{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:36:17Z","timestamp":1769729777278,"version":"3.49.0"},"reference-count":84,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,11,25]]},"abstract":"\n BACKGROUND<\/jats:title>\n Stereotactic radiosurgery is a favorable alternative to surgery for intracranial cerebral metastases. Fourth ventricle (V4) metastases are challenging because of the location and surrounding structures, with a high risk for obstructive hydrocephalus and brainstem compression. Here, the authors evaluate the effectiveness in terms of safety, tumor control rates, and permanent cerebrospinal fluid (CSF) diversion of primary Gamma Knife radiosurgery (GKRS) in treating V4 metastases.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n \n Eleven of 1060 patients had V4 brain metastases. No patients had pre-GKRS hydrocephalus. The mean tumor volume was 3.3 cm\n 3<\/jats:sup>\n , treatment dose was 18 Gy to the 50.5% isodose line (average 14 shots), conformity index was 1.4, and volume of brainstem receiving greater than 12 Gy was 0.2 cm\n 3<\/jats:sup>\n . Eight patients had radiographic and clinical follow-ups. The average time to initial follow-up was 3.1 months. Karnofsy Performance Status did not change from the initial consultation to the post-GKRS follow-up. No patients developed hydrocephalus or required permanent CSF diversion. One patient required transient external ventricular drain placement; however, neurological symptoms resolved with steroid therapy. Seven patients received steroid therapy post-GKRS. Seven patients had radiographic disease control at the 6-month follow-up. One patient had tumor progression at 6 months and underwent surgery.\n <\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Primary GKRS for V4 metastases with a close follow-up is safe and optimizes quality of life for patients with significant cancer burden.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24293<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24293","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T13:04:47Z","timestamp":1732539887000},"source":"Crossref","is-referenced-by-count":2,"title":["Stereotactic radiosurgery for fourth ventricle brain metastases: tumor control outcomes and the need for CSF diversion. Patient series"],"prefix":"10.3171","volume":"8","author":[{"given":"Shivani D.","family":"Rangwala","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane S.","family":"Han","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Strickland","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Yu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason C.","family":"Ye","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology, The Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"J Neurosurg","first-page":"466","article-title":"The effect of Gamma Knife radiosurgery on large posterior fossa metastases and the associated mass effect from peritumoral edema","volume":"134","author":"Muhsen","year":"2021","unstructured":"Muhsen BAJoshi KCLee BS, et al. The effect of Gamma Knife radiosurgery on large posterior fossa metastases and the associated mass effect from peritumoral edema. J Neurosurg. 2021;134(2):466-474."},{"issue":"10","key":"bib2","series-title":"J Neurol","first-page":"1357","article-title":"Management of brain metastases","volume":"249","author":"Soffietti","year":"2002","unstructured":"Soffietti RRud\u0101 RMutani R. Management of brain metastases. J Neurol. 2002;249(10):1357-1369."},{"issue":"2","key":"bib3","series-title":"J Neurosurg","first-page":"339","article-title":"The surgical treatment of tumors of the fourth ventricle: a single-institution experience","volume":"128","author":"Ferguson","year":"2018","unstructured":"Ferguson SDLevine NBSuki D, et al. The surgical treatment of tumors of the fourth ventricle: a single-institution experience. J Neurosurg. 2018;128(2):339-351."},{"key":"bib4","series-title":"Surgical Disorders of the Fourth Ventricle","first-page":"94","author":"Cohen","year":"1996","unstructured":"Cohen A. Surgical Disorders of the Fourth Ventricle. Blackwell Science; 1996:94-143."},{"key":"bib5","series-title":"Neuro-oncology","first-page":"309","article-title":"Intracranial metastatic tumors: an overview","author":"Sano","year":"1991","unstructured":"Sano K. Intracranial metastatic tumors: an overview. In: Paoletti PTakakura KWalker MDButti GPezzotta S, eds. Neuro-oncology. Springer Netherlands; 1991:309-319."},{"key":"bib6","series-title":"Clin Imaging","first-page":"226","article-title":"MRI of intracranial intraventricular lesions","volume":"52","author":"Muly","year":"2018","unstructured":"Muly SLiu SLee RNicolaou SRojas RKhosa F. MRI of intracranial intraventricular lesions. Clin Imaging. 2018;52:226-239."