Role of temozolomide in spinal cord low grade astrocytomas: results in two paediatric patients.

BACKGROUND: The optimal treatment of low grade intramedullary spinal cord tumours remains controversial. In many cases the tumours continue to progress even after surgery and radiation. Effective chemotherapy may be an important therapeutic adjunct in this setting. Temozolomide is widely used for brain gliomas, yet its role in the management of spinal cord tumours has not been reported. PROCEDURE: Two paediatric patients with low grade spinal cord astrocytomas were diagnosed to have progression of the tumour in spite of surgery and radiotherapy. They received temozolomide, 200 mg/m2 daily for five days every four weeks for 10 cycles, and were followed serially. RESULTS: Stabilization of the spinal tumour in both patients was observed at 18 months of follow-up. One of the patients developed haematological toxicity requiring platelet transfusion and dose reduction. CONCLUSION: Based on our findings in two paediatric patients, temozolomide may be a useful agent in the management of progressive recurrent low grade spinal cord astrocytomas.

Spontaneous subdural haematoma in anabolic steroids dependent weight lifters: reports of two cases and review of literature.

Spontaneous subdural haematoma is very rare in young patients. The complications of anabolic steroid intake in weight lifters are numerous, yet subdural haematomas have not been reported. We report on two cases of spontaneous subdural haematomas in young weight lifters. Both patients underwent surgical evacuation and made a full recovery. A review of the literature on the complications associated with valsalva manoeuvres is also presented including hemodynamic and intracranial changes. We propose that patients on chronic anabolic steroids may have vascular changes that predispose them to bleeding during a Valsalva manoeuvre (VM).

Concomitant fibrous dysplasia and aneurysmal bone cyst of the skull base. Case report and review of the literature.

The combination of fibrous dysplasia and aneurysmal bone cyst of the skull base is extremely rare yet it should be recognized, lest the rapid growth of the lesion and the radiological picture lead to the wrong diagnosis of a malignant process. We report on a 6(1/2)-year-old patient who suffered from concomitant fibrous dysplasia and aneurysmal bone cyst of the skull base. He is still disease-free 4 years postoperatively. The treatment of choice remains early surgical removal of the maximal amount of involved bone that can safely be achieved. There is no role for radiotherapy in the treatment of these lesions. A review of the literature is included.

Dural osteochondroma: case report, review of the literature and proposal of a new classification.

Complete excision of a dural osteochondroma is presented. Upon reviewing the literature we noted that basal and convexity osteochondromas, although considered as a single pathological entity, differ in epidemiology, pathogenesis, management and natural history. A new classification is proposed.

Cranial osteomas: their classification and management. Report on a giant osteoma and review of the literature.

BACKGROUND: Cranial osteomas are regarded by some as very common; yet their classification, symptomatology, and management have been neglected. METHODS: We report on a giant enostotic convexity osteoma and have reviewed the medical literature. RESULTS: A new comprehensive classification for cranial osteomas is proposed: (1) intraparenchymal, (2) dural, (3) skull base, and (4) skull vault. The latter is in turn, subdivided into exostotic and enostotic variants. Three symptom producing enostotic convexity osteomas have been reported in the world literature. We also describe a giant enostotic skull vault osteoma and propose an original surgical technique used to successfully resect this unusual tumor. CONCLUSIONS: Most cranial osteomas are asymptomatic and need not be resected. Those that are symptomatic should be managed properly. Their excision, if nor properly performed, may lead to unforeseen cerebral complications.

Primary malignant melanoma of the gasserian ganglion associated with neurofibromatosis.

A case of primary intracranial malignant melanoma of the left gasserian ganglion associated with temporal lobe gliosis in a patient suffering from von Recklinghausen's disease is reported. The association of primary malignant melanoma of the trigeminal nerve and neurofibromatosis is discussed.

Traumatic intracranial aneurysms caused by missiles: their presentation and management.

Only 30 cases of traumatic intracranial aneurysm (TICA) secondary to missile injury have been reported to date. To these we add 15 more cases. Missile TICAs are often seen on a secondary branch of the middle cerebral artery and are usually accompanied by a intracerebral hematoma (80%) or by an acute subdural hematoma (26%). Fourteen of our cases were secondary to shrapnel injuries and only one was secondary to a bullet. None of the injuries was through-and-through. TICAs may enlarge in time and, seemingly inoffensive, may rupture and lead to death. All seven TICAs studied histologically proved to be false aneurysms. TICAs are best treated through trapping and excision. The outcome depends on the patient's status and level of consciousness before surgery. Indications for angiography are discussed.

Cerebral giant serpentine aneurysm: case report and review of the literature.

We present a case of cerebral giant serpentine aneurysm (GSA) and propose a definition of GSA. Our literature review disclosed only 16 cases, including our own, that fit our criteria. GSAs belong to the subgroup of giant aneurysms, but are distinct from giant saccular and fusiform aneurysms. We discuss their specific characteristics.

Intracranial complications of submucous resection of the nasal septum.

Submucous resection of the nasal septum (SMR) is a relatively simple and frequently performed operation. Yet, its intracranial complications, although rare, can be very serious and include anosmia, visual disturbances, cavernous sinus thrombosis, meningitis, cerebrospinal fluid rhinorrhea, pneumocephalus, subarachnoid hemorrhage, subdural empyema, and brain abscess. This article reviews intracranial complications of SMR, and the pathogenesis and prevention of such complications are discussed.