Anaplastic Pilocytic Astrocytoma in adults: A comprehensive literature review based on 2 clinical cases

Anaplastic Pilocytic Astrocytoma (APA) is a subtype of Pilocytic Astrocytoma (PA) that appears when the tumor shows signs of anaplasia and follow an aggressive clinical course. It is a very rarely tumor, especially in older than 18 years. We made a screening of our data base to find patients who was discharged with the diagnostic of APA and we made a search in PubMed to find articles that represents this kind of tumors and realize a literature review. We present 2 cases of patients with APA diagnostic: a progression from a Pilocytic Astrocytoma in a 38 years-old woman and a 36 years-old woman with a cerebellar APA. Both patients were operated without complications and persist asymptomatic in a five- and seven-years follow-up. On the literature review we found 18 articles with a total of 84 patients and described demographic, clinical, radiological, histopathological and genetic features. To our knowledge, the pathological presentation behavior of our clinical cases is very rare and can contribute important data to the published literature.APA is more aggressive than classical PA. It is important to identify this variant for stablish the best and faster treatment options, adjuvant therapies, appropriate prognosis and active follow-up

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. This was an observational retrospective study. A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures