Among spinal tumors that occur intradurally, meningiomas, nerve sheath tumors, ependymomas, and astrocytomas are the most common. While a spinal MRI is the state of the art to diagnose intradural spinal tumors, in some cases CT scans, angiography, CSF analyses, and neurophysiological examination can be valuable. The management of these lesions depends not only on the histopathological diagnosis but also on the clinical presentation and the anatomical location, allowing either radical resection as with most extramedullary lesions or less invasive strategies as with intramedullary lesions. Although intramedullary lesions are rare and sometimes difficult to manage, well-planned treatment can achieve excellent outcome without treatment-related deficits. Technical advances in imaging, neuromonitoring, minimally invasive approaches, and radiotherapy have improved the outcome of intradural spinal tumors. However, the outcome in malignant intramedullary tumors remains poor. While surgery is the mainstay treatment for many of these lesions, radiation and chemotherapy are of growing importance in recurrent and multilocular disease. We reviewed the literature on this topic to provide an overview of spinal cord tumors, treatment strategies, and outcomes. Typical cases of extra- and intramedullary tumors are presented to illustrate management options and outcomes.

Objective To establish a maximum tolerated dose of superselective intraarterial cerebral infusion (SIACI) of Cetuximab after osmotic disruption of the blood-brain barrier (BBB) with mannitol, and examine safety of the procedure in patients with recurrent malignant glioma. Methods A total of 15 patients with recurrent malignant glioma were included in the current study. The starting dose of Cetuximab was 100 mg/m(2) and dose escalation was done to 250 mg/m(2). All patients were observed for 28 days post-infusion for any side effects. Results There was no dose-limiting toxicity from a single dose of SIACI of Cetuximab up to 250 mg/m(2) after osmotic BBB disruption with mannitol. A tolerable rash was seen in 2 patients, anaphylaxis in 1 patient, isolated seizure in 1 patient, and seizure and cerebral edema in 1 patient. Discussion SIACI of mannitol followed by Cetuximab (up to 250 mg/m(2)) for recurrent malignant glioma is safe and well tolerated. A Phase I/II trial is currently underway to determine the efficacy of SIACI of cetuximab in patients with high-grade glioma.

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In this article the authors discuss the development of neurosurgical approaches and the advances in science and technology that influenced this development throughout history. They provide a broad overview of this interesting topic from the first attempts of trephination by ancient cultures to the work of the pioneers of neurosurgery and the introduction of microsurgery.

The Brain Tumor Biotech Center at the Feinstein Institute for Medical Research, in collaboration with Voices Against Brain Cancer hosted The Brain Tumor Biotech Summit at in New York City in June 2015. The focus was once again on fostering collaboration between neuro-oncologist, neurosurgeons, scientists, leaders from biotechnology and pharmaceutical industries, and members of the financial community. The summit highlighted the recent advances in the treatment of brain tumor, and specifically focused on targeting of stem cells and EGFR, use of prophage and immunostimulatory vaccines, retroviral vectors for drug delivery, biologic prodrug, Cesium brachytherapy, and use of electric field to disrupt tumor cell proliferation. This article summarizes the current progress in brain tumor research as presented at 2015 The Brain Tumor Biotech Summit.

Key WorDs • cavernous sinus • cavernous hemangioma • pregnancy • oncologyAbbreviations used in this paper: CH = cavernous hemangioma; CS = cavernous sinus; VEGF = vascular endothelial growth factor. This article contains some figures that are displayed in color on line but in black-and-white in the print edition. J. S. Haber et al. 1310J Neurosurg / Volume 120 / June 2014 tion, she was referred to an outside neurologist who found ophthalmoplegia of the left eye and sensory deficit in the left V1 distribution.Clinical Course. The patient was then referred to the emergency department of the NewYork-Presbyterian Hospital where her examination was notable for 2 mm of ptosis in the left eye, impaired adduction, elevation, and depression of the left eye consistent with a partial left oculomotor nerve palsy and an inability to abduct the left eye, consistent with a complete left abducens palsy. Magnetic resonance imaging showed an expansile mass in the left CS (Fig. 1A) presumed to be a schwanomma.Several weeks later, the patient's left periorbital pain and numbness as well as the vertical motility of the left eye improved. However, repeat MRI showed a slight increase in lesion size and multiple serpentine T2 hyperintense structures, which together were suggestive of a CSCH (Fig. 1B). A cesarean section was recommended to reduce the risk of enlargement and hemorrhage during delivery. The neurosurgery team recommended no acute surgical treatment given the extent of the lesion within the CS, close follow-up, and postpartum imaging to assess for possible spontaneous involution.At 30 weeks of gestation the patient presented with progressive left orbital pressure, lid edema, worsened ptosis to 5 mm of the left eye and a new 2-mm anisocoria with mydriasis of the left eye. Repeat MRI revealed a significant enlargement of the lesion with extension to the orbital apex (Fig. 1C). There was severe compression of the left internal carotid artery and increased impingement of the left optic nerve. The patient was offered the option of immediate delivery, but she declined. A cesarean section was scheduled for 37 weeks.At 35 weeks of gestation, the patient was referred to a neuro-ophthalmologist for declining left visual acuity. Neuro-ophthalmic examination confirmed a complete left abducens palsy and partial left oculomotor palsy, including a mild adduction defect, mild ptosis and mydriasis, worse in light. However, there was no relative afferent pupillary defect. Visual acuity in the left eye improved with a +2 lens, consistent with blurry vision from a lens accommodation paresis associated with the oculomotor palsy rather than from optic nerve compression (Fig. 2).Postpartum Course. The patient underwent the scheduled cesarean section without complication. Two weeks postpartum, she developed complete ptosis and decreased supra-and infra-adduction of the left eye, consistent with worsened oculomotor nerve function. Furthermore, in addition to left mydriasis in the light, a relative miosis in dim light had developed, consistent with ...

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