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This prospective randomized clinical study will address the efficacy of radiation (RT)-alone and combined with pre-RT chemotherapy (CTX) treatments and propose the novel standard treatment strategy for intracranial primary pure germinoma. Between 2005 and 2008, there were 54 patients diagnosed with intracranial primary pure germinomas in a single institute. Twenty-eight patients were enrolled. The mean age of the patients was 16.2 years (range 6–31 years). There were 19 men and 9 women (men/women ratio = 2.1:1). There were 21 patients with solitary tumors and 7 with multiple tumors. These patients were randomized as RT-only treatment group (11 solitary and 3 multiple tumors) and combined (10 solitary and 4 multiple tumors, neo-adjuvant CTX followed by response-adapted RT) treatment group. The follow-up period for RT only group has a median of 58 months (mean 58.2 months, range 41–82 months), and for combine therapy group, the median was 68.5 months (mean 67.8 months, range 41–88 months). All 14 patients in the RT-only group showed complete response (CR) and no recurrence. Eleven patients in the combined group had CR and three patients had partial response after neo-adjuvant CTX. All patients responded to RT as CR without recurrence. At the time of analysis, all 28 patients were alive without evidence of disease. Neo-adjuvant CTX for localized germinomas seems to be unnecessary as a method to reduce radiation dose in our RT protocol. However, the effective control of multifocal or disseminated germinoma can be achieved by neo-adjuvant CTX followed by response-adapted reduced dose RT.

The objective of this study is to establish which treatment is the best operative intervention for arachnoid cyst.We reviewed a series of 209 cases with arachnoid cysts focusing on the effectiveness and safety. The cysts were treated with several surgical procedures including open surgery for fenestration, endoscopic fenestration, or cystoperitoneal shunting.Follow-up imaging studies showed that 176 out of 209 arachnoid cysts (84.2%) reduced in size during a mean postoperative follow-up period of 6.9 years (range, 1 to 14 years). Although a cystoperitoneal shunt was the best method for early achieving an obliteration of the sylvian cyst (89%), it had the danger of shunt dependency (42%) in addition to four early complications. Although endoscopic fenestration tended to be less effective in reducing the size of a sylvian cyst, it was safe and particularly effective in completely obliterating a suprasellar, quadrigeminal, and prepontine cyst.Although the shunt for arachnoid cyst can get the more rapid good radiological outcome, the shunt-related complication and dependency would be hazardous. We suggest that endoscopic or reduced open procedures offer the advantage of avoiding a large craniotomy or the known complications of a cystoperitoneal shunt in treatment of arachnoid cysts. We could get the nearly same surgical outcome without shunt complications with endoscopic or open procedures.