Atypical teratoid/rhabdoid tumors (AT/RT) of the central nervous system are rare and extremely aggressive malignancies of early childhood. We report a case of AT/RT in an adult patient. A 30-year-old woman presented with headache, vomiting and ataxia during the second trimester of pregnancy. Magnetic resonance imaging revealed a posterior fossa mass. A gross total resection was performed. Pathological examination revealed an AT/RT. Despite the dismal prognosis the patient decided not to undergo an abortion. For this reason postoperative accelerated hyperfractionated radiotherapy was limited to the tumor region. Six months later the woman delivered a healthy baby. One week postpartum, a central nervous system recurrence localized apart from the primary lesion was treated with radiosurgery. Two months later a diffuse progression was noted. Despite a 6 week course of oral temozolomide, the tumor progressed and the patient died 11 months after diagnosis. Although survival was short, surgery and involved field radiotherapy yielded a progression-free interval of 9 months. This allowed the patient to carry pregnancy to term. Radiosurgery resulted in a complete remission of the first recurrence. Oral chemotherapy was not effective in controlling diffuse tumor spread.

Sensation in the parasagittal occipital region is usually provided by fibres from the second cervical root via the greater occipital nerve. In the case presented occipital neuralgia could be relieved only by coagulation of the C1 nerve root with 96% ethyl alcohol. Possible explanations for this observation are discussed and a technique for CT-guided treatment is described.

We report a case of multiple spinal leptomeningeal metastases from an intracerebral glioblastoma and the original tumor having been an oligoastrocytoma (WHO II). Three time resection of this right frontal tumor with opening of the lateral ventricle preceded intraventricular spread. Diagnosis of spinal dissemination was based on the previous history and Gadolineum-DTPA enhanced MR.

We studied the diagnostic value of MRI in spinal emergency. One hundred patients were analyzed retrospectively and the MR-findings were compared with operative results or autopsy whenever available. The advantages of MRI compared to CT and conventional myelography are discussed. The limitations of MRI are addressed and the important features of appropriate diagnostic procedure are outlined with special attention to neurosurgical requirements.

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