The objective of the study was to evaluate the safety and therapeutic efficacy of intralesional administration of doxorubicin in brain gliomas. Ten patients with recurrent grade III or IV glioma were enrolled in the study, after the second operation. All patients had not responded to radiation therapy. Chemotherapy was administered directly in the tumor through an Ommaya pump placed in the site of disease at the time of craniotomy. Doxorubicin 0.5 mg was administered in the Ommaya reservoir every 24 hours on days 1 to 10. Patients were evaluated at 6- to 8-week intervals until tumor progression and death. All patients were evaluated for response. Six of 10 patients had clinical improvement lasting from 12 to 73 weeks. Objective radiologic response was observed in 5 of 10 (50%) patients. One patient achieved complete response with time to disease progression of 119 weeks, and 4 patients had a partial response (duration 14-39 weeks) with 25% or more reduction of tumor volume on computed tomography scan compared with pretreatment measurements. Time to disease progression in patients who responded after the intratumoral chemotherapy was 39.83 +/- 40.5 weeks. One additional patient had stable disease for a duration of 12 weeks. The median survival of the patients with response was 55.17 +/- 54.22 weeks (range: 21-164 weeks), whereas survival of those who did not respond was 17.0 +/- 12.36 weeks (range: 8-35) (Mann Whitney U test: z = -2.13, p = 0.033). The median survival of all 10 patients was 39.9 +/- 45.52 weeks (range: 8-73 weeks). Bifrontal headache was reported in 4 of 10 patients immediately after the administration of doxorubicin. There were no other clinically significant adverse reactions either in the brain or systematically. Intralesional administration of doxorubicin appears to be a safe and effective treatment and should be further explored in the management of brain gliomas resistant to conventional forms of treatment.
Intraventricular cavernoma (IVC) is a rare intracranial vascular malformation and only 100 cases of IVC have been described in the literature. Although IVCs share some common characteristics with intraparenchymal cavernomas, they also have some distinct features involving structure, clinical symptoms, radiologic appearance, and onset of symptoms. This review presents our experience, consisting of five IVC cases over a period of 11 years. We describe the symptoms leading to hospital admission, the main radiologic findings, the management of each ICV case, and the patients' clinical status after surgery. We also reviewed the international literature on IVC, presenting the main demographic characteristics, their most common location in the ventricular system, and the main signs and symptoms. Finally, we present the management options according to the current literature, the advantages and disadvantages of every management option, accompanied by a brief follow-up of most IVC cases, whether the cavernoma was treated surgically or conservatively.
Dorsal epidural migration of an extruded disc fragment is an infrequent event, especially in the thoracic spine. An uncommon case involving a 55-year-old man is presented, with a 1-month history of paraparesis and thoracolumbar pain. Magnetic resonance imaging demonstrated a dorsally located, extramedullary mass at the T10-T11 intervertebral level. The lesion was suspected to be a tumor. The patient underwent a T10-T11 laminectomy. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was found. The pathologic diagnosis was inflammatory tissue and disc material. Six months after the operation, the patient remained asymptomatic, and radiologic control showed no residual mass. Although rare, a sequestered disc fragment should be included in the differential diagnosis of an enhancing posterior extramedullary thoracic mass. Preoperative diagnosis of such pathology is difficult because the clinical signs and radiologic images may not entirely exclude other more common thoracic spinal lesions, especially tumors.
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