Despite definite survival gains over the last years, the considerable outcome disparities between the less affluent SEE region and the United States for AYAs with malignant CNS tumors point to health care delivery inequalities. No considerable prognostic deficits for CNS tumors are evident for AYAs versus children. Cancer 2017;123:4458-71. © 2017 American Cancer Society.

Calcified chronic subdural hematoma (SDH) is a rare late complication of shunting procedures for infantile hydrocephalus. 1,2,4 Bilateral calcified chronic SDHs may be so extensive that they give the appearance of a so-called "armored brain." 3,5 This 33-year-old man was admitted to our department with symptoms of increased intracranial pressure. According to his medical history, the patient had undergone a ventriculoatrial shunt insertion for hydrocephalus 2 months after his birth at a children's hospital. His mild spastic quadriparesis and learning difficulties were obvious since childhood. One year before the present admission, a brain computed tomographic (CT) scan performed after a minor head injury had shown the presence of large, calcified, bilateral SDHs, together with small ventricles and a ventricular catheter in place (Fig. 1A). At admission, a new brain CT scan revealed ventricular dilation (Fig. 1B). A ventriculoperitoneal shunt was inserted in the patient. The new ventricular catheter was inserted via a right frontal bur hole near the midline, avoiding the calcified hematoma. The old shunt was left in place because the catheter was considered to be entrapped inside the calcification. The postoperative clinical course of the patient was uneventful. The patient improved and returned to his neurological status before the dysfunction of the shunt, and a postoperative CT scan confirmed a reduction of ventricular size (Fig. 1C). Chronic SDHs that remain undiagnosed during childhood may contribute to neurological impairments, therefore intensive follow-up is necessary after shunting procedures in infants and children. Cases of bilateral extensively calcified SDHs have been rarely reported. 5 Revision of the malfunctioning shunt in cases like these may be troublesome.

We present a 32-year-old woman with intracranial haemorrhage due to rupture of a saccular aneurysm arising from the trunk of an accessory middle cerebral artery. This is the first report of an aneurysm arising distally to the anomalous vessel's origin from the A1 segment of the anterior cerebral artery.

This 52-year-old woman complained of lower trunk and limb numbness 2 months before admission. She presented with deteriorating leg weakness and urinary incontinence. Spastic quadriparesis, with impaired pinprick sensation below the T-2 dermatome, was demonstrated.Magnetic resonance (MR) imaging of the cervical spine with slight Gd enhancement revealed a diffuse intramedullary tumor extending from C-5 to T-3. Brain and lumbosacral MR images were negative. The tumor was radically resected via a posterior cervicothoracic laminectomy and midline myelotomy by the senior surgeon (C.E.G.) (Fig. 1). The gross appearance of the lesion was that of an intramedullary astrocytoma. At surgery, the tumor was easily dissected from the normal spinal cord. There was no distinct tumor capsule. The postoperative clinical course was uneventful, and the patient's neurological condition remarkably improved. She underwent rehabilitation for 3 months and has been followed for 8 months. She remains in excellent neurological condition without evidence of tumor recurrence. Histopathological examination showed a vascularized neoplasm composed of nonatypical vacuolated cells with clear cytoplasm and displaced deep-colored nuclei. Immunohistochemical analysis for S100 protein, vimentine, keratin AE1, and epithelial membrane antigen (EMA) was positive, whereas it was negative for glial fibrillary acidic protein (Fig. 2). The conclusion was that the tumor was a chordoma.Chordomas are tumors arising from the embryological remnants of the notochord. The presence of chordomas as intradural extramedullary lesions of the spine without osseous involvement is extremely rare. To the best of our knowledge, our case represents the first report of a purely intramedullary spinal chordoma. 1-4