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William O. Bell, Roger J. Packer, Kathy R. Seigel, Lucy B. Rorke, Leslie N. Sutton, Derek A. Bruce, and Luis Schut

L eptomeningeal spread of primary central nervous system (CNS) tumors is a well-known phenomenon; 5, 6, 12, 17, 29, 30, 40 this is particularly true in spread of primitive neuroectodermal tumors such as medulloblastomas, ependymoblastomas, central neuroblastomas, ependymomas, and germ-cell tumors. 6, 30 Leptomeningeal spread of primary intramedullary spinal cord tumors is less frequent. 9, 23 Over the last 6 years at Children's Hospital of Philadelphia we have treated three patients with intramedullary spinal cord tumors that subsequently infiltrated the

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Jacob S. Young, Andrew J. Gogos, Matheus P. Pereira, Ramin A. Morshed, Jing Li, Matthew J. Barkovich, Shawn L. Hervey-Jumper, and Mitchel S. Berger

resection. However, other authors have found that subventricular tumor location, and not operative entry into the ventricle, is actually what leads to worse outcomes for these patients. 12 Given these incongruent findings, we set out to determine the effects of VE on survival, distant tumor recurrence, leptomeningeal disease, and complications for patients who undergo resection of GBM. We hypothesized that tumor location, rather than VE, would be associated with worse prognosis and leptomeningeal spread. Methods Patient Selection and Characteristics After obtaining

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Darryl Lau, Dominic H. Moon, Paul Park, Shawn Hervey-Jumper, Paul E. McKeever, and Daniel A. Orringer

The incidence of MPNST has a slight female predominance, and the tumor is seen in patients of all ages, with most presenting in their 3rd decade of life. 10 The most common locations for MPNSTs are in the extremities and trunk; they occur less commonly in the head and neck. 27 Primary intradural MPNST involving the cauda equina is extremely rare, with only 4 case reports in the literature. 1–3 , 5 , 9 , 21 , 25 , 28 , 29 Leptomeningeal spread from such lesions is extremely uncommon. 29 We report a unique case of a patient with RT-induced intradural MPNST of the

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Taylor J. Abel, Abhineet Chowdhary, Mahesh Thapa, Joe C. Rutledge, J. Russell Geyer, Jeffrey Ojemann, and Anthony M. Avellino

dissemination of the intramedullary spinal cord tumor to the cisternal space surrounding the midbrain and into the suprasellar region, as well as extension into the auditory canal ( Fig. 4 ). One week postoperatively, he commenced a chemotherapy regimen consisting of carboplatin and vincristine. Total spine MR imaging performed 2 months later demonstrated stability of the spinal cord tumor. However, head MR imaging demonstrated two new areas of supratentorial subarachnoid leptomeningeal spread. Six months postoperatively, hydrocephalus and associated mild ventriculomegaly

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Thomas Flannery, Hideyuki Kano, Juan J. Martin, Ajay Niranjan, John C. Flickinger, L. Dade Lunsford, and Douglas Kondziolka

location. Ultimately, all 7 patients died of local or distant disease progression or leptomeningeal spread. Discussion Current multimodality treatment of PNETs is associated with 5-year survival of 70–80% for standard-risk patients and 5-year survival of 55–76% for high-risk patients. 19 High-risk patients with medulloblastoma are ≤ 3 years of age, have metastases, or show residual tumor progression. 7 Neuraxis radiation therapy is often deferred in such patients, with a consequent risk of tumor progression. 3 , 9 Other factors associated with poor outcome in

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Roland N. Auer, George P. A. Rice, George G. Hinton, A. Loren Amacher, and Joseph J. Gilbert

✓ Juvenile cerebellar astrocytoma characteristically has a very benign course and good prognosis. A case is reported of juvenile cerebellar astrocytoma with massive craniospinal leptomeningeal spread prior to surgical intervention. The patient died 8 months after the onset of symptoms and only 5 weeks after presentation to the hospital. At postmortem examination, it was found that tumor encased the brain and spinal cord. The histology was benign. The literature on cerebellar astrocytoma is reviewed.

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Jonathan A. Forbes, Lola B. Chambless, Jason G. Smith, Curtis A. Wushensky, Richard L. Lebow, JoAnn Alvarez, and Matthew M. Pearson

traditionally associated with an elevated risk of leptomeningeal spread. When this imaging is performed preoperatively, there is a decrease in the number of false-positive images related to debris in the immediate postoperative period. 5 Additionally, the presence of LD is associated with a worse prognosis, and knowledge of the extent of spread has the potential to affect the risk/benefit analysis of aggressive resection. 34 , 47 However, complete imaging of the neuraxis is not without risk or cost. Costs associated with standardized, published Medicare rates for neuraxis

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Michael Murphy, Craig Timms, Penny Mckelvie, Anthony Dowling, and Nicholas Trost

Optic nerve gliomas account for 1% of all intracranial neoplasms with 90% occurring in individuals younger than 20 years of age. 1, 4 They are rare in adults and usually malignant. 3, 4 Adult optic nerve gliomas differ from those of childhood in that they more often involve the posterior component of one optic nerve and the chiasm, are more aggressive in their behavior, may be cystic, and are not associated with neurofibromatosis. 4 They are also more commonly seen in middle-aged men. 2, 3 There has been one reported case of leptomeningeal spread within the

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José M. Roda and Manuel Gutiérrez-Molina

are three possible explanations for the multiple locations of this tumor: multifocality, glial meningeal het-erotopia, and/or leptomeningeal spread. Multifocality The tumor might have had multiple primary foci, and in this sense, it could be a multicentric astrocytoma. After excluding cases with concomitant disease such as neurofibromatosis, tuberous sclerosis, or multiple sclerosis, Barnard and Geddes 3 found 18 cases (7.5%) of multicentric tumor among the 241 cerebral gliomas they examined postmortem. Only six cases of the 18 were classified as

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Sunit Das, Kenji Muro, Stewart Goldman, Veena Rajaram, and Arthur J. DiPatri Jr.

ventricle. The presence of the fourth ventricle mass with evidence of diffuse leptomeningeal spreading was confirmed on MR imaging ( Fig. 1 ). An MR image of the spine showed no evidence of metastatic disease. F ig . 1. Gadolinium-enhanced T 1 -weighted MR images demonstrating a large heterogeneously enhancing mass occupying the floor of the fourth ventricle and deforming the medulla oblongata at the level of the dorsal clivus. The arrow indicates an area where the lesion is spreading into the subarachnoid space. Operation After placement of a right