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El Beltagy M.A.,Childrens Cancer Hospital Egypt CCHE | El Beltagy M.A.,Cairo University | Atteya M.M.E.,Childrens Cancer Hospital Egypt CCHE | Atteya M.M.E.,Cairo University
Child's Nervous System | Year: 2013

Background: Safe and radical excision of pediatric fourth ventricular tumors is by far the best line of management. Pediatric fourth ventricular tumor surgery is a challenge for neurosurgeons. The aim of the study is to present the authors' experience and to evaluate the possible benefits of neuro-navigated intraoperative ultrasonography (NIOUS) during the surgery of fourth ventricular tumors in children. Methods: Nonrandomized clinical trial study was conducted on 60 children with fourth ventricular tumors who were treated at Children's Cancer Hospital-Egypt. Mean age was 5.2 (±2.6) years. Thirty cases were operated upon utilizing the conventional microneurosurgical techniques. Another 30 cases were operated upon utilizing the NIOUS technique. Results: Total tumor excision was achieved in 29 cases (96.7 %) of NIOUS group versus 24 cases (80 %) in the conventional group. Mean operative time NIOUS group was 150 min [standard deviation (SD) = 18.28) versus 140.6 min (SD = 18.6) in the conventional group (p value = 0.055). The mean operative blood loss was 67.5 ml (SD = 17) in NIOUS group versus 71 ml (SD = 15.4) in the conventional group. Postoperative cerebellar mutism occurred in one case (3.3 %) of NIOUS group versus in six cases (20 %) of the conventional group. Conclusions: Integration of navigated intraoperative ultrasonography in surgery of pediatric fourth ventricular tumors is a useful technology. It safely monitors maximum stepwise tumor excision. It is associated with less operative morbidity without significantly added operative time. It is a real-time, cost-effective, easily applicable, and easily interpretable tool that could substitute the use of intraoperative MRI especially in pediatric neurosurgery. © 2013 Springer-Verlag Berlin Heidelberg. Source


Eldebawy E.,Childrens Cancer Hospital Egypt CCHE | Eldebawy E.,Cairo University | Attalla E.,Childrens Cancer Hospital Egypt CCHE | Attalla E.,Cairo University | And 4 more authors.
Journal of the Egyptian National Cancer Institute | Year: 2011

Purpose: To evaluate set-up variation of pediatric patients undergoing 3D conformal radiotherapy (3DCRT) using electronic portal image device (EPID), in an effort to evaluate the adequacy of the planning target volume (PTV) margin employed for the 3DCRT treatment of pediatric patients. Materials and methods: Set-up data was collected from 48 pediatric patients treated with 3DCRTfor head and neck (31 patients), abdomino-pelvic (9 patients) and chest (8 patients) sites during the period between September 2008 and February 2009. A total of 358 images obtained by EPID were analyzed. The mean (M) and standard deviation (SD) for systematic and random errors were calculated and the results were analyzed. Results: All images were studied in anterior and lateral portals. The systematic errors along longitudinal, lateral and vertical directions in all patients showed an M equal to 1.9, 1.6, and 1.6. mm with SD of 1.8, 1.4, and 1.8. mm, respectively; (head and neck cases: M equal to 1.5, 1.2, and 1.6. mm with SD 1.4, 1.2, and 1.8. mm; chest cases: M equal to 2.5, 1.8, and 0.8. mm with SD 2.7, 1.7, and 1.2. mm, abdomino-pelvic cases: M equal to 2.9, 2.8 and 2.3. mm with SD 1.6, 1.2, and 2.3. mm). Similarly, the random errors for all patients showed SD of 1.9, 1.6, and 1.8. mm, respectively (head and neck cases: SD 1.7, 1.3, and 1.5. mm; chest cases: SD 1.2, 1.9, and 2.5. mm; abdomino-pelvic cases SD 2.5, 2, and 2.4. mm, respectively). Using Van Herk's formula the suggested (PTV) margin around the clinical target volume (CTV) of 5.5. mm appears to be adequate. Conclusion: The ranges of set-up errors are site specific and depends on many factors. © 2011. Source

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