[Stereotactic radiotherapy for spinal meningiomas and neurinomas].

INTRODUCTION: Over the past decades, stereotactic conformal radiotherapy of intracranial meningiomas and schwannomas has been recognized as an effective and safe procedure. Due to the wide use of the CyberKnife system and the procedure of extracranial stereotactic radiotherapy and radiosurgery, the positive experience can be used to treat spinal tumors. This study assessed the effectiveness of stereotactic radiaotherapy of spinal meningiomas and neurinomas using the CyberKnife system. MATERIAL AND METHODS: 46 patients (34 females and 12 males) received treatment between November 2009 and December 2013 (65 tumor nodules). The median age of patients receiving radiotherapy was 49 years (range: 20 to 82 years). Twenty neoplasms were subjected to surgical treatment. In 11 patients, formation of the recurrent tumor foci following treatment was observed along with the systemic disease, neurofibromatosis. Six patients had multiple meningiomas. The median total dose of radiation therapy of neurinomas was 13.6 Gy (12.1-14.1 Gy) per fraction; up to 18.2 Gy (16.0-21.1 Gy) per three fractions; and up to 25.6 Gy (24.8-27.6 Gy) per five fractions. Higher doses were used for meningiomas: 15.9 Gy (14.1-16.2 Gy) per fraction; 20.9 Gy (19.5-21.1 Gy) per three fractions; and 27.5 Gy (25.0-29.9 Gy) per five fractions. The load to 0.15 cm3 of the spinal cord was no higher than the maximum permissible load of 12 Gy per fraction. The mean catamnestic follow-up was 18.1 (4-52) months: 21,1 (4-52) months for neurinomas and 18 (4-31) months for meningiomas. We have not observed complete tumor elimination (i.e., complete response to radiation therapy) in our series. Partial response was observed in 9 (13.8%) cases; stabilization was achieved in 54 (83.1%) cases; and tumor continued to grow in 2 (3.1%) cases. The patients' status was evaluated using the Frankel, the Karnofsky, and the VAS scales. CONCLUSIONS: Our findings clearly demonstrate the short-term benefits of using CyberKnife radiotherapy for benign spinal cord tumors. The catamnestic follow-up needs to be extended to elaborate recommendations for radiation. The progress in this therapy type will considerably improve the quality of medical care provided to this cohort of patients.

Late diagnosis and removal of a large wooden foreign body in the cranio-orbital region.

The rare case of a large wooden foreign body impaled in the cranio-orbital region, and its late diagnosis and successful removal, is presented. A 26-year-old man was admitted to a regional hospital after suffering a severe penetrating craniocerebral injury from a motorcycle accident. Two months after the accident, computed tomographic examination at Burdenko Neurosurgical Institute revealed a large foreign body located in the cranio-orbital region and penetrating the right temporal lobe, with surrounding abscess development. Radiological examination, including three-dimensional computed tomography, enables one to choose the optimal surgical approach and to remove the foreign body, thereby avoiding purulent, inflammatory complications.

Removal of a cranio-orbital foreign body by a supraorbital-pterion approach.

Foreign body removal in blind, penetrating craniocerebral injuries, especially those involving craniobasal localization, could entail additional brain trauma risk. Under such conditions one can use surgical approaches for tumor removal or clipping of intracranial aneurysms. In this report, we present a case of blind, penetrating craniofacial injury in which a supraorbital-pterion approach for foreign body removal was used. Craniography, carotid angiography, and computed tomography data, including three-dimensional imaging, were taken into consideration while planning the operation.

Five patients with a recently described novel leukoencephalopathy with brainstem and spinal cord involvement and elevated lactate.

Recently, a novel leukoencephalopathy syndrome was described in eight patients with a distinct pattern of MRI abnormalities. Here we describe the clinical, laboratory, and MRI findings in five new, unrelated patients. The clinical picture was homogeneous with onset in childhood, a slowly progressive course, variable mental deficits, signs of pyramidal and cerebellar dysfunction and sometimes dorsal column dysfunction. In two patients, a minor head trauma was followed by neurological deterioration and fever. No underlying metabolic defect was found. In two patients serum lactate was elevated, but no evidence of a mitochondrial defect was found. MRI showed variably extensive, diffuse, or spotty cerebral white matter abnormalities and a selective involvement of particular brainstem tracts. The tracts involved included the pyramidal tracts, sensory tracts, superior and inferior cerebellar peduncles, and intraparenchymal trajectories of the trigeminal nerve. In four patients spinal MRI was performed and revealed involvement of tracts over the entire length depicted. Single voxel proton MRS in three patients revealed increased lactate within the abnormal white matter. The uniform and highly characteristic MRI findings, in combination with the similarities in clinical and MRS findings, provide evidence for a distinct nosological entity.