{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:37:15Z","timestamp":1769726235773,"version":"3.49.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"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 Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,22]]},"abstract":"\n BACKGROUND<\/jats:title>\n Secondary hydrocephalus caused by tumor obstruction of the aqueduct leads to anatomical distortion of the third ventricle (3V) and the surrounding structures. This report quantifies and discusses the dosimetric impact of hydrocephalus in stereotactic radiosurgery (SRS) treatment and discusses the optimal sequencing between radiosurgery and endoscopic third ventriculostomy (ETV).<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors review a case of intracranial metastasis causing secondary obstructive hydrocephalus that underwent ETV before SRS. Dual SRS plans were made based on the MRI before and after the ETV to evaluate the impact of the ventricular volume on dosimetry. Both plans had the same treatment parameters. The time interval between the MRI studies was approximately 20 days, with a 74% increase in the tumor size. The post-ETV plan revealed a reduced ventricular volume, particularly the 3V, with a noticeable shift in normal brain structures, leading them to receive increased doses.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n The anatomical changes caused by the ventricular reduction after the ETV associated with the tumor growth were enough to produce a higher dose to the healthy tissue, exposing the patient to a greater risk of adverse radiation effects. Shortening the interval between ETV and SRS can minimize anatomical shifts and the risk of adverse effects while maintaining adequate patient management.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25275<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25275","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:27:43Z","timestamp":1758587263000},"source":"Crossref","is-referenced-by-count":0,"title":["Is there an optimal sequencing of endoscopic third ventriculostomy and stereotactic radiosurgery for brain metastasis with secondary obstructive hydrocephalus? Illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9746-7931","authenticated-orcid":true,"given":"Victor","family":"Goulenko","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1517-9707","authenticated-orcid":true,"given":"Venkatesh Shankar","family":"Madhugiri","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil D.","family":"Almeida","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8120-3358","authenticated-orcid":true,"given":"Rohil","family":"Shekher","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Fabiano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6615-4235","authenticated-orcid":true,"given":"Dheerendra","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York"},{"name":"Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Adv Radiat Oncol","first-page":"101402","article-title":"Stereotactic radiosurgery in the management of brain metastases: a case-based radiosurgery society practice guideline","volume":"9","author":"Ladbury","year":"2024","unstructured":"Ladbury CPennock MYilmaz TStereotactic radiosurgery in the management of brain metastases: a case-based radiosurgery society practice guideline. Adv Radiat Oncol. 2024;9(3):101402."},{"issue":"11","key":"bib2","series-title":"Lancet Oncol","first-page":"1037","article-title":"Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial","volume":"10","author":"Chang","year":"2009","unstructured":"Chang ELWefel JSHess KRNeurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037-1044."},{"issue":"4","key":"bib3","series-title":"JAMA","first-page":"401","article-title":"Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial","volume":"316","author":"Brown","year":"2016","unstructured":"Brown PDJaeckle KBallman KVEffect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016;316(4):401-409."},{"issue":"1","key":"bib4","series-title":"J Neurosurg Pediatr","first-page":"20","article-title":"Long-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas","volume":"11","author":"Romeo","year":"2013","unstructured":"Romeo ANaftel RPGriessenauer CJLong-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas. J Neurosurg Pediatr. 2013;11(1):20-25."},{"issue":"2","key":"bib5","series-title":"Acta Neurochir (Wien)","first-page":"119","article-title":"Changes in ventricular size after endoscopic third ventriculostomy","volume":"150","author":"Santamarta","year":"2008","unstructured":"Santamarta DMartin-Vallejo JD\u00edaz-Alvarez AMaillo A.Changes in ventricular size after endoscopic third ventriculostomy. Acta Neurochir (Wien). 