Spinner RJ

    更新日期:2020-09-01 00:00:00

  • Spontaneous Regression in Intracranial Germinoma: Case Report and Literature Review.

    abstract:BACKGROUND:Spontaneous regression in intracranial germ cell tumors (GCTs) is an extremely rare phenomenon with only 9 cases reported. The mechanism and natural history of this phenomenon are still equivocal. METHODS:A 12-year-old boy presented with a lesion in the suprasellar region with involvement of basal ganglia a...

    journal_title:World neurosurgery

    pub_type: 杂志文章,评审


    authors: Zhang S,Li Q,Ju Y

    更新日期:2019-11-01 00:00:00

  • Comparison of Surgical Invasiveness Between Microdiscectomy and 3 Different Endoscopic Discectomy Techniques for Lumbar Disc Herniation.

    abstract:OBJECTIVE:Muscle injury is inevitable during surgical exposure of the spine. This study compared paraspinal muscle injury after 4 surgical techniques: microdiscectomy (MD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous endoscopic interlaminar discectomy (PEID), unilateral biportal endoscopic discectomy...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Choi KC,Shim HK,Hwang JS,Shin SH,Lee DC,Jung HH,Park HA,Park CK

    更新日期:2018-08-01 00:00:00

  • Minimally Invasive Decompression and Intracorporeal Bone Grafting Combined with Temporary Percutaneous Short-Segment Pedicle Screw Fixation for Treatment of Thoracolumbar Burst Fracture with Neurological Deficits.

    abstract:OBJECTIVE:We evaluated the clinical and radiographic outcomes of patients with thoracolumbar burst fractures and neurological deficits treated with minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. METHODS:Patients with thoracolumbar burst fractur...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Chen L,Liu H,Hong Y,Yang Y,Hu L

    更新日期:2020-03-01 00:00:00

  • Anaplastic Lymphoma Kinase-Negative Anaplastic Large Cell Lymphoma Manifesting as a Scalp Hematoma After an Acute Head Injury-a Case Report and Literature Review.

    abstract:BACKGROUND:Anaplastic large cell lymphoma (ALCL) is a malignant non-Hodgkin lymphoma, typically associated with anaplastic lymphoma kinase (ALK) expression. In some cases, lack of ALK translocation correlated with a more unfavorable prognosis. CASE DESCRIPTION:We describe a case of ALK(-) ALCL that manifested as a pro...

    journal_title:World neurosurgery

    pub_type: 杂志文章,评审


    authors: Yeung CY,Hong KT,Chiang CP,Chen YH,Ma HI,Tsai TH

    更新日期:2016-04-01 00:00:00

  • Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter for Intracranial Midline Shift in Patients with Head Trauma.

    abstract:OBJECTIVE:Measurement of the optic nerve sheath diameter (ONSD) by using sonography is a straightforward, noninvasive technique to detect an increased intracranial pressure, which can even be conducted at the bedside. However, the correlation between ONSD and intracranial midline shift has not been studied. METHODS:Th...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Kazdal H,Kanat A,Findik H,Sen A,Ozdemir B,Batcik OE,Yavasi O,Inecikli MF

    更新日期:2016-01-01 00:00:00

  • The role of endoscopic third ventriculostomy in the treatment of communicating hydrocephalus.

    abstract:OBJECTIVE:To elucidate the role of endoscopic third ventriculostomy (ETV) in patients with secondary and idiopathic communicating hydrocephalus (HCP). METHODS:A series of 36 patients with communicating HCP (21 men and 15 women) were treated by ETV between November 2007 and February 2010. The patients age ranged from 1...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Rangel-Castilla L,Barber S,Zhang YJ

    更新日期:2012-03-01 00:00:00

  • Association Between Neurological Outcomes Related to Aneurysmal Subarachnoid Hemorrhage and Onsite Access to Neurointerventional Radiology.

    abstract:OBJECTIVE:An onsite access to neurointerventional radiology (NIR) may be useful for managing patients with aneurysmal subarachnoid hemorrhage (aSAH) after the aneurysm-securing procedure. We aimed to assess the association between neurological outcomes related to aSAH and onsite access to NIR service. METHODS:This was...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Mogollon JP,Smoll NR,Panwar R

    更新日期:2018-05-01 00:00:00

  • Fenestration of the Basilar Artery Associated with Aneurysm Treated by the Support of a Temporary Bridging Device-Comaneci: A Case Report.

    abstract:BACKGROUND:Fenestration of the basilar artery is a segmental duplication of the vessel due to nonfusion of the embryonal arteries and is the second most common vascular disjunction. Here, we present a single case example demonstrating the utility of the temporary bridging device Comaneci as a new option in the endovasc...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Sirakov SS,Panayotova AP,Sirakov AS,Hristov H,Minkin K,Raychev R

    更新日期:2018-11-01 00:00:00

  • Optic Nerve Atrophy Due to Long-Standing Compression by Planum Sphenoidale Meningioma.

    abstract:PURPOSE:In this study we report an uncommon endoscopic endonasal image of an atrophic optic nerve as seen after surgical removal of a suprasellar meningioma. The peculiarity of this case is the long-lasting underestimated ocular symptomatology of the patient who reported a 15-year history of impairment of vision on her...

    journal_title:World neurosurgery

    pub_type: 杂志文章


    authors: Di Somma A,Kaen AM,Cárdenas Ruiz-Valdepeñas E,Cavallo LM

    更新日期:2018-05-01 00:00:00