Gamma knife radiosurgery for recurrent anaplastic ependymoma with intracranial disseminations: a case report

Intracranial ependymomas are relatively rare type of gliomas which have high recurrence rates after multimodal therapy with surgery, fractionated radiation therapy and chemotherapy. We report the case of a 15-year-old girl with recurrent anaplastic ependymoma [WHO grade III] who underwent multiple surgical excisions for a right temporoparietal tumor in 1998, followed by fractionated radiation therapy and chemotherapy. Eleven years after initial treatment, follow-up imaging of the brain demonstrated tumor recurrence with multiple intracranial dissemination. Clinically, the patient was asymptomatic. We managed her with gamma knife radiosurgery at our center. The recurrent ependymoma along with four intracranial disseminations were defined with gamma plan and a prescription dose of 16 Gy was delivered to the mean target volume of 1.56 ml [range 0.159 - 5.7 ml] with a mean isodose line of 54.3% [range 50 - 65%]. Images on post-radiosurgery follow-up at 21 months revealed complete remission of the recurrent ependymoma and significant decrease in size of all disseminations

Cystic meningioma

Cystic meningiomas are uncommon tumours. Computed tomography scan and conventional magnetic resonance imaging may not differentiate those lesions form other tumours that are more frequently associated with cystic or necrotic changes; like gliomas or metastases. We are reporting 2 cases of cystic meningiomas in which the diagnosis was not suspected preoperatively because of short clinical history and rapid neurological deterioration. In addition; the cystic appearance of the tumours on imaging studies further confused accurate diagnosis. Although some authors believe that haemorrhage is rare in cases of meningioma, one of our cases was associated with haemorrhage and was proven to be a WHO Grade II meningioma. Because total resection is usually the goal in meningioma surgery, the help of a neruopathologist is important to establish the diagnosis during surgery

Vertebrobasilar artery dissection complicating cervico-dorsal intramedullary Ependymoma: a case report

Vertebral artery dissection [VAD] is an important cause of posterior circulation stroke in young adults. It could be either spontaneous or traumatic; initial symptoms are often non-specific, and diagnostic arteriography is not performed until neurological deficits are obvious. We describe a rare case of a patient who presented with cervico-dorsal intramedullary ependymoma, and developed brain stem infarction caused by vertebrobasilar artery dissection during her postoperative period, which was diagnosed by Magnetic Resonance Imaging [MRI] and Magnetic Resonance Angiography [MRA]. Although vertebrobasilar artery dissection is rare, it should be considered in the differential diagnosis of brain stem infarction, and urgent MRI / MRA should be done as it is a reliable diagnostic tool and less invasive compared to cerebral angiogram

Familial trigeminal neuralgia-report of two cases

Familial trigeminal neuralgia is a rare condition with only 125 cases described until now. Two sisters with trigeminal neuralgia are presented, focusing on the clinical details with the surgical findings, and their relationship to the characteristics of the familial neuralgia group. The surgical findings in both cases are discussed. The scope of the current theories for the pathology responsible for the condition, the differences between familial and the general trigeminal neuralgia group and the future possibilities for clarifying the cause of these differences are also highlighted