Surgical anatomy of a neurenteric cyst anterior to the brainstem

Abstract The authors report on a sixteen-month old boy who presented a neurenteric cyst located in the cervicomedullary junction, anterior to the brain stem. Centred on the ventral aspect of the premedullary cistern, the cyst extended from the prepontine space to the cervicomedullary junction, causing important brain stem compression. The lesion was totally removed via a posterior approach with suboccipital craniotomy and laminectomy of C1. After surgery the patient recovered his neurological function and the postoperative MRI showed total resection of the cyst

Resultados quirúrgicos en pacientes con epilepsia refractaria secundaria a displasia cortical focal en edad pediátrica empleando electrodos intracraneales

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 26-05-2017Esta tesis tiene embargado el acceso al texto completo hasta el 26-11-201

Tumours in the pineal region in the paediatric age: Reports of 23 cases and a review of the literature

Introducción. Los tumores de la región pineal se localizan en una encrucijada de estructuras neurovasculares de difícil acceso quirúrgico y limitadas posibilidades de resección; por ello, el manejo de estas lesiones habitualmente requiere la asociación de tratamiento adyuvante radioterápico y/o quimioterápico. Pacientes y métodos. Análisis retrospectivo de las características epidemiológicas, clínicas, neurorradiológicas y anatomopatológicas de 23 pacientes con tumores de la región pineal tratados entre los años 1997 y 2010 en el Hospital Infantil Niño Jesús. Se discuten los factores implicados en el pronóstico de esta cohorte tras el tratamiento quirúrgico o adyuvante. Resultados. El estudio incluyó 6 niñas y 17 niños con edades comprendidas entre los 4 meses y 18 años. El 95% de los pacientes comenzó con signos de hidrocefalia aguda o subaguda, que precisaron la implantación de una derivación ventriculoperitoneal (82%). Se obtuvo una muestra histológica tumoral en todos los casos. Cinco pacientes fueron biopsiados y 18 fueron intervenidos mediante craneotomía. El germinoma (ocho casos) y el teratoma maduro (un caso) fueron los tumores con mayor supervivencia; los tumores no germinomatosos (tres casos), del parénquima pineal (cuatro casos) y gliomas (cinco casos) presentaron mayor tasa de recidiva y un peor pronóstico. Conclusión. El estudio de marcadores tumorales permite orientar el diagnóstico de determinados tumores de la región pineal. Actualmente, se recomienda realizar una toma histológica tumoral para establecer un diagnóstico preciso y un tratamiento oncológico específicoIntroduction. Tumours in the pineal region are located at a meeting point of several neurovascular structures that are difficult to reach surgically and for which the possibility of resection is limited; as a result the management of these lesions usually requires associated adjunctive treatment with radiotherapy and/or chemotherapy. Patients and methods. This study is a retrospective analysis of the epidemiological, clinical, neuroimaging and pathological characteristics of 23 patients with tumours in the pineal region who were treated between the years 1997 and 2010 in the Hospital Infantil Niño Jesús. The factors involved in the prognosis of this cohort following surgical or adjunctive treatment are also discussed. Results. Subjects included in the study were 6 girls and 17 boys with ages ranging from 4 months to 18 years. It was found that the initial symptoms in 95% of the patients were signs of acute or subacute hydrocephalus, which required the placement of a ventriculoperitoneal shunt (82%). A histological sample of the tumour tissue was collected in all cases. Biopsy samples were taken in the case of five patients and 18 underwent surgery involving a craniotomy. Germinoma (eight cases) and mature teratoma (one case) were the tumours with the longest survival times; non-germinomatous tumours (three cases), those of the pineal parenchyma (four cases) and gliomas (five cases) presented the highest rates of recurrence and a poorer prognosis. Conclusions. The study of tumour markers can be used to guide the diagnosis of certain tumours of the pineal region. At present, the recommended procedure involves taking a histological sample of the tumour in order to establish an accurate diagnosis and a specific oncological treatmen

