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Background: The use of chemotherapy in patients with malignant gliomas has remained a controversial issue even after the publication of favorable study data and a meta-analysis. The present study was initiated to support the use of chemotherapy in patients with relapsed high-grade gliomas (HGG)., Patients and Methods: Six Austrian centers recruited 43 patients with histologically confirmed HGG at first recurrence. Twelve chemotherapy-naïve patients received oral temozolomide at a dose of 200 mg/m(2) once a day for five consecutive days and 26 patients a dose of 150 mg/m(2) also for five days after various first-line chemotherapies. TMZ treatment was repeated every four weeks for a total of six cycles., Results: Twenty-one patients (52.5 %) received at least six cycles of therapy. Two patients experienced complete remission and eight patients a partial response. Twenty patients survived at one year after enrolment in the study; eight patients survived beyond three years of follow-up. Hematological toxicities consisted of three thrombocytopenias G4 and 35 lymphocytopenias G3 and G4; these did not cause interstitial pneumonia or require inpatient treatment. Non-hematological toxicities were rare and without clinical relevance. Patients' quality of life was maintained during treatment., Conclusion: The study data confirm the feasibility and efficacy of chemotherapy with temozolomide in patients with relapsed/progressive HGG.

Objectives: Juxta facet cysts are a common cause of low back and radicular pain. They are mostly associated with degenerative facet joints and spondylolisthesis. The study focuses on long-term outcomes after microsurgical treatment without fusion., Method: From April 2002 to April 2004, 31 patients (23 female and 8 male) underwent microsurgical resection of lumbar juxta facet cysts. The patient age ranged from 31 to 83 years (mean 67.2 years). The most affected level was L4-L5 (19 patients), followed by L3-L4 (9 patients). Fourteen patients additionally had spondylolisthesis of the involved segment. All patients had signs of nerve root compression and had received conservative treatment preoperatively. We performed limited bone removal (sparing the facet joints) and cyst resection in 27 patients. In four patients, cyst resection and standard laminectomy were performed owing to spinal stenosis., Results: Conservative treatment was without any effect in all patients. At follow-up, 12-30 months after surgery, excellent to good outcome was achieved in 25 of 31 patients (80.7%), and 6 patients (19.3%) showed fair results. Persistent low back pain was more common in patients with spondylolisthesis than in the other group (6/14 vs 3/17); this may be due to instability. Spondylolisthesis did not progress or become mobile after surgery radiographically in any of our patients., Conclusions: Conservative therapy does not adequately improve symptoms in patients with intraspinal juxta facet cysts and radicular signs. Juxta facet cysts can be treated effectively with a minimally invasive microsurgical approach. This may be of particular significance when the cysts are associated with spondylolisthesis, minimizing the risk of instability and the need for fusion. In a selected group of patients with persistent low back pain, fusion may become necessary to improve symptoms.

Objective: Prostate cancer is a well known cause of spinal column metastases; however, an intradural location is extremely rare. It is considered to be a type of leptomeningeal spread. Cerebral seeding has usually occurred by the time of presentation. Due to a poor prognosis, surgery is rarely indicated, and controversially discussed., Patient and Results: We review the known cases of spinal leptomeningeal prostate cancer spread, including our patient, who developed paraparesis over 6 weeks, 3 years after prostate cancer was diagnosed. Following surgical decompression and resection, the patient additionally received radiation therapy of the spinal meninges and antihormonal treatment. 6 months after surgery, the patient is still ambulatory with a good quality of life., Conclusion: Spinal leptomeningeal metastases occur at a late stage of systemic disease, and the prognosis is generally poor. In the literature, outcomes after surgery are reported as devastating, with mortality and morbidity rates of up to 20% and 60%. The aim of surgery is to relieve pain, preserve or even restore neurological function, and reveal histology if uncertain. This may be achieved by debulking the tumor without placing the patient at an unacceptably high risk. Surgery should be performed in selected cases of spinal leptomeningeal metastases, in patients who are still ambulatory with controlled systemic disease, and should be followed by adjuvant therapy.

Objective: Accurate radiographic documentation of the proper placement of cages, plates, and screws following cervical spine surgery significantly impacts clinical outcome. Postoperative computed tomography scans clearly show that the position of implants is sometimes far from ideal. The morbidity of anterior cervical disc surgery is well documented, but the incidence and influence of the misplacement of interbody spacers, plates, and screws are underestimated. We used isocentered fluoroscopy with three-dimensional image reconstruction intraoperatively to evaluate the extent of bony decompression and position of implants before wound closure., Methods: From October 2003 through April 2004, 27 patients had anterior cervical procedures: 22 one-level and 5 two-level operations. Herniated cervical discs were diagnosed in 21 individuals, whereas 6 exhibited spondylosis. A radiolucent operating table made of carbon fibers was used in all patients. Before wound closure, intraoperative three-dimensional fluoroscopy was performed to evaluate the location of cervical implants and anterior bone resection., Results: The entire scanning procedure required 5 minutes; the actual scanning time was only 120 seconds. In all patients, we were able to adequately evaluate the placement of cage, plates, and screws. Utilization of intraoperative three-dimensional fluoroscopy revealed that two cages were malpositioned and required revision before wound closure., Conclusions: Intraoperative three-dimensional fluoroscopy is a valuable tool for the intraoperative imaging of bony decompression and implants in anterior cervical spine surgery. The technique is safe and reliable and should help us to avoid incomplete decompression or misplacement of implants and therefore improve long-term functional outcomes in the future.

LINAC radiosurgery has provided increasing access and changed treatment strategies in patients with benign skull base meningiomas in recent years. From January 1996 to January 2003, 37 patients with skull base meningiomas were treated with LINAC radiosurgery. A combination of the University of Florida system and the X Knife System, developed by Radionics, was used in all patients. Eight patients were treated by microsurgical resection before radiosurgery, in two patients tumor recurrence was treated and in 29 patients LINAC radiosurgery was the initial treatment procedure. The median treatment volume was 5.9 mL (0.7 to 22 mL) and the median given dose was 14.6 Gy (12.8 to 18 Gy) prescribed to the 80 percent isodose line. The follow-up period is between 12 and 96 months, median 66 months. 12 patients (32.4 %) showed a significant reduction in tumor size, in 11 patients (29.7 %) there was significantly less contrast enhancement and in 13 patients (35.1 %) the skull base meningioma was without any change. In one patient (2.8 %) there was tumor growth 48 months after radiosurgery, so the tumor control rate was 97.2 %. Two patients (5.6 %) showed neurological worsening after radiosurgery, whereas the symptoms were transient in one patient. LINAC radiosurgery offers us an effective treatment modality and changes treatment strategies in skull base meningiomas towards a less aggressive surgical approach. By combining microsurgery and radiosurgery we can achieve high tumor control rates with an acceptable low morbidity and a high level of quality of life.