phosphorus-radioisotopes and Arachnoid-Cysts

The management of multiple symptomatic intracranial pathological processes in a single patient presents a rare and challenging problem for the neurosurgeon and the patient. Neurosurgeons must utilize a full spectrum of neurosurgical options to achieve the best patient outcome.. We present a unique case of a 63-year-old woman who presented with a large convexity meningioma causing headaches, an acoustic neuroma causing deafness and imbalance and a suprasellar arachnoid cyst compromising the visual fields. Therapeutic intervention was staged based on the primum non nocere concept. First, the patient underwent stereotactic intracavitary cyst irradiation using colloidal 32P. Secondly, microsurgical resection of the convexity meningioma was performed. Finally, Gamma Knife radiosurgery of the acoustic neuroma was performed. One year after multimodality management, the patient was neurologically improved. There was no evidence of meningioma or cyst recurrence and the growth of the acoustic neuroma was arrested.. This case demonstrates the value of multi-modality treatment of neurosurgical pathology, utilizing minimally invasive techniques when possible.

Topics: Arachnoid Cysts; Female; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Middle Aged; Minimally Invasive Surgical Procedures; Neuroma, Acoustic; Phosphorus Radioisotopes; Radiosurgery; Radiotherapy, Adjuvant; Sella Turcica; Stereotaxic Techniques; Tomography, X-Ray Computed; Treatment Outcome

Intracavitary irradiation is reported as an additional treatment for intracranial arachnoid cysts that do not communicate with the subarachnoid space. A 46-year-old woman with a large suprasellar arachnoid cyst that had enlarged over a 4-year interval presented with new onset headaches. Stereotactic intracavitary irradiation was performed using colloidal phosphorus-32 as an alternative to craniotomy or insertion of a shunt. Total regression of the cyst occurred within one month with resolution of her headaches. After three years of follow-up, imaging studies showed only an empty sella appearance, and no cyst recurrence. No early or delayed morbidity occurred. Intracavitary irradiation may be a useful therapy for arachnoid cysts, in an attempt to alter the biology of the cyst lining.

Topics: Adult; Arachnoid Cysts; Female; Follow-Up Studies; Frontal Lobe; Humans; Injections, Intralesional; Minimally Invasive Surgical Procedures; Phosphorus Radioisotopes; Recurrence; Stereotaxic Techniques; Tomography, X-Ray Computed