Management of Intramedullary Cystic Pilocytic Astrocytoma With Rhenium-186 Intracavitary Irradiation

Abstract

Abstract OBJECTIVE We report a case of cystic spinal cord pilocytic astrocytoma treated with surgical resection and 2 intracavitary injections of 186rhenium. CLINICAL PRESENTATION A 22-year-old man presented with low-back pain, saddle dysesthesia, and sphincter and sexual dysfunction. Spinal cord magnetic resonance showed a large, cystic, intramedullary tumor extending from T9 to T12. TREATMENT Two surgical approaches and 1 computed tomography (CT)-scan guided tapping allowed shrinkage of the cystic component but each time the cyst enlarged and neurological symptoms worsened. Pathological examination allowed the diagnosis of pilocytic astrocytoma. The patient underwent 2 intracystic CT-scan guided injections of 186rhenium that achieved good control of cystic component. CONCLUSION Interstitial intracavitary 186rhenium brachytherapy of recurrent spinal cord cystic astrocytomas achieved excellent stabilization of the cyst with minor side-effects and dramatic improvement of neurological deficits.