Cystic Echinococcosis in Spain: Current Situation and Relevance for Other Endemic Areas in Europe

Cystic echinococcosis (CE) remains an important health problem in many regions of the world, both where no control measures have been implemented, and where control programs have been incompletely successful with ensuing re-emergence of the disease. In Spain, official data on CE show an increase in the proportion of intermediate hosts with CE during the last few years, and autochthonous pediatric patients have been reported, a sign of active local transmission of disease. A similar picture emerges from data reported to the European Food Safety Authority by other European countries. Nevertheless, several crucial aspects related to CE that would help better understand and control the disease have not been tackled appropriately, in particular the emergence of infection in specific geographical areas. In this respect, while some data are missing, other data are conflicting because they come from different databases. We review the current situation of CE in Spain compared with areas in which similar problems in the CE field exist, and offer recommendations on how to overcome those limitations. Specifically, we believe that the introduction of national registries for CE with online data entry, following the example set by the European Registry for Alveolar Echinococcosis, would help streamline data collection on CE by eliminating the need for evaluating and integrating data from multiple regions, by avoiding duplication of data from patients who access several different health facilities over time, and by providing much needed clinical and epidemiological data that are currently accessible only to clinicians

Caracterização fitossociológica do estrato arbóreo em um remanescente de floresta estacional semidecidual, em Montenegro, RS Phytosociological characterization of arboreal stratum in a remainder of a semidecidual seasonal forest in Montenegro, Rio Grande do Sul

O presente trabalho foi realizado em um remanescente de Floresta Estacional Semidecidual antropizado, localizada nas coordenadas 29&deg; 49'S e 52&deg; 25'W, nas proximidades do pólo petroquímico no município de Montenegro (RS), Brasil, com o objetivo de conhecer seus aspectos florísticos e fitossociológicos. A amostragem foi sistemática constituída de 21 faixas com 10m de largura e comprimento variável de acordo com a extensão da floresta, distantes entre si em 80m, onde foram distribuídas parcelas contíguas de 10 x 10m (100m²). Foram avaliados indivíduos que apresentavam circunferência à altura do peito (CAP)>15cm, totalizando 3.854 indivíduos (1,83ha), distribuídos em 81 espécies, 59 gêneros e 32 famílias. As famílias botânicas mais representativas na formação foram Myrtaceae (13 espécies), Fabaceae (7), Lauraceae (6), Meliaceae (5), Moraceae e Euphorbiaceae (4). As espécies mais características e importantes da floresta foram Sebastiania commersoniana, Casearia sylvestris, Myrsine umbellata, Mimosa bimucronata, Allophylus edulis e Syagrus romanzoffiana, representando 51,52 % do VI. A floresta apresentou média diversidade, com índice de Shannon de 1,9948 (nats.), indicando antropismo.<br>This research was developed in a Semideciduous Seasonal Forest located at coordinates (29&deg; 49'S; 52&deg; 25'W) in Montenegro Petrochemical pole, Rio Grande do Sul, Brazil, aiming at studying the floristic and phytossociological aspects of the forest. Sampling was systematic and composed of 21 strips (10m wide and variable length according to fragment extension located 80m apart. In the strips the distribution was in contiguous 10 X 10m plots (100m²). Individuals that presented circumference at breast height (CBH)>15cm, totaling 3.854 individuals (1,83ha), distributed in 81 species, 59 geneus and 32 families were appraised. The most representative botanic families in the forest formation were Myrtaceae (13 species); Fabaceae (7), Lauraceae (6); Meliaceae (5), Moraceae and Euphorbiaceae (4). The most valuable species were Sebastiania commersoniana, Casearia sylvestris, Myrsine umbellata, Mimosa bimucronata, Allophylus edulis e Syagrus romanzoffiana, representing 51.52 % of IV. The forest had been presented low diversity with Shannon index of 1.9948 (nats/individuals), indicating human impact