PMC7406467_01
cerebral CT sections with contrast product injection in all three planes, showing the cerebellar tumour process with triventricular hydrocephalus
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F1
The patient was investigated by a brain CT scan that showed a cerebellar tumour process with two components; a fleshy component and a cystic component, measuring 70 mm in diameter; this process compresses the 4th ventricle and leads to significant tri-ventricular hydrocephalus with signs of trans-ependymal resorption of cerebrospinal fluid (Figure 1).
axial section brain MRI T1 injected (A+B+C+D) sagittal slice (E) and coronal slice (F), axial sections T2 (G+H) and coronal slice (I), showing cerebellar hemangioblastoma with both fleshy and cystic components
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F2
The exploration was completed by a cerebral MRI which showed a solido-cystic cerebellar tumour process measuring 70*57*60 mm evoking a pilocytic astrocytoma responsible for tonsillar involvement (Figure 2).
disposition of irradiation beams on the three plans (axial, sagittal and coronal)
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F3
As the surgical removal was partial and the patient's clinical symptoms did not improve, the patient was referred to our hospital where he was given three-dimensional conformal external radiotherapy at a total dose of 50,4Gy in 28 fractions, at a daily dose fraction of 1,8Gy, one fraction per day and 5 sessions per week, over 5.6 weeks, using the 3D conformal radiotherapy technique with fields prescribed to the 100% isodose line, using 6-MV photons (Figure 3).
three plans view of the conformity of the prescribed dose to the target volume in blue and the respect of the optic chiasm and brainstem
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F4
We were able to keep the tolerable doses to the organs at risk such as the brain stem, optic chiasma, optic nerves, retina and pituitary within normal limits and at the same time deliver the expected radiation dose to the tumour site (Figure 4).
brain MRI control showing a decrease in the size of the tumor process after radiation therapy; axial section T1 injected (A+B+C) sagittal slice (D) and coronal sliceS (E+F), coronal sections T2 (G+H+I)
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F5
A cerebral MRI was done in the patient at 3 months after the end of irradiation which showed a decrease in the size of the cerebellar process (Figure 5).