Effectiveness of Breath Hold with a ABC for SRS of Lung Cancer

PURPOSE: It is very important to remove or to reduce the effect of organ motion due to respiration in stereotatic radiosurgery of lung. This study reports the effectiveness of the breath hold technique with a ABC for reducing the breathing effect. MATERIALS AND METHODS: Whole body stereotactic frame (Elekta, Sweden) was used for lung SRS. Patients who have tumor motion range larger than 10 mm from fluoroscopic observation were selected to apply a ABC. Seventeen patients were enrolled in this study. Passive breath hold is possible with our ABC. Automatic breath hold was set at 80% of deep inspiration. Breath hold time was 25~30 seconds depending on the patients. Three consecutive CT scans were performed as indicated in Asan Medical Center SRS procedure for each patients. Lung volume and PTV differences between with breath hold and free breath were examined for 5 patients. RESULTS: The breath hold technique with ABC could be applied for 15 patients. Inter-, intra-treatment organ motion with ABC showed 1.5 mm, while it was 2.3 mm with abdomen compress. When with breath hold technique, PTV and CTV was reduced 33.7% and 45.4%, respectively, and lung volume was increased 32.3 % compared to conventional SRS method. CONCLUSION: Better target localization could be achieved with breath hold technique in lung SRS. Tumor motion could be minimized and relative lung volume irradiation could be reduced

Comparative Study on Frameless Stereotactic Hematoma Aspiration versus Frame-Based Stereotactic Hematoma Aspiration in Deep Seated Intracerebral Hemorrhage: A Clinical Article / 대한뇌혈관외과학회지

OBJECTIVE: We compare the frameless stereotactic hematoma aspiration (FSA) with frame-based stereotactic hematoma aspiration (FBSA) in intracerebral hemorrhage (ICH) about operative advantage and result. MATERIAL AND METHODS: Between January 2002 and December 2002, we surgically treated 30 patients presenting with spontaneous ICH at our hospital. 15 patients underwent FBSA via Codman-Roberts-Wells system and catheter placement with urokinase infusion and drainage, and 15 patients underwent FSA and catheter placement via neuronavigator with urokinase infusion and drainage. RESULTS: The amount of remaining hematoma and removal rate were from 1 to 26 and 76% in FSA and from 2 to 55 and 60.4% in FBSA. The entry point was selected within 2.03+/-0.85 cm in a frontal direction from Kocher's point and 2.86+/-0.57 cm in lateral direction from Kocher's point and the trajectory was selected toward the distal margin of hematoma along the long axis of hematoma in FSA but the entry point was restricted within Kocher's point and the trajectory was selected toward the center of the maximum axial section of hematoma in FBSA. The mean time of operative preparation was mean 61 minutes in FSA and 78 minutes in FBSA. The number of patients not required with infusion of urokinase was 10 in FSA and 7 in FBSA. The mean duration of urokinase infusion was 3.6 day in FSA and 4.1 day in FBSA. CONCLUSION: FSA is fast, simple and effective procedure. In comparison with FBSA, FSA has advantage in selecting the entry point and the trajectory for hematoma aspiration and catheter placement, and in a less time-consuming procedure.

Stereotactic Removal of Intracerebral Sparganum: A Case Report

Intracerebral sparaganosis, caused by the Plerocercoid of Spirometa mansoni, is very rare. A 54-yeas-old man, who has a history of having eaten raw frogs and snakes 20 years ago, was admitted with 2 years duration of focal seizure and monoparesis on right upper extremity. The brain CT scan and MRI demonstrated extensive and irregular hypodense lesion with punctate calcification in subcortical region of left parietal lobe. A whitish ribbon-like moving parasite could be picked up using CRW stereotactic frame under local anesthesia. On pathological examination was disclosed a sparganum with characteristic calcospherule. Also, preoperative ELISA test for sparganum-specific antibody(IgG) showed positive reaction to sparganum absorbance 1.04 in serum and 0.61 in CSF, respectively(normal abs. : below 0.22). Immediately after removal of parasite, the seizure and motor weakness disappeared. Stereotactic removal of cerebral sparganum can be considered a useful method in selected patients.

Stereotactic Evacuation of Spontaneous Intracerebellar Hemorrhage

The incidence of spontaneous cerebellar hemorrhage is a range of between 0.3% and 0.7% in several large series and accounts for 10% of all intracranial hemorrhages. The course and prognosis of spontaneous intracerebellar hemorrhage, regardless of treatment, is poor. The Cosman-Robert-Wells(CRW) stereotactic instrument is recently developed modification, based on an arc-radius design, of the Brown-Roberts-Wells(BRW) stereotactic frame utilizing the exising fixation and fiducial components of the BRW stereotactic system localize and verify target data. During the year of 1989 through 1991, 25 patients with spontaneous cerebellar hemorrhage operated on using CRW stereotactic instrument and fibrinolysis. The age incidence was most frequent in 7th decade. 19 cases(76%) obtained a favorable outcome after operation and 4 cases(16%) death. 2 cases subsequently developed postoperative rebleeding and a case infection. The short operating time, the relatively low risk involved, and the lack of danger to healthy brain support the use of CT-guided stereotactic removal and fibrinolysis. In our opinion, CT guided sterotactic removal is simple, effective and safe method for spontaneous cerebellar hematoma.