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

Stereotactic surgery: diagnostic and therapeutic role in the management of brain disorders and our experience at Ibn Sina hospital

To present the results of our experience with stereotactic surgery, which is a safe and minimally invasive technique, in the field of neurosurgery. Prospective study. Department of Neurosurgery, Ibn Sina Hospital, Kuwait. Forty patients underwent stereotactic surgery for diagnostic and therapeutic purposes during the five years between 2006 and 2011. There were 26 male and 14 female patients with a mean age of 47 years [range 9 - 70 yrs]. Twenty seven [67.5%] patients had diagnostic brain procedures and 13 [32.5%] had diagnostic as well as therapeutic procedures. The stereotactic surgery was carried out with the help of computerized tomography [CT] - guided Leksell stereotactic frame[registered] and Leksell SurgiPlan[registered] software. Stereotactic surgery. Outcome of surgery and complications. Stereotactic biopsies confirmed 28 [70%] patients with brain tumors; six [14%] with cerebral infections, four [10%] with multiple sclerosis and one with cerebral infarction. Stereotactic aspirations were performed in nine patients; four with cystic brain tumors and five with brain abscesses. Stereotactic insertion of Ommaya reservoir was performed in four patients with cystic brain lesions. Complication, related to the procedure was observed only in one patient and was managed conservatively. No other morbidity or mortality was noted. Stereotactic surgery is a minimal invasive technique that helps the neurosurgeon in further planning of an appropriate treatment after tissue biopsy. It can also be used as primary mode of treatment in patients with brain abscesses, cysts and intracranial hematomas

Gamma knife radiosurgery: one year preliminary experience at Kuwait gamma knife center, Ibn Sina Hospital, Kuwait

To introduce a novel treatment modality in neurosurgery practice in Kuwait and report our preliminary experience with this technique. Prospective study. Ibn Sina hospital, Kuwait. Fifty-seven patients who underwent radiosurgery in the first year of operation in our center. There were 32 [56%] male and 25 [44%] female patients with their age ranging from 12 to 76 years. Thirty five [61.5%] patients presented with benign tumors, 12 [21%] with malignant tumors [high grade gliomas, metastases], 8 patients [14%] with vascular malformations and two [3.5%] with functional disorders [trigeminal neuralgia]. Thirty one [57.2%] patients underwent radiosurgery for their residual lesions after attempted surgical excisions or other procedures. Gamma knife radiosurgery. Outcome of surgery and complications. The mean follow-up period was 9.7 months [range 3- 20 months]. The follow-up was achieved in 54 [95%] patients while three were lost to follow-up. Post-radiosurgery imaging demonstrated decrease in lesion size in 24 patients, no change in 27 and increase in three patients. These three patients were managed with surgery. Patients with trigeminal neuralgia were pain-free without any medications within three months of Gamma knife. Complications were observed in five [9.3%] patients, which were transient and improved after conservative treatment. No mortality was experienced in our patients, related to the procedure. Gamma knife radiosurgery is a safe and an effective treatment alternative to conventional neurosurgery in selected patients with brain disorders

Treatment of meningitis in neurovascular intensive care unite

The central neuron system [CNS] could be infected by several micro organisms despite being protected by several mechanisms. The routs of entry are multiple, and several factors could predispose patients to CNS infection. CNS infection in the Intensive Care Unit [ICU] is particularly significant due to the peculiar patients affected and the associated high mortality and morbidity. This article is an overview of the CNS infections in the ICU set-up, presenting the commonest types of infections, their clinical presentation, the diagnostic work-up, and the treatment modalities advocated