},{"issue":"6","key":"bib7","series-title":"Neurosurgery","first-page":"E1213","article-title":"Choroid plexus metastasis from papillary thyroid carcinoma presenting with intraventricular hemorrhage: case report","volume":"66","author":"Wasita","year":"2010","unstructured":"Wasita BSakamoto MMizushima MKurosaki MWatanabe T. Choroid plexus metastasis from papillary thyroid carcinoma presenting with intraventricular hemorrhage: case report. Neurosurgery. 2010;66(6):E1213-E1214."},{"issue":"5","key":"bib8","series-title":"J Neurosurg","first-page":"499","article-title":"Survival and pattern of failure in brain metastasis treated with stereotactic Gamma Knife radiosurgery","volume":"97","author":"Petrovich","year":"2002","unstructured":"Petrovich ZYu CGiannotta SLO\u2019Day SApuzzo MLJ. Survival and pattern of failure in brain metastasis treated with stereotactic Gamma Knife radiosurgery. 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J Neurosurg Sci. 2016;60(3):357-366."},{"issue":"4","key":"bib12","series-title":"Int J Radiat Oncol Biol Phys","first-page":"797","article-title":"A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis","volume":"28","author":"Flickinger","year":"1994","unstructured":"Flickinger JCKondziolka DLunsford LD, et al. A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys. 1994;28(4):797-802."},{"key":"bib13","series-title":"Clin Neurosurg","first-page":"32","article-title":"The case for radiosurgery","volume":"45","author":"Alexander","year":"1999","unstructured":"Alexander ELoeffler JS. The case for radiosurgery. 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Magn Reson Imaging. 1997;15(10):1121-1132."},{"issue":"suppl","key":"bib16","series-title":"J Neurosurg","first-page":"90","article-title":"Neuroimaging and quality-of-life outcomes in patients with brain metastasis and peritumoral edema who undergo Gamma Knife surgery","volume":"109","author":"Pan","year":"2008","unstructured":"Pan HCSun MHChen CCCChen CJLee CHSheehan J. Neuroimaging and quality-of-life outcomes in patients with brain metastasis and peritumoral edema who undergo Gamma Knife surgery. J Neurosurg. 2008;109(suppl):90-98."},{"issue":"2","key":"bib17","series-title":"J Neurooncol","first-page":"169","article-title":"Treatment strategy for metastatic brain tumors from renal cell carcinoma: selection of gamma knife surgery or craniotomy for control of growth and peritumoral edema","volume":"98","author":"Shuto","year":"2010","unstructured":"Shuto TMatsunaga SSuenaga JInomori SFujino H. Treatment strategy for metastatic brain tumors from renal cell carcinoma: selection of gamma knife surgery or craniotomy for control of growth and peritumoral edema. J Neurooncol. 2010;98(2):169-175."},{"issue":"suppl","key":"bib18","series-title":"J Neurosurg","first-page":"26","article-title":"Stereotactic radiosurgery for intraventricular brain metastases","volume":"121","author":"Farnia","year":"2014","unstructured":"Farnia BVoong KRBrown PD, et al. Stereotactic radiosurgery for intraventricular brain metastases. J Neurosurg. 2014;121(suppl):26-34."},{"issue":"12","key":"bib19","series-title":"Cancer","first-page":"2919","article-title":"Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status","volume":"75","author":"Glantz","year":"1995","unstructured":"Glantz MJHall WACole BF, et al. Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status. Cancer. 1995;75(12):2919-2931."},{"issue":"2","key":"bib20","series-title":"J Neurooncol","first-page":"341","article-title":"Surgical resection of fourth ventricular ependymomas: case series and technical nuances","volume":"130","author":"Winkler","year":"2016","unstructured":"Winkler EABirk HSafaee M, et al. Surgical resection of fourth ventricular ependymomas: case series and technical nuances. J Neurooncol. 2016;130(2):341-349."},{"issue":"1","key":"bib21","series-title":"J Neurosurg Pediatr","first-page":"52","article-title":"Fourth ventricle tumors in children: complications and influence of surgical approach","volume":"27","author":"Toescu","year":"2021","unstructured":"Toescu SMSamarth GLayard Horsfall H, et al. Fourth ventricle tumors in children: complications and influence of surgical approach. 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Front Surg. 2022;9:915253."},{"key":"bib26","series-title":"World Neurosurg","first-page":"e1045","article-title":"Frailty is associated with in-hospital morbidity and nonroutine disposition in brain tumor patients undergoing craniotomy","volume":"146","author":"Bonney","year":"2021","unstructured":"Bonney PAChartrain AGBriggs RG, et al. Frailty is associated with in-hospital morbidity and nonroutine disposition in brain tumor patients undergoing craniotomy. World Neurosurg. 2021;146:e1045-e1053."},{"issue":"5","key":"bib27","series-title":"CA Cancer J Clin","first-page":"362","article-title":"Frailty and cancer: implications for oncology surgery, medical oncology, and radiation oncology","volume":"67","author":"Ethun","year":"2017","unstructured":"Ethun CGBilen MAJani ABMaithel SKOgan KMaster VA. Frailty and cancer: implications for oncology surgery, medical oncology, and radiation oncology. 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