Abstract:
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.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Johnson PB,Monterroso MI,Yang F,Bossart E,Keyvanloo A,Mellon EAdoi
10.1016/j.wneu.2018.11.140subject
Has Abstractpub_date
2019-03-01 00:00:00pages
e218-e227eissn
1878-8750issn
1878-8769pii
S1878-8750(18)32699-8journal_volume
123pub_type
杂志文章abstract:BACKGROUND:Malignant degeneration of epidermoid cyst (EC) with accompanying leptomeningeal carcinomatosis (LC) at presentation is extremely rare. We add two cases to the literature, including the first case of primary brainstem involvement with simultaneous diffuse LC, and discuss clinical and radiological cues to diff...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2015.11.039
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Occipitocervical fusion is an important surgical procedure to treat instability of the upper cervical and craniocervical junction. Fixation to the dense cortical bone of the occiput, contemporaneously typically accomplished with a plate and screws, is known to be strong and durable, but there are many compet...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.12.159
更新日期:2021-01-07 00:00:00
abstract:BACKGROUND:We performed a rigorous statistical analysis of the complications and outcomes of patients with ruptured or unruptured intracranial aneurysms. Our emphasis was on the potential predictive factors when both surgical and endovascular management are offered by a team with balanced microsurgical and endovascular...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.10.094
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Intracranial hemorrhage is a common complication of traumatic brain injury (TBI). The purpose of this study is evaluation of the effect of tranexamic acid (TXA) on hemorrhagic mass growth in TBI patients. PATIENTS AND METHODS:In this randomized, double-blind clinical trial, 149 patients with TBI and any kin...
journal_title:World neurosurgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.wneu.2017.10.075
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:The incidence of meningioma has increased drastically recently, particularly in older adults. Surgical intervention has the potential to reduce neurologic symptoms and achieve favorable, long-term outcomes. There is considerable variability in the literature examining the relationship between age and outcome...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.09.021
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:To compare fluorescence intensity of tumor specimens, as measured by a fluorescence-guided surgery microscope and a spectrometer, to evaluate tumor infiltration of dura mater around meningiomas with help of these 2 different 5-aminolevulinic acid (5-ALA)-based fluorescence tools, and to correlate fluorescence...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.08.140
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:To investigate the incidence, distribution characteristics, and radiographic features of the ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the nuchal ligament (ONL) and to analyze the correlation between the location of ONL and degree of ossification in patients with...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.05.130
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Atlantoaxial instability, a common finding in patients with Down syndrome (DS), is attributed to laxity of ligamentous structures. Cervical spondylosis identified in these patients has a pathogenesis of ligament laxity and early degeneration compared with the normal population. No cases have been reported sh...
journal_title:World neurosurgery
pub_type:
doi:10.1016/j.wneu.2020.07.040
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Bilateral subthalamic nucleus deep brain stimulation improves motor symptoms and treatment-related complications in patients with Parkinson's disease. However, some patients have trouble adjusting socially after successful neurosurgery, in part because of "unrealistic" expectations and psychiatric disorders....
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.09.128
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Spine surgery relies heavily on imaging, with radiography-based devices being the major operating room imaging modality. Radiation exposure is an occupational risk historically recognized shortly after the discovery of radiation itself. Exposure of both patients and operating room staff is of increasing conc...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2016.05.025
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Brain aneurysms (BAs) are the most common intracranial vascular condition, with an overall incidence of 1%-2%. Among the common causes of their initial formation and growth, the role of radiation therapy (RT) has been reported in some studies. The aim of the present study is to report the most relevant featu...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2019.09.157
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Telemedicine has seen substantial growth in the past 20 years, related to technologic advancements and evolving reimbursement policies. The risks and opportunities of neurosurgical telemedicine are nuanced. METHODS:We reviewed general and peer-reviewed literature as it relates to telemedicine and neurosurge...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2016.01.075
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:Intracranial pseudoaneurysm is a rare complication of endoscopic endonasal surgery. Herein, we describe 2-staged stent-assisted coil embolization for posterior communicating artery pseudoaneurysm after endoscopic endonasal surgery for pituitary adenoma. CASE DESCRIPTION:A 68-year-old man had a history of se...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.12.047
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Hiccups are a well-known short-term phenomenon in daily life. If they persist or become intractable, they may be a primary symptom of a disease. Recent studies identified the medulla oblongata as the neuroanatomic center of the hiccup reflex arc. In previous cases, an isolated lesion at the dorsal side of th...
