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[This corrects the article DOI: 10.1371/journal.pone.0225638.].
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BACKGROUND: Rare and deep located tumors are surgical challenge with high morbidity. Minimal invasive techniques should be encouraged for a better outcome. Intralabyrinthine schwannoma (ILS) is a rare benign tumor that usually presents with hearing loss and tinnitus. Surgery is associated with high rate of facial paralysis and deafness. Radiosurgery is an option for tinnitus treatment, without the risk of facial paralysis. CASE DESCRIPTION: A young male patient presented with severe hearing loss and incapacitating tinnitus. Magnetic resonance revealed the presence of a small ILS. Radiosurgery was performed and obtained tinnitus control without complications and no further tumor growth. CONCLUSIONS: Tumor control and symptoms relief could be safely achieved through a precisely plan using Gamma Knife radiosurgery, decreasing morbidity. This is the first radiosurgical description for a transmodiolar schwannoma.
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Neoplasias del Oído/cirugía , Enfermedades del Laberinto/cirugía , Neuroma Acústico/cirugía , Procedimientos Neuroquirúrgicos/métodos , Radiocirugia/métodos , Adulto , Pérdida Auditiva/etiología , Pérdida Auditiva/cirugía , Humanos , Enfermedades del Laberinto/complicaciones , Imagen por Resonancia Magnética , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Neuroma Acústico/complicaciones , Acúfeno/etiología , Acúfeno/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION: This study explores the possibility of a relationship between the sphericity degree of a target volume with the dose distribution. This relationship is evaluated based on the ratio isodose volume / target volume (IV/TV) and the metrics coverage, i.e., selectivity, gradient index, conformity index and mean dose when planning radiosurgery for vestibular schwannoma. METHODS: Sphericity degree (φ) was calculated for each target volume (TV) of 64 patients who underwent stereotactic radiosurgery (SRS) for vestibular schwannoma. The calculation of this parameter was developed using the theoretical definition for operational sphericity φ = VP/VCS. The values found are evaluated considering the following metrics:-Coverage (C), selectivity (S), gradient index (GI), Paddick conformity index (CIPaddick) and dose distribution (IV/TV). The planning was also carried out considering a spherical target volume defined in a spherical phantom. The spherical volume is the same as the target used in the treatment plan. The planning of the spherical target was considered as a reference plan to evaluate the dose distribution inside and outside the volume. RESULTS: It was possible to observe that the majority of target volumes has (Ï) around 0,66-0,77, corresponding to 54,7% of the total. Considering the mean values for metrics, the results are: C = 0,98, S = 0,78, GI = 3,11 and CI = 0,81. The dose distribution was equivalent for treatment plans and reference plans. Quantitative analysis for IV/TV shows that these values are higher than 30% for treatment plans where shot density is large. CONCLUSION: This study demonstrates that de sphericity degree (φ) can be related to the dose distribution (IV/TV). Therefore the sphericity degree is a good parameter to evaluate the dose distribution of a plan for vestibular schwannoma treatment, considering the reference plan as being a spherical target using a leksell gamma knife® perfexion (LGKP). This study shows that the sphericity degree offers important information of the dose distribution outside and inside the target volume. This is not evaluated by the other parameters already implemented as metric to analyzing the GKP plans.
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Neoplasias Encefálicas/radioterapia , Neuroma Acústico/radioterapia , Anciano , Anciano de 80 o más Años , Algoritmos , Neoplasias Encefálicas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuroma Acústico/patología , Radiocirugia , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por ComputadorRESUMEN
OBJECTIVE: To present the feasibility of fetal myelomeningocele (MMC) repair through a mini-hysterotomy and to describe the perinatal results from our initial experience. METHODS: A descriptive study of cases of fetal MMC correction via mini-hysterotomy performed between 2014 and 2016. RESULTS: Forty-five women underwent fetal surgery and 87% (39/45) delivered. A complete multilayer correction of the MMC was possible in all cases. There were no maternal, fetal or neonatal deaths. No maternal or fetal complications occurred from fetal MMC correction until maternal hospital discharge. The average gestational age (GA) at surgery was 24.5 weeks (standard deviation, SD: 1.7; range: 20.7-26.9). The median hysterotomy length was 3.05 cm (SD: 0.39; range: 2.50-3.50). One patient (1/39; 2.6%) experienced chorioamniotic separation. Nine patients (9/39; 23.1%) had premature preterm rupture of membranes at a median GA of 34.1 weeks (range: 31.1-36.0). The average GA at delivery was 35.3 weeks (SD: 2.2; range: 27.9-39.1). Ninety-five percent (37/39) of our patients had an intact hysterotomy site at delivery. Ventriculoperitoneal shunt placement was necessary for 7.7% (3/39) of the neonates. CONCLUSION: Fetal MMC repair is feasible through a mini-hysterotomy. This approach appears to be associated with reduced risks of very preterm delivery and maternal, fetal and neonatal complications.
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Histerotomía/efectos adversos , Meningomielocele/cirugía , Complicaciones Posoperatorias/prevención & control , Adulto , Malformación de Arnold-Chiari/etiología , Malformación de Arnold-Chiari/prevención & control , Brasil/epidemiología , Estudios de Factibilidad , Femenino , Rotura Prematura de Membranas Fetales/epidemiología , Rotura Prematura de Membranas Fetales/etiología , Rotura Prematura de Membranas Fetales/prevención & control , Estudios de Seguimiento , Edad Gestacional , Humanos , Hidrocefalia/etiología , Hidrocefalia/prevención & control , Hidrocefalia/cirugía , Incidencia , Recién Nacido , Masculino , Meningomielocele/embriología , Meningomielocele/fisiopatología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Embarazo , Segundo Trimestre del Embarazo , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Nacimiento Prematuro/prevención & control , Riesgo , Derivación Ventriculoperitoneal/efectos adversosRESUMEN
OBJECTIVE The role of tractography in Gamma Knife thalamotomy (GK-T) planning is still unclear. Pyramidal tractography might reduce the risk of radiation injury to the pyramidal tract and reduce motor complications. METHODS In this study, the ventralis intermedius nucleus (VIM) targets of 20 patients were bilaterally defined using Iplannet Stereotaxy Software, according to the anterior commissure-posterior commissure (AC-PC) line and considering the localization of the pyramidal tract. The 40 targets and tractography were transferred as objects to the GammaPlan Treatment Planning System (GP-TPS). New targets were defined, according to the AC-PC line in the functional targets section of the GP-TPS. The target offsets required to maintain the internal capsule (IC) constraint of < 15 Gy were evaluated. In addition, the strategies available in GP-TPS to maintain the minimum conventional VIM target dose at > 100 Gy were determined. RESULTS A difference was observed between the positions of both targets and the doses to the IC. The lateral (x) and the vertical (z) coordinates were adjusted 1.9 mm medially and 1.3 mm cranially, respectively. The targets defined considering the position of the pyramidal tract were more medial and superior, based on the constraint of 15 Gy touching the object representing the IC in the GP-TPS. The best strategy to meet the set constraints was 90° Gamma angle (GA) with automatic shaping of dose distribution; this was followed by 110° GA. The worst GA was 70°. Treatment time was substantially increased by the shaping strategy, approximately doubling delivery time. CONCLUSIONS Routine use of DTI pyramidal tractography might be important to fine-tune GK-T planning. DTI tractography, as well as anisotropy showing the VIM, promises to improve Gamma Knife functional procedures. They allow for a more objective definition of dose constraints to the IC and targeting. DTI pyramidal tractography introduced into the treatment planning may reduce the incidence of motor complications and improve efficacy. This needs to be validated in a large clinical series.