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

OBJECTIVE: We report a case of cystic spinal cord pilocytic astrocytoma treated with surgical resection and 2 intracavitary injections of (186)rhenium. 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 (186)rhenium that achieved good control of cystic component. CONCLUSION: Interstitial intracavitary (186)rhenium brachytherapy of recurrent spinal cord cystic astrocytomas achieved excellent stabilization of the cyst with minor side-effects and dramatic improvement of neurological deficits.