PMC4150677_01
A: T1 MRI demonstrating PVH in the left trigone.. B: T2 Coronal MRI status-post implantation of intracranial electrodes.. C: Dose plan for Case 1.. D: Axial T2 MRI showing left trigone PVH.
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MRI demonstrated an 8-mm periventricular heterotopia adjacent to the left trigone and associated left mesial temporal sclerosis (Fig. 1A). Four strip electrodes were placed over temporal neocortex (Fig. 1B). A dose of 30 Gy was delivered to a 50% isodose line with three shots (Fig. 1C). Unfortunately, she continued to experience seizures at 12-month follow-up and an MRI revealed no lesional changes in the PVH (Fig. 1D).
PMC4150677_02
A: Coronal T2 MRI showing left trigone PVH.. B: CT scan demonstrating cerebral edema from radiation necrosis.. C: Dose plan for initial LINAC treatment for Case 2.. D: Dose plan for second LINAC treatment for Case 2.
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Brain MRI revealed a PVH adjacent to the trigone of the left lateral ventricle and left mesial temporal sclerosis (Fig. 2A). The first treatment occurred 8 months after invasive monitoring and consisted of a dose of 21 Gy delivered to a 92% isodose line, covering 98% of the lesion (Fig. 2C). This time, 40 Gy was administered to a 91% isodose line covering 100% of the lesion : measuring 2.21 cc (Fig. 2D). A CT scan of her brain demonstrated left-sided cerebral edema, for which she was placed on steroids (Fig. 2B).
PMC4150677_03
A: Post-operative coronal T1 MRI showing depth electrodes.. B: Dose plan for Case 3.. C: Axial FLAIR MRI at 19 months post-treatment showing radiation necrosis.
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Imaging studies included an MRI consistent with PVH involving the left lateral ventricle in the trigone and region of the occipital horn (Fig. 3A). Two months after localization via invasive monitoring, he was treated with 37.5 Gy GKR delivered to a 50% isodose line, covering 100% of the lesion, which measured 0.5 cc in volume (Fig. 3B). A CT scan and subsequent MRI demonstrated lateralized cerebral edema consistent with radiation necrosis (Fig. 3C).