Use of interferon alpha in cystic craniopharyngioma

BV UNIFESP: Teses e dissertaçõe

Fetal hydrocephalus

Introduction Hydrocephalus is the most frequent and devastating illness affecting a fetus. the development of both ultrasonography and magnetic resonance, associated with laboratorial tests, has greatly facilitated its diagnosis.Materials and methods in the Fetal Medicine Service of the Federal University of São Paulo and in the Santa Joana/Pro-Matre Paulista Hospital Complex, in São Paulo, SP, Brazil, repeated cephalocenteses, ventricular-amniotic shunting, and neuroendoscopy were used to treat 57 fetuses with hydrocephalus, all of them at a gestational age under 32 weeks. Another eight fetuses had myelomeningocele and underwent correctional open surgery to prevent hydrocephalus.Results Thirty-nine patients were followed up for a period longer than 3 years and had their intelligence coefficient assessed: 26 of them were considered normal (IQ above 70); six had mild or moderate handicaps (IQ from 35 to 70), and seven were severely handicapped (IQ below 35). Out of the eight patients operated for correction of myelomeningocele, only two came to require shunting. There were no cases of maternal morbidity, and no infectious condition was observed in any of the patients subjected to intrauterine treatment.Conclusion Selected cases of isolated, evolutive, non-destructive hydrocephaly diagnosed before 32 gestational weeks may benefit from fetal neurosurgical procedures. With the accuracy improvement of diagnoses, the number of patients fitting into that group has become very small.Universidade Federal de São Paulo, Sect Pediat Neurosurg, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Sect Pediat Neurosurg, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, BR-04023062 São Paulo, BrazilWeb of Scienc

Resuscitation at birth in neonates with meningomyelocele

Aims: Compare the need for neonatal resuscitation procedures between newborn infants with and without meningomyelocele (MMC).Results: This retrospective case-control study included 94 neonates with MMC, defined as open spinal dysraphism with exposure of nervous tissue, and 94 controls without malformations, paired with MMC infants by gender, mode of delivery, gestational age and time of birth. Infants were born at a university hospital in São Paulo, Brazil, from 2001 to 2010. After adjusting for perinatal variables (prenatal care, maternal hypertension, birth during the day shift, cephalic presentation, meconium in the amniotic fluid, gestational age <37 weeks and small-for-gestational-age infants), MMC increased the chance of positive pressure ventilation at birth [odds ratio (OR) 4.55 95% confidence interval (CI) 1.82-11.41], intubation at birth (OR 3.94 95% CI 1.14-13.59) and 1-min Apgar score 95% CI 0.99-7.57).Conclusion: MMC is an independent factor associated with the need for positive pressure ventilation and intubation at birth.Universidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Use of interferon alpha in intratumoral chemotherapy for cystic craniopharyngioma

Objectives: This study analyzed the intratumoral activity of interferon alpha (IFN-alpha) in the treatment of cystic craniopharyngiomas. Patients and methods: From January 2000 to January 2004, nine patients presenting with cystic craniopharyngiomas were treated with intratumoral injection of IFN-alpha at the Pediatric Oncology Institute of the Federal University of São Paulo-Escola Paulista de Medicina. Age ranged from 1 year and 10 months to 18 years (mean 10 years). All intratumoral catheters were inserted by a subfrontal approach. Doses varied from 36 to 108 MU. Results: There was complete disappearance of the lesion in seven cases. in two cases, partial reduction of tumor size was observed at follow-up. Follow-up varied from 1 year to 3 years and 6 months (mean 1 year 8 months). Conclusions: IFN-alpha proved to be an effective drug in the control of cystic craniopharyngiomas. Additional studies should be carried out to determine the optimal dose of IFN-alpha in the treatment of cystic craniopharyngioma. in addition, other drugs possessing high efficacy and low neurotoxicity should be analyzed.Universidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Neurol & Neurosurg, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Pediat, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Genet, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Neuroradiol, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Neurol & Neurosurg, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Pediat, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Genet, BR-4023061 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Pediat Oncol Inst, Dept Neuroradiol, BR-4023061 São Paulo, BrazilWeb of Scienc

Antenatal management of fetal neurosurgical diseases

The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.Univ Fed Sao Paulo, Dept Neurosurg, Rua Botucatu 591,Conj 41, BR-04023062 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Gynecol & Obstet, Rua Botucatu 591,Conj 41, BR-04023062 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Neurosurg, Rua Botucatu 591,Conj 41, BR-04023062 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Gynecol & Obstet, Rua Botucatu 591,Conj 41, BR-04023062 Sao Paulo, SP, BrazilWeb of Scienc

Valproic acid and Hedgehog pathway: A possible drug resistance mechanism in medulloblastoma?

Universidade Federal de São Paulo, Dept Pediat, Pediat Oncol Inst GRAACC, São Paulo, BrazilUniversidade Federal de São Paulo, Div Genet, Dept Morphol & Genet, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, Pediat Oncol Inst GRAACC, São Paulo, BrazilUniversidade Federal de São Paulo, Div Genet, Dept Morphol & Genet, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol, São Paulo, BrazilWeb of Scienc