title: Primum non nocere: Multimodality management strategies when multiple mass lesions strike a single patient.
abstract: BACKGROUND
  The management of multiple symptomatic intracranial pathological processes in a single patient presents a rare and challenging problem for the neurosurgeon and the patient. Neurosurgeons must utilize a full spectrum of neurosurgical options to achieve the best patient outcome.
  
  
  METHODS
  We present a unique case of a 63-year-old woman who presented with a large convexity meningioma causing headaches, an acoustic neuroma causing deafness and imbalance and a suprasellar arachnoid cyst compromising the visual fields. Therapeutic intervention was staged based on the primum non nocere concept. First, the patient underwent stereotactic intracavitary cyst irradiation using colloidal 32P. Secondly, microsurgical resection of the convexity meningioma was performed. Finally, Gamma Knife radiosurgery of the acoustic neuroma was performed. One year after multimodality management, the patient was neurologically improved. There was no evidence of meningioma or cyst recurrence and the growth of the acoustic neuroma was arrested.
  
  
  CONCLUSIONS
  This case demonstrates the value of multi-modality treatment of neurosurgical pathology, utilizing minimally invasive techniques when possible.
authors.affiliation: Straub Hospital & Clinic, Honolulu, Hawaii, USA.
authors.forename: T P
authors.initials: TP
authors.lastname: Thompson
authors.forename: E I
authors.initials: EI
authors.lastname: Levy
authors.forename: H D
authors.initials: HD
authors.lastname: Jho
authors.forename: L D
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D016080:Arachnoid Cysts / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009464:Neuroma, Acoustic / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use*; D016634:Radiosurgery / Q000379:methods; D018714:Radiotherapy, Adjuvant; D012658:Sella Turcica; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010761:Phosphorus Radioisotopes