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Inadvertent subclavian artery catheterization during attempted central venous access is a well-known complication. Historically, these patients are managed with an open operative approach and repair under direct vision via an infraclavicular and/or supraclavicular incision. We describe our experience and technique for endovascular management of these injuries.

Brainstem tumors (BSTs) are usually gliomas and are divided into diffuse BSTs (DBSTs) and focal BSTs (FBSTs). The aim of this study is to investigate the different outcomes of these two entities.Thirty-one patients with BSTs were admitted to our institution from 1995 to 2003. Patients with DBSTs were treated with locoregional radiotherapy (1.8 Gy/day for 54 Gy) and weekly vincristine for radiosensitization (1.5 mg/sm for six total doses). Patients with FBSTs underwent surgical resection. Chemotherapy and/or radiotherapy were considered in progression.Fourteen patients were diagnosed as having DBSTs. The responses to treatment were ten cases of partial response, three of stable disease, and one of progressive disease. General and/or neurological symptoms improved in more than 80% of patients. The median time from diagnosis to progression and to death were, nonetheless, 8 (range of 3–13) and 13 (range of 4–25) months, respectively, with a 2-year overall survival rate of 12.3% [standard error (SE) 11.2]. Seventeen patients were diagnosed as having FBSTs. Gross total removal was achieved in 4/17 cases, subtotal removal in 7/17, and partial removal in 6/17. There was one surgery-related death. Eight out of 17 patients had adjuvant chemo- and/or radiotherapy after progression: 6/8 are without neurological symptoms and 2/8 have died due to tumor progression. The 4-year overall and disease-free survival rates are 87.4 (SE 8.4) and 58.8% (SE 11.9), respectively, the extent of resection being the most important prognostic factor (p=0.012). DBSTs continue to carry a dismal prognosis, thus demanding new treatment modalities; FBSTs can be treated surgically and patients benefit from a better prognosis.

Viene analizzato il trattamento delle lesioni cistiche nei ventricoli e nelle regioni paraventricolari in una serie che comprende differenti tipi di patologia inclusa quella neoplastica. Abbiamo trattato 27 pazienti, 12 maschi e 15 femmine, di eta compresa fra poche settimane e 15 anni; il 63% dei pazienti aveva un idrocefalo associato.Per il trattamento delle cisti endo e para-ventricolari sono stati proposti differenti interventi chirurgici: resezione micro-chirurgica, fenestrazione, ventricolo-cistostomia, cisto-cisternostomia, aspirazione stereotattica, derivazione cisto-subdurale e cisto-peritoneale. In letteratura è anche descritto il trattamento endoscopico delle cisti della fossa cranica posteriore sia localizzata in sede mediana che laterale. La tecnica chirurgica che noi abbiamo adottato è simile a quella proposta da Schroeder e anche noi troviamo utile effettuare un'ampia apertura per evitare successive chiusure della stomia.L'endoscopia ha un importante ruolo nel trattamento delle cisti endo e paraventricolari sia come unico trattamento, sia in associazione al posizionamento di un catetere di derivazione. Per la sua mini-invasività, il trattamento endoscopico è oggi da considerarsi una valida alternativa ai trattamenti tradizionali delle lesioni cistiche endocraniche.