Outcome after radiotherapy of primary spinal cord glial tumors.

Primary spinal cord tumors are rare, and treatment recommendations are therefore difficult. We reviewed a 22-year experience of postoperative radiotherapy for spinal cord tumors to elucidate prognostic factors and recommendations. Twenty-two patients with spinal cord tumors were treated from 1969-1991. Ten patients had ependymomas, of which two were high grade. Twelve had astrocytomas, of which 4 were high grade. Karnofsky status, age, extent of resection, tumor histology, grade, and radiation dose were evaluated, as well as degree of clinical improvement after treatment based on change in Karnofsky status. Ependymomas achieved 100% local control with postoperative radiotherapy. Grade and dose were of indeterminate significance because of these excellent results. High-grade astrocytomas all recurred and caused death. Disease recurred in 1 of 8 patients with low-grade astrocytic or mixed astrocytic tumors. The only prognostic variables of significance were histology, grade, and change in Karnofsky status after treatment. Radiation of primary spinal cord tumors is rare. In nearly all cases, local fields may be used. Improvement in Karnofsky status after radiotherapy may predict better survival. Treatment recommendations for these rare tumors are discussed.

Intraarterial use of sodium methohexital for provocative testing during brain embolotherapy.

PURPOSE AND METHODS: To assess its vascular effects and safety, we used sodium methohexital (Brevital)--an ultrashort-acting barbiturate--as the provocative intraarterial agent in a series of 30 patients with arteriovenous malformations at a 1% concentration and at doses of less than 5 mg per injection. Digital vascular imaging was performed just prior to and just after the injections. RESULTS: No angiographic or clinical evidence of apparent vasospasm occurred in the trial population (66 vascular pedicle injections in 30 patients). When functional tissue was perfused with 1-6 mg of the 1% Brevital solution, evidence of altered neurologic status became immediately apparent, but cleared within 2 minutes in all cases. None of the patients experienced either prolongation of the induced clinical symptoms or seizures to suggest any adverse effects related to either crystallization of the Brevital or the effects of injecting an alkaline solution in the cerebral circulation. CONCLUSION: Though the full effects of methohexital in the cerebral circulation remain to be elucidated, existing reports suggest it is a safe provocative agent for use prior to embolotherapy for brain arteriovenous malformations.

Suprasellar tumors of maldevelopmental origin in Klinefelter's syndrome. A report of two cases.

Patients with Klinefelter's syndrome may have a predisposition for the development of neoplasia, particularly extragonadal germ-cell tumors, but a suprasellar location is rarely reported. The clinical and neuroradiologic features in two patients with Klinefelter's syndrome and dysmorphic suprasellar masses of maldevelopmental origin (presumably lipomas or lipodermoids) are described. One patient had bilateral optic atrophy and decreased vision. To our knowledge, only one similar case (a suprasellar hamartoma) has been previously reported in association with Klinefelter's syndrome.

Management of large skin defects in newborn children with myelodysplasia: a new method.

A method successfully used in closing a large skin defect in each of three children with myelodysplasia is described in detail. Full thickness skin closure was achieved in 7--10 days without skin grafts or rotation flaps.

Closure of large skin defect associated with thoracolumbar rachischisis. Case report.

The management of a premature infant with a large skin defect associated with thoracolumbar rachischisis is presented. Full-thickness closure was achieved in 8 days using a new technique, adapted from a method of closing large omphaloceles.