Is there an optimal sequencing of endoscopic third ventriculostomy and stereotactic radiosurgery for brain metastasis with secondary obstructive hydrocephalus? Illustrative case

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. https://thejns.org/doi/10.3171/CASE25275.