Primum non nocere: Multimodality management strategies when multiple mass lesions strike a single patient

BACKGROUND The management of multiple symptomatic intracranial pathological processes in a single patient presents a rare and challenging problem for the neurosu rgeon and the patient. Neurosurgeons must utilize a full spectrum of neuros urgical options to achieve the best patient outcome. CASE DESCRIPTION We present a unique case of a 63-year-old woman who presented with a large convexity meningioma causing headaches, an acoustic neuroma causing deafnes s and imbalance and a suprasellar arachnoid cyst compromising the visual fi elds. Therapeutic intervention was staged based on the primum non nocere co ncept. First, the patient underwent stereotactic intracavitary cyst irradia tion using colloidal P-32. Secondly, microsurgical resection of the convexi ty meningioma was performed. Finally, Gamma Knife radiosurgery of the acous tic neuroma was performed. One year after multimodality management, the pat ient was neurologically improved. There was no evidence of meningioma or cy st recurrence and the growth of the acoustic neuroma was arrested. CONCLUSION This case demonstrates the value of multi-modality treatment of neurosurgic al pathology, utilizing minimally invasive techniques when possible. (C) 20 01 by Elsevier Science Inc.