Dorsally exophytic brain stem tumors: total removal of a medullary pilocytic astrocytoma in child. Clinicopathological considerations and case report.

The authors describe the case of 4-year-old girl who was operated on for a pilocytic astrocytoma of the brain stem, exophytic and protruded backward into the fourth ventricle. The removal through a suboccipital midline approach was performed and macroscopically complete. Postoperative complications compelled a heavy reanimation with a prolonged follow-up therapy. The neurological recovery was favorable. Three years later, this little girl is almost autonomous in all daily activities. Postoperative scans showed total tumor resection. The patient received no complementary treatment such as radiotherapy, chemotherapy or corticotherapy. The long-term survival, without the need for adjunctive therapy, confirms the good prognosis for this unusual group of brain stem tumors. The clinicopathological and radiological features are described and surgical questions are discussed especially regarding complete or subtotal removal of brain stem tumors in demarcated-benign astrocytomas.

Intramedullary epidermoid cyst: preoperative diagnosis and surgical management after MRI introduction. Case report and updating of the literature.

Many patients with spinal tumours of developmental origin do not receive preoperative diagnosis and the surgical management, especially as for capsule resection, is often unplanned. Like other uncommon tumours, the intramedullary epidermoid cyst is often an operative or histological finding. Since magnetic resonance imaging (MRI) introduction, evidence has accumulated that they may be preoperatively suspected. In reporting the case of a young patient with a T3-T4 intramedullary epidermoid cyst, the authors present an overview of the clinical, radiological and surgical aspects of such tumors and review the latest literature in which MRI and microsurgical excision were performed. Despite the introduction of new diagnostic and surgical instrumentation, the preoperative diagnosis and surgical management of such tumours need further discussion.