A 29-year-old Caucasian female diagnosed with multiple sclerosis (MS) for seven years, presented with a history of headaches and a single episode of new onset seizures. Her physical examination was unremarkable and she was placed on anti-seizure medications. A computed tomography (CT) scan showed a right frontal brain lesion causing minimal mass effect (Figure 1). Magnetic resonance imaging (MRI) revealed a large nonenhancing space occupying lesion in the right frontal lobe, in addition to numerous smaller lesions which were characteristic of MS plaques (Figures 2 & 3). The large lesion was causing mass effect with right to left midline shift (Figures 2, 3A & B). Given the patient’s history, the appearance and unusually large size of the frontal lesion, it was unclear whether it was a demyelinating MS plaque, or an intra-axial tumour.

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Aim: The availability of long-term (>2 years) safety outcomes of spinal cord stimulation (SCS) remains limited. We evaluated safety in a global SCS registry for chronic pain. Methods: Participants were prospectively enrolled globally at 79 implanting centers and followed out to 3 years after device implantation. Results: Of 1881 participants enrolled, 1289 received a permanent SCS implant (1776 completed trial). The annualized rate of device explant was 3.5% (all causes), and 1.1% due to inadequate pain relief. Total incidence of device explantation >3 years was 7.6% (n = 98). Of these, 32 subjects (2.5%) indicated inadequate pain relief as cause for removal. Implant site infection (11 events) was the most common device-related serious adverse event (<1%). Conclusion: This prospective, global, real-world study demonstrates a high-level of safety for SCS with low rate of explant/serious adverse events. Clinical Trial Registration: NCT01719055 ( ClinicalTrials.gov )

A 28-year-old man presented to the emergency room with a severe headache of one day's duration. A computerized tomography scan showed a hemorrhagic tumor measuring 3.9 x 4.4 cm in the left cerebellar hemisphere. The resection specimen revealed medulloblastoma. He had two episodes of rebleeding and multiple postoperative issues preventing the use of prone craniospinal radiotherapy. We designed a supine technique for this tall man, which was not complicated to set up. The rapid safe implementation of this technique allowed us to avoid further rebleeding and successfully treat the residual tumor. This technique is the described technique in this case report and is compared to other techniques. At 7.5 years after surgery, he is alive without cancer and with only a mild residual deficit. This case is unusual since the majority of patients with the diagnosis of hemorrhagic medulloblastoma died.