journal_title:World neurosurgery
pub_type:
doi:10.1016/j.wneu.2020.06.013
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:Although the endoscopic transpterygoid approach has been popularized, there are no studies about anatomy-specific morbidities of this approach. The objective of this study is to investigate the surgical morbidities associated with the endoscopic transpterygoid approach for resection of anatomic structures. M...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.12.023
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Complete aneurysm obliteration is the goal of aneurysm treatment. In selected cases, a neck remnant may be left to preserve a critical branch. Literature on ophthalmic artery sacrifice in the treatment of cerebral aneurysms and subsequent risk of vision loss is limited. CASE DESCRIPTION:Herein, we describe ...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2020.04.196
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:Posterior circulation strokes account for over one quarter of all ischemic strokes. The frequency of vertebral artery origin stenosis (VAOS) in patients with vertebrobasilar insufficiency (VBI) has been estimated to be as high 26%-32%, and VAOS is the direct cause of posterior circulation strokes in 9% of pat...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.06.203
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:Spinal neuronavigation improves accuracy of pedicle screw placement but may increase operative time, and its use in oncologic operations remains relatively unstudied. We compared the use of two-dimensional (2D) fluoroscopy and three-dimensional (3D) spinal neuronavigation relative to operative time in instrum...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.06.016
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:Transforaminal endoscopic lumbar discectomy (TELD), a minimally invasive spinal technique, has advantages over open discectomy. Unilateral TELD for disc herniation causing bilateral symptoms is challenging. In this study, we describe a percutaneous endoscopic herniotomy technique by using a unilateral approa...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.06.191
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVE:Although syringomyelia associated with extensive spinal adhesive arachnoiditis (SAA) can be a progressive disease that has potentially devastating clinical consequences, its surgical resolution has remained poorly defined. The aim of the present study was to verify the safety and efficacy of syringoperitoneal...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.08.103
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:As the population ages, the proportion of elderly patients with glioblastomas has increased. Recently, many researchers have focused on the treatments available to and prognoses in elderly patients with glioblastomas. METHODS:We conducted a retrospective study of glioblastoma patients aged 60 years old or o...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.07.079
更新日期:2016-11-01 00:00:00
abstract::Recent advances in neuroimaging demonstrated many markedly improved images hitherto unavailable, specifically the areas that lie deep in the brain. The anatomic images of the deep brain structure taken in vivo using 7.0 T magnetic resonance imaging (MRI) and the molecular images using high resolution research tomograp...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2012.10.020
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVE:The treatment of giant olfactory groove meningiomas (OGMs; maximum diameter ≥ 6 cm) poses special problems and represents a surgical challenge. We discuss the long-term results in a series of 18 patients with giant OGMs and report our experience on a global strategy encompassing the pterional approach to mana...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2011.03.021
更新日期:2011-09-01 00:00:00
abstract:OBJECTIVE:Thrombectomy increases the survival rate of acute ischemic stroke patients corresponding to large vessel occlusion. This study aimed to determine clinical predictors for good outcomes in patients subjected to tissue window guided thrombectomy. METHODS:This study was performed at the stroke center of the Firs...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.11.047
更新日期:2020-11-17 00:00:00
abstract:OBJECTIVE:Three-dimensional (3D), high-definition (HD) endoscopy has been recently introduced in neurosurgery, and its value has been discussed extensively in endonasal skull base surgery. Because there has been no reported clinical series on the use of a recent 3D-HD ventriculoscope, the aim of this study was to descr...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.01.219
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:The long-term outcome after carotid endarterectomy (CEA) is determined by many confounding factors. Ischemic heart disease (IHD) is linked to atherosclerotic stroke, and it is an important cause of death during the perioperative and follow-up periods after CEA. We aimed to investigate mortality and long-term...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.11.092
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:The aim of this study was to analyze the clinical outcomes of diagnostic transforaminal epidural injection (DTEI) in selective percutaneous endoscopic lumbar discectomy for multilevel disc herniation with monoradicular symptom. METHODS:A prospective randomized clinical study was performed from November 2013...
journal_title:World neurosurgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.wneu.2019.02.102
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To delineate the learning style that best defines a successful practitioner in the field of neurosurgery by using a validated learning style inventory. METHODS:The Kolb Learning Style Inventory, a validated assessment tool, was administered to all practicing neurosurgeons, neurosurgical residents, and neurol...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2014.04.067
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:The minimized approach for superficial temporal to middle cerebral artery (STA-MCA) bypass surgery is frequently associated with unfamiliar situations and technical problems. OBJECTIVE:Description of operative nuances and evaluation of problem-solving aspects to facilitate potential limitations related with...
journal_title:World neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.wneu.2015.12.029
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Dissection of brain surface adhesions during recurrent glioma surgery carries a risk of injury to cortical vessels and important surface vessels. We present our experience with the use of BioD film, a biocompatible amniotic membrane implant, to help prevent postoperative adhesions. We describe a novel method...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.07.143
更新日期:2017-11-01 00:00:00