2008;150(2):119-127."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e714","article-title":"Acute management of gamma knife radiosurgery for asymptomatic obstructive hydrocephalus associated with posterior fossa metastases","volume":"144","author":"Matsunaga","year":"2020","unstructured":"Matsunaga SShuto TKobayashi NMurata HYamamoto T.Acute management of gamma knife radiosurgery for asymptomatic obstructive hydrocephalus associated with posterior fossa metastases. World Neurosurg. 2020;144:e714-e722."},{"key":"bib7","series-title":"World Neurosurg","first-page":"e333","article-title":"Radiologic and clinical outcomes of stereotactic radiosurgery for intraventricular metastases","volume":"157","author":"Mantziaris","year":"2022","unstructured":"Mantziaris GPikis SMarquis OSheehan J.Radiologic and clinical outcomes of stereotactic radiosurgery for intraventricular metastases. World Neurosurg. 2022;157:e333-e341."},{"issue":"suppl","key":"bib8","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 PDStereotactic radiosurgery for intraventricular brain metastases. J Neurosurg. 2014;121(suppl):26-34."},{"key":"bib9","series-title":"J Clin Neurosci","first-page":"117","article-title":"Do brain mets grow while you wait? A volumetric natural history assessment of brain metastases from time of diagnosis to gamma knife treatment","volume":"68","author":"Plunkett","year":"2019","unstructured":"Plunkett RJBarone TABrady WEAttwood KMPrasad D.Do brain mets grow while you wait? A volumetric natural history assessment of brain metastases from time of diagnosis to gamma knife treatment. J Clin Neurosci. 2019;68:117-122."},{"issue":"1","key":"bib10","series-title":"Brain Tumor Res Treat","first-page":"10","article-title":"Systematic analysis of clinical outcomes following stereotactic radiosurgery for central neurocytoma","volume":"5","author":"Bui","year":"2017","unstructured":"Bui TTLagman CChung LKSystematic analysis of clinical outcomes following stereotactic radiosurgery for central neurocytoma. Brain Tumor Res Treat. 2017;5(1):10-15."},{"issue":"10","key":"bib11","series-title":"Cancer","first-page":"2276","article-title":"Gamma knife radiosurgery for central neurocytoma: primary and secondary treatment","volume":"110","author":"Kim","year":"2007","unstructured":"Kim CYPaek SHJeong SSGamma knife radiosurgery for central neurocytoma: primary and secondary treatment. Cancer. 2007;110(10):2276-2284."},{"issue":"2","key":"bib12","series-title":"Acta Neurochir (Wien)","first-page":"247","article-title":"Gamma Knife radiosurgery for low-grade tectal gliomas","volume":"157","author":"El-Shehaby","year":"2015","unstructured":"El-Shehaby AMReda WAAbdel Karim KMEmad Eldin RMEsene IN.Gamma Knife radiosurgery for low-grade tectal gliomas. Acta Neurochir (Wien). 2015;157(2):247-256."},{"issue":"34","key":"bib13","series-title":"J Clin Oncol","first-page":"3283","article-title":"Phase II trial of response-based radiation therapy for patients with localized CNS nongerminomatous germ cell tumors: a Children\u2019s Oncology Group study","volume":"37","author":"Fangusaro","year":"2019","unstructured":"Fangusaro JWu SMacDonald SPhase II trial of response-based radiation therapy for patients with localized CNS nongerminomatous germ cell tumors: a Children\u2019s Oncology Group study. J Clin Oncol. 2019;37(34):3283-3290."},{"issue":"3","key":"bib1","series-title":"Adv Radiat Oncol","first-page":"101402","article-title":"Stereotactic radiosurgery in the management of brain metastases: a case-based radiosurgery society practice guideline","volume":"9","author":"Ladbury","year":"2024","unstructured":"Ladbury CPennock MYilmaz TStereotactic radiosurgery in the management of brain metastases: a case-based radiosurgery society practice guideline. Adv Radiat Oncol. 2024;9(3):101402."},{"issue":"11","key":"bib2","series-title":"Lancet Oncol","first-page":"1037","article-title":"Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial","volume":"10","author":"Chang","year":"2009","unstructured":"Chang ELWefel JSHess KRNeurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037-1044."},{"issue":"4","key":"bib3","series-title":"JAMA","first-page":"401","article-title":"Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial","volume":"316","author":"Brown","year":"2016","unstructured":"Brown PDJaeckle KBallman KVEffect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016;316(4):401-409."