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Fifty-three-year-old male suffering from a presumptive non-functioning pituitary adenoma was qualified for stereotactic radiosurgery in our institution. Two attempts of surgical treatment were taken three months before radiotherapy. Excessive bleeding did not allow to remove the tumour or to take samples for histopathological examination. Diagnosis was put on the basis of radiological assessment and lack of hypersecretion of pituitary hormones. However, radiological reevaluation in our Institute revealed the presence of a well-bounded tumour invading the cavernous sinus with high contrast enhancement in FLAIR and T2-sequence. Moreover, a constriction of the normal pituitary gland with tumour mass was seen. The imaging features of the lesion finally led to diagnosis of cavernous sinus haemangioma with intrasellar expansion. The patient received radiosurgical treatment with the use of linear accelerator (LINAC). A dose of 7 Gy in one fraction was administered to achieve satisfactory local control, prevent potential further bleeding and reduce the risk of progressive neurological deficits. Stable size of the tumour and absence of any complications are confirmed in six years of follow-up.

Aim of the study The purpose of this study was to evaluate the efficacy and safety of applying CyberKnife (CK) radiosurgery in patients with spinal metastases. Material and methods Twenty-eight patients with vertebral metastases treated using the CK system were included in the study. Eleven patients suffered from pain, and in 1 case neurological symptoms were observed. The remaining patients were free from clinical symptoms of metastatic disease. The doses applied ranged between 8 and 40 Gy delivered in 4 fractions of 8–15 Gy. Results In the first follow-up evaluation (mean 4.5 months after the treatment), pain was stable in 5 of 8 evaluable cases and in 3 regression occurred. The last follow-up examination (mean 11 months after stereotactic radiosurgery) revealed stable ailments in 3 of 6 evaluable cases, improvement in 3 and new complaints in another 4 patients. In 17 patients imaging studies were conducted after a mean time of 11 months after CK treatment. Stabilization was confirmed in 11, regression in 4 and progression in 2 cases. Median overall survival was 20.6 months. Median progression-free survival was 12.6 months. No side effects attributable to the treatment were observed, but during follow-up transient or permanent deterioration in neurological status as a consequence of disease progression was diagnosed in 4 patients. Delivery time of a single fraction ranged between 0.5 and 1.5 hours. Conclusions Robotic stereotactic radiosurgery as part of multimodality therapy for metastatic spinal tumours is safe and effective. Because of long irradiation times, this kind of treatment is not suitable for patients in poor general condition.

Streszczenie Mioklonie powiek z napadami nieświadomości (zespol Jeavonsa) to bardzo rzadka, genetycznie uwarunkowana, idiopatyczna uogolniona padaczka ujawniająca sie w wieku dzieciecym. Objawem charakterystycznym są mioklonie powiek, ktorym mogą towarzyszyc napady nieświadomości. Napady są czeste i mogą wystepowac wielokrotnie podczas dnia. Pacjenci wykazują wysoką fotowrazliwośc oraz zazwyczaj prawidlowy rozwoj psychomotoryczny i brak odchylen w badaniu neurologicznym. W środnapadowym zapisie EEG wystepują uogolnione wyladowania typu zespolow iglica, wieloiglica–fala, poprzedzone najcześciej zamknieciem oczu lub przerywaną fotostymulacją. Kwas walproinowy, etosuksymid i lamotrygina w monoterapii lub terapii skojarzonej, to najcześciej stosowane preparaty w leczeniu zespolu Jeavonsa, jakkolwiek leczenie tego typu padaczki czesto bywa nieskuteczne. Przedstawiamy przypadek 10-letniego chlopca z rozpoznanym zespolem Jeavonsa z bardzo dobrą odpowiedzią na leczenie kwasem walproinowym w monoterapii z dodatnim wywiadem rodzinnym (brat z rozpoznaną padaczką z napadami nieświadomości, ponadto gluchota u brata i rodzicow), jako przyklad rodzinnego wspolwystepowania zespolow padaczkowych.