The use of stereotactic body radiotherapy (SBRT) is well-accepted 2).
SRS for spine metastases from Ewing sarcoma can be considered as a treatment option in adolescent and young adult patients and is associated with acceptable toxicity rates. Further studies must be conducted to determine long-term local control and toxicity for this treatment modality 3).
Combined intracranial/extracranial lesions.
Intradural Extramedullary Ewing’s Sarcoma in the Cervical Region 4).
A 21-year-old woman presenting with quadriplegia which was initially diagnosed with an epidural abscess in view of her MR scan and raised inflammatory marker levels. Histology revealed an epidural extra-osseous Ewing’s sarcoma (EES). Epidural location of EES is a very rare condition which can be very challenging to diagnose. Early diagnosis and surgical excision followed by chemotherapy represent the main stem of management 5).
Facial nerve schwannoma
Even in these tumors, hearing loss tends to precede facial paresis. Hearing loss may be sensorineural from VIII cranial nerve compression from tumors arising in the proximal portion of VII cranial nerve (cisternal or internal auditory canal (IAC) segment), or it may be conductive from erosion of the ossicles by tumors arising in the second (tympanic, or horizontal) segment of VII. Facial palsy (peripheral) may also develop, usually late 4).
Computed tomography (CT) of the temporal bone is important for evaluating the impact on the surrounding structures 5).
Treatment for intracranial facial nerve schwannomas depends on clinical presentation, tumor size, preoperative facial, and hearing function.
Conservative management is recommended for asymptomatic patients with small tumors. Stereotactic radiosurgery may be an option for smaller and symptomatic tumors with good facial function. If tumor is large or the patient has facial paralysis, surgical resection should be indicated. If preservation of the facial nerve is not possible, total resection with nerve grafting should be performed for those patients with facial paralysis, whereas subtotal resection is best for those patients with good facial function 6).
These tumors must be assessed with imaging studies, incisional biopsy is not recommended. The treatment is surgical resection in symptomatic patients with facial paralysis greater than grade III of House-Brackmann, with immediate reconstruction of the nerve 7).