Primary diffuse leptomeningeal gliosarcomatosis.

We report a 48-year-old woman with primary diffuse leptomeningeal gliomatosis (PDLG) histologically diagnosed as gliosarcoma. She was admitted complaining of headache, numbness of the right arm, double vision, and visual field defects. Computerized tomography (CT) scans showed ventricular dilatation consistent with communicating hydrocephalus. Magnetic resonance imaging (MRI) revealed diffuse meningeal thickening and gadolinium enhancement without a definite intraparenchymal lesion. Whole-spine MRI demonstrated across-the-board dural thickening and gadolinium enhancement. Cytological examination showed atypical anaplastic cells. As no diagnosis could be made she underwent biopsy of the leptomeninges. Histological examination of the specimen returned a diagnosis of gliosarcoma. Despite chemotherapy and radiotherapy she died 11 months after admission. Autopsy findings included gliosarcoma in the leptomeninges and spinal cord without an underlying parenchymal tumor. To our knowledge, this is the first report of primary diffuse leptomeningeal gliosarcomatosis.

Multi-detector-row CT angiography as a preoperative evaluation for spinal arteriovenous fistulae.

The role of multi-detector-row computed tomographic angiography (MDCTA) in spinal vascular malformations has not yet been determined. We present a report on a short series of spinal arteriovenous fistulae (AVF) evaluated by MDCTA. With 4-row and 16-row MDCTA, three cases of spinal dural AVF and one case of perimedullary AVF were examined. Each case was also examined by magnetic resonance (MR) imaging and spinal catheter angiography. In two patients with spinal dural AVF, including one patient with angiographically occult AVF, MDCTA successfully located the site of the AVF in a multi-planar reformation image. MDCTA failed to locate the remaining case of spinal dural AVF, probably due to the small amount of shunting blood volume at the fistula. In a patient with perimedullary AVF, MDCTA visualized the broad range of the lesion, including the anterior spinal artery as a single feeder, the fistulous point, and the single perimedullary draining vein. In conclusion, although conventional spinal angiography might be still essential, MDCTA provides useful information for the surgeon in treatment of the spinal dural AVF. Further accumulation of clinical cases is required to determine the potential of MDCTA for perimedullary AVF. MDCTA should be considered as a choice of investigation in the evaluation of spinal AVFs.

De novo distal posterior cerebral artery aneurysm.

BACKGROUND: De novo aneurysms in the posterior circulation are very rare. The authors describe a first case of ruptured de novo posterior cerebral artery (PCA) aneurysm in the P3 portion. CASE DESCRIPTION: A 52-year-old woman with ruptured de novo P3 aneurysm was treated by early endovascular obliteration using Guglielmi Detachable Coils (GDC). To prevent vasospasm, she received postoperative treatment with a hypertensive hypervolemia dilution and a calcium antagonist. She was discharged without neurologic deficits. CONCLUSIONS: Aneuryms arising from peripheral segment of PCA are rare, and delayed surgical clipping has been recommended for these lesions. This is the first report of a de novo P3 ruptured aneurysm treated by endovascular embolization using GDC in the acute stage of subarachnoid hemorrhage. The characteristics of de novo posterior circulation aneurysms and the strategy for the distal PCA aneurysms are discussed.

Interhemispheric arachnoid cyst in the elderly: case report and review of the literature.

BACKGROUND: Preoperative differential diagnosis of interhemispheric cysts is sometimes difficult. CASE DESCRIPTION: We recently experienced a case of symptomatic interhemispheric arachnoid cyst in a 62-year-old woman. We reviewed interhemispheric arachnoid cysts in the elderly and the management of symptomatic interhemispheric arachnoid cysts in elderly patients. Symptomatic interhemispheric arachnoid cysts in the elderly are predominantly located on the right side, have a long history of progressive symptomology, occur predominantly in females, and have no communication with the subarachnoid space. Interhemispheric arachnoid cysts are usually not associated with agenesis of the corpus callosum in elderly patients, whereas interhemispheric nonarachnoid cysts are usually associated with agenesis of the corpus callosum, which will be clearly demonstrated on magnetic resonance imaging. CONCLUSIONS: It is highly possible that an interhemispheric cyst without agenesis of the corpus callosum in an adult is an arachnoid cyst.

Long-term results of conventional treatment of diencephalic pilocytic astrocytoma in infants.

BACKGROUND: To develop an effective therapeutic strategy for patients with diencephalic pilocytic astrocytomas (PA), we must understand the long-term effects and problems of conventional treatments. METHODS: We performed a retrospective follow-up of four infants with PA in the diencephalon. CONCLUSION: The initial treatment consisted of partial tumor removal and/or external radiation. The mean progression-free duration after the initial treatment was 108.5 months. All patients received a second course of radiation to treat recurrent tumors. These conventional treatments produced relatively long survival. Three patients died 105, 202, and 379 months after the initial treatment. One patient is still alive at 249 months after the initial treatment. However, mental retardation was obvious in all four patients 6 to 12 years after the first irradiation and within 2 years of the second course of irradiation. Therefore, new therapeutic strategies must focus on delaying the timing of radiation until the patients are at least 5 years old and avoiding a second course of radiation to treat recurrence.