Immature teratoma (IMT) is the most frequent histological subtype of infantile intracranial teratoma, the most common congenital brain tumor. IMT contains incompletely differentiated components resembling fetal tissues. Infantile intracranial IMT has a dismal prognosis, because it is often inoperable due to its massive size and high vascularity. Neoadjuvant chemotherapy has been shown to be effective in decreasing tumor volume and vascularity to facilitate surgical resection in other types of infantile brain tumors. However, only one recent case report described the effectiveness of neoadjuvant chemotherapy for infantile intracranial IMT in the literature, even though it is common entity with a poor prognosis in infants. Here, we describe the case of a 2-month-old male infant with a very large intracranial IMT. Maximal surgical resection was first attempted but was unsuccessful because of severe intraoperative hemorrhage. Neoadjuvant carboplatin and etoposide (CARE) chemotherapy was then administered with the aim of shrinking and devascularizing the tumor. After neoadjuvant chemotherapy, tumor size did not decrease, but intraoperative blood loss significantly decreased and near-total resection was achieved by the second and third surgery. The patient underwent adjuvant CARE chemotherapy and has been alive for 3 years after surgery without tumor regrowth. Even when neoadjuvant chemotherapy does not decrease tumor volume of infantile intracranial IMT, surgical resection should be tried because chemotherapy can facilitate surgical resection and improve clinical outcome by reducing tumor vascularity.

A 54-year-old man presented with a very rare case of radiation-induced intramedullary spinal cord anaplastic astrocytoma, which developed 37 years after radiotherapy for testicular seminoma. The patient presented with weakness and numbness of the left lower extremity that had gradually aggravated for 3 months. Magnetic resonance imaging demonstrated an intramedullary mass lesion with syringomyelia at the T9 to T12 levels. Subtotal removal of the tumor was performed using standard microsurgical technique. Histological examination revealed anaplastic astrocytoma. Although radiotherapy was seriously considered, chemotherapy was employed as adjuvant therapy considering the previous treatment. Although his neurological status improved transiently after surgery, relentless neurological decline occurred and resulted in death 9 months following surgery. Considering that subtotal removal of the tumor and chemotherapy had little influence on the quality of life and the length of survival in our case, cordectomy may be the optimum treatment for patients with radiation-induced spinal intramedullary malignant astrocytoma.

Objective:The authors present a case with persistent primitive hypoglossal artery (PPHA) associated with a ruptured basilar aneurysm. Clinical presentation: A 58-year-old woman with subarachnoid hemorrhage (SAH) was admitted to our hospital. Her neurological condition was Grade III (Hunt and Kosnic). Cerebral angiography revealed a PPHA and a saccular aneurysm at the tip of the basilar artery. The aneurysm was successfully embolized with GDC coils through the PPHA. After a ventriculo-peritoneal shunt for hydrocephalus, the patient was discharged without any neurological defi cit. Conclusion:The aneurysm at the basilar artery associated with PPHA can be safely treated with coil embolization through the PPHA.

Pyogenic spondylitis is relatively rare. However, mild cases are sometimes overlooked and it may spontaneously disappear in some cases. Conservative therapy with antibiotics is effective in most patients with inflammation alone. However, decompression with without fusion is required in the presence of spinal cord compression related symptoms. When vertebral body intervertebral disk destruction results in instability or marked kyphosis, fixation is necessary. After the inflammation subsides, anterior fixation with an autograft is usually performed, followed by posterior fixation. However, recent studies have employed simultaneous anterior posterior fixation in an increasing number of patients. Furthermore, there are several case reports in which anterior posterior fixation using a titanium mesh cage led to a favorable course without recurrent infection. We report 2 patients with pyogenic spondylitis of the cervical vertebrae and vertebral body destruction who underwent curettage of the affected vertebral body and anterior fixation after antibiotic therapy relieved the inflammation, and review the literature. The patients were one 35 and one 56 year old male without any medical history of note. Vertebral body biopsy did not reveal any tumor tissue. No causative bacteria were identified. In the two patients, active inflammation was not observed during surgery. After debridement of the relatively soft, affected vertebral body, anterior fixation with an autograft and a titanium plate was performed in one case, and that using an anterior distraction device ADD and titanium plate were used in the other patient. In the future, long term follow up should be performed. To date, there has been no exacerbation of the inflammation, and favorable fixation has been maintained.

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