Trigeminal neuralgia caused by vertebrobasilar dolichoectasia is a rare condition. It is characterized by paroxysmal hemifacial pain which is lancinating in type mostly refractory to medical management. This is a report of trigeminal neuralgia secondary to vertebral dolicholectasia refractory to medical management treated with cyber knife stereotactic radiosurgery to the dose of 66 Gy in single fraction to the proximal nerve root. Pain relief was achieved immediately after the treatment and with a follow up period of 2 years, patient is pain free. Cyberknife assisted radiosurgery is relatively safe in delivering high ablative doses with precise conformality to small target regions like proximal nerve root entry of trigeminal nerve with no major toxicities and achieving early pain relief. It is an outpatient and non-invasive procedure. It can be used as a definite treatment modality for trigeminal neuralgia induced by vertebrobasilar dolichoectasia.

Pineoblastomas are rare, malignant, pineal region lesions that account for <0.1% of all intracranial tumors and can metastasize along the neuroaxis. Pineoblastomas are more common in children than in adults and adults account for <10% of patients. The management of pinealoblastoma is multimodality approach, surgery followed with radiation and chemotherapy. In view of aggressive nature few centres use high dose chemotherapy with autologus stem cell transplant in newly diagnosed cases but in recurrent setting the literature is very sparse. The present case represents the management of pinealoblastoma in the recurrent setting with reirradiation and adjuvant carmustine chemotherapy wherein the management guidelines are not definitive.

No abstract

Background: Malignant chondroid syringoma is one of the rarest clinical entities. It is a mixed cutaneous tumor with propensity for local invasion resulting in multiple local recurrences. Malignant chondroid syringoma has female predilection common in extremities. We are presenting this case in view of its rare presentation among the population, and unique clinical course. Case Report: A 38-year-old lady, known case of malignant chondroid syringoma of the left hand was treated for multiple local recurrences with excision, local radiation therapy and chemotherapy. She developed distant visceral metastasis over a span of 20 years after the primary diagnosis. Conclusion: Malignant chondroid syringoma has potential for both local recurrence and distant metastasis over a prolonged clinical course with on and off remission period. Because of its longer clinical course patients are recommended to be on regular follow up.