Complications associated with intra-arterial BCNU administered in combination with vincristine and procarbazine for the treatment of malignant brain tumors.

We have used intra-arterial (i.a.) 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) either alone or as part of adjuvant chemotherapy in patients with malignant brain tumors over a 3 year period (1979-1982). The i.a. BCNU technique was used 111 times to infuse 134 arteries in 37 patients. These patients, 28 cases with glial tumor and 9 cases with brain metastasis, received i.a. BCNU in combination with Vincristine and Procarbazine every 6 weeks. Complications encountered were transient and included: periorbital erythralgia or occipital-nuchal pain in 23 (62%), mild confusion and disorientation in 14 (38%), and ipsilateral conjunctival edema in 10 (27%). Reversible myelosuppression was not found. Our findings suggest that BCNU (100 mg/M2) may be given by i.a. infusion in combination chemotherapy without persistent severe untoward effects with a cumulative dose of 700 mg/M2.

Therapeutic benefits of combination chemotherapy with vincristine, BCNU, and procarbazine on recurrent cystic craniopharyngioma. A case report.

The authors report a case of recurrent cystic craniopharyngioma managed with chemotherapy. The patient refused adamantly the alternative therapy methods, such as surgery and radiotherapy, initially offered. Eight courses of chemotherapy with vincristine (2 mg/M2, i.v.) on day 1,1,3-bis(2-chloroethyl)-1-nitrosourea (100 mg/M2, i.v.) on day 2, and procarbazine (50 mg, b.i.d., p.o.) on days 3 to 21 were administered at 6 week intervals. The effectiveness of this treatment modality has been evaluated by the unequivocal neurological improvement and by the decreases in size of the cyst using serial computerized tomography. Toxocities were mild and chiefly hematological.

Intracranial meningioma presenting as a mass in the neck.

A meningioma demonstrating unusual anatomical and clinical manifestations is described. This intracranial tumor originated in the petrous region and extended into the neck, the patient remaining neurologically asymptomatic for nearly 2 years. The radiological features of this tumor as well as a review of the pertinent literature are presented.

Peripheral enhancement in computerized cranial tomography: a non-specific finding.

Peripheral enhancement of intracranial lesions on CT examination is still being considered by some radiologists as specific for an abscess or a cystic tumor. A review of the last 4,000 scans at this institution has demonstrated that it is neither specific nor, in many cases, of much help in the differential diagnosis of the lesions. Examples of the various types of lesions that can demonstrate peripheral enhancement are shown. It is suggested that many if not all types of pathology would demonstrate this effect if the cranial CT scans were done at a fortuitous time or sequentially. Some differential diagnostic suggestions are also made.

Multiple aneurysm formation as a complication of interventive angiography.

The authors describe a case in which transcatheter embolization was used to treat a large arteriovenous malformation of the scalp (cirsoid aneurysm), with subsequent development of multiple aneurysms at the embolization sites. This previously unreported complication may have far reaching implications in treatment modality selection.

Some observations in progressive arterial occlusions in children and young adolescents: (Moyamoya disease).

In "primary arterial occlusions of children", an unusual collateral circulation has been described first by Japanese, and later by others worldwide. As experience was gained some workers started to realize that the "typical angiographic appearance" could be found in several disease entities. It thus became evident that angiographic differentiation is important. In this communication we wish to discuss this entity and outline its significance as well as emphasize the pitfalls.

Unusual angiographic manifestations of craniopharyngioma: a case report.

A craniopharyngioma with two unusual manifestations, a dense capsular stain and occlusion of the internal carotid artery, is reported. Neither of these findings appear to have been reported previously. Explanations for these unusual phenomena are offered.