},{"issue":"1","key":"bib4","series-title":"J Neurosurg Pediatr","first-page":"20","article-title":"Long-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas","volume":"11","author":"Romeo","year":"2013","unstructured":"Romeo ANaftel RPGriessenauer CJLong-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas. J Neurosurg Pediatr. 2013;11(1):20-25."},{"issue":"2","key":"bib5","series-title":"Acta Neurochir (Wien)","first-page":"119","article-title":"Changes in ventricular size after endoscopic third ventriculostomy","volume":"150","author":"Santamarta","year":"2008","unstructured":"Santamarta DMartin-Vallejo JD\u00edaz-Alvarez AMaillo A.Changes in ventricular size after endoscopic third ventriculostomy. Acta Neurochir (Wien). 2008;150(2):119-127."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e714","article-title":"Acute management of gamma knife radiosurgery for asymptomatic obstructive hydrocephalus associated with posterior fossa metastases","volume":"144","author":"Matsunaga","year":"2020","unstructured":"Matsunaga SShuto TKobayashi NMurata HYamamoto T.Acute management of gamma knife radiosurgery for asymptomatic obstructive hydrocephalus associated with posterior fossa metastases. World Neurosurg. 2020;144:e714-e722."},{"key":"bib7","series-title":"World Neurosurg","first-page":"e333","article-title":"Radiologic and clinical outcomes of stereotactic radiosurgery for intraventricular metastases","volume":"157","author":"Mantziaris","year":"2022","unstructured":"Mantziaris GPikis SMarquis OSheehan J.Radiologic and clinical outcomes of stereotactic radiosurgery for intraventricular metastases. World Neurosurg. 2022;157:e333-e341."},{"issue":"suppl","key":"bib8","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 PDStereotactic radiosurgery for intraventricular brain metastases. J Neurosurg. 2014;121(suppl):26-34."},{"key":"bib9","series-title":"J Clin Neurosci","first-page":"117","article-title":"Do brain mets grow while you wait? A volumetric natural history assessment of brain metastases from time of diagnosis to gamma knife treatment","volume":"68","author":"Plunkett","year":"2019","unstructured":"Plunkett RJBarone TABrady WEAttwood KMPrasad D.Do brain mets grow while you wait? A volumetric natural history assessment of brain metastases from time of diagnosis to gamma knife treatment. J Clin Neurosci. 2019;68:117-122."},{"issue":"1","key":"bib10","series-title":"Brain Tumor Res Treat","first-page":"10","article-title":"Systematic analysis of clinical outcomes following stereotactic radiosurgery for central neurocytoma","volume":"5","author":"Bui","year":"2017","unstructured":"Bui TTLagman CChung LKSystematic analysis of clinical outcomes following stereotactic radiosurgery for central neurocytoma. Brain Tumor Res Treat. 2017;5(1):10-15."},{"issue":"10","key":"bib11","series-title":"Cancer","first-page":"2276","article-title":"Gamma knife radiosurgery for central neurocytoma: primary and secondary treatment","volume":"110","author":"Kim","year":"2007","unstructured":"Kim CYPaek SHJeong SSGamma knife radiosurgery for central neurocytoma: primary and secondary treatment. Cancer. 2007;110(10):2276-2284."},{"issue":"2","key":"bib12","series-title":"Acta Neurochir (Wien)","first-page":"247","article-title":"Gamma Knife radiosurgery for low-grade tectal gliomas","volume":"157","author":"El-Shehaby","year":"2015","unstructured":"El-Shehaby AMReda WAAbdel Karim KMEmad Eldin RMEsene IN.Gamma Knife radiosurgery for low-grade tectal gliomas. Acta Neurochir (Wien). 2015;157(2):247-256."},{"issue":"34","key":"bib13","series-title":"J Clin Oncol","first-page":"3283","article-title":"Phase II trial of response-based radiation therapy for patients with localized CNS nongerminomatous germ cell tumors: a Children\u2019s Oncology Group study","volume":"37","author":"Fangusaro","year":"2019","unstructured":"Fangusaro JWu SMacDonald SPhase II trial of response-based radiation therapy for patients with localized CNS nongerminomatous germ cell tumors: a Children\u2019s Oncology Group study. J Clin Oncol. 2019;37(34):3283-3290."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/12\/article-CASE25275.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/12\/article-CASE25275.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/12\/article-CASE25275.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:14:02Z","timestamp":1769685242000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/12\/article-CASE25275.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":26,"journal-issue":{"issue":"12"},"URL":"https:\/\/doi.org\/10.3171\/case25275","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,22]]}}}