Management of intramedullary cystic pilocytic astrocytoma with rhenium-186 intracavitary irradiation: case report.

OBJECTIVE: We report a case of cystic spinal cord pilocytic astrocytoma treated with surgical resection and 2 intracavitary injections of rhenium. CLINICAL PRESENTATION: A 22-year-old man presented with low-back pain, saddle dysesthesia, and sphincter and sexual dysfunction. Spinal cord magnetic resonance showed a large, cystic, intramedullary tumor extending from T9 to T12. TREATMENT: Two surgical approaches and 1 computed tomography (CT)-scan guided tapping allowed shrinkage of the cystic component but each time the cyst enlarged and neurological symptoms worsened. Pathological examination allowed the diagnosis of pilocytic astrocytoma. The patient underwent 2 intracystic CT-scan guided injections of rhenium that achieved good control of cystic component. CONCLUSION: Interstitial intracavitary rhenium brachytherapy of recurrent spinal cord cystic astrocytomas achieved excellent stabilization of the cyst with minor side-effects and dramatic improvement of neurological deficits.

Early surgical management of antenatal diagnosed cystic lesions of the foramen of Monro causing monoventricular hydrocephalus.

INTRODUCTION: After diagnosis of an antenatal monoventricular hydrocephalus caused by a cystic lesion of the foramen of Monro, treatment modality and time frame may be difficult to assess. Previously, this type of hydrocephalus was often treated with internal shunting. The advent of neuroendoscopy has changed the surgical management of this pathology. MATERIALS AND METHODS: We report on two cases of cystic lesions of the foramen of Monro discovered on antenatal ultrasonography. A cavum veli interpositi in one case and a choroid plexus cyst in the other were responsible for unilateral hydrocephalus. In both cases, endoscopic treatment before 1 month of age was performed as the primary procedure with a successful outcome. CONCLUSIONS: We advise early endoscopic treatment for newborns presenting with progressive unilateral hydrocephalus caused by a cystic lesion of the foramen of Monro. It has been, in our hands, a safe and efficient procedure.

Aneurysm clipping after endovascular treatment with coils: a report of 13 cases.

In 1996, Civit et al. (Neurosurgery, 38:955-961, 1996) reported a series of eight patients whose aneurysms were clipped after previous embolization with coils. This paper highlighted the safety of this surgery in second line, with a low complication rate and a favorable outcome. The two major surgical indications were either after deliberate partial occlusion of the aneurysm (N=3) or partial occlusion after endovascular treatment (N=3). Reviewing 13 additional patients from 1996 to June 2005, the authors compared the surgical indications and focused on the technical problems of clipping after coiling. Thirteen patients (men=6, women=7) with aneurysm clipping following one or more endovascular embolizations have been operated on since 1996. The patients' files were reviewed retrospectively by both a senior consultant neurosurgeon and a neuroradiologist. Demographic data included sex, age at admission, relevant medical history, initial endosaccular treatment and its quality (partial or complete effectiveness), the rationale for surgery, and the complications arising from the different treatments. In addition to the patient's clinical follow-up, angiograms were performed soon after the surgical procedure, 3 months, 1 year, and 5 years after the coiling, respectively. None of the initial endovascular treatments was complete. Surgical indication was related firstly to anatomical particularities of the aneurysm (width of the neck, N=5; arterial branches from the aneurysm, N=4; no individualized neck in a small aneurysm, N=1); secondly to a shift of the coils with delayed aneurysm regrowth and repermeabilization, N=4; and thirdly to rebleeding, N=3. All the patients who were operated on underwent complete surgical exclusion of their aneurysm (controlled by angiogram). Twelve out of 13 patients recovered satisfactorily (92.3%), attaining the same neurological state they presented prior to surgery. One patient died after the operation. He had already been in a serious condition because of severe rebleeding following the embolization. Aneurysm clipping following a previous endovascular embolization procedure is a rare, although not so exceptional, indication. It is a safe and effective procedure, probably under-used. Nowadays, "hemostatic" and incomplete embolization of an aneurysm increases the risk of future growth and rebleeding of the residual pouch. An additional aneurysm clipping may therefore be required rapidly after embolization.