Primary hydatid cyst of the brain in a child : a case report

BACKGROUND: Primary intracranial hydatid cyst is a rare location of human echinococcosis whose spontaneous, traumatic or even iatrogenic rupture, as in case of misdiagnosis, may cause anaphylactic reactions and dissemination. CASE REPORT: We discuss the management of a 9-year-old boy who was admitted to our Emergency Department with an intracranial hypertension syndrome. Head CT scan and brain MRI showed a huge intra-axial right temporo-parieto-occipital cyst with a marginal calcification, associated with left ventricular uncompensated hydrocephalus. DTI showed displacement of the ipsilateral corticospinal tract, whereas MR spectroscopy showed absence of normal brain metabolites and presence of succinate and lactate within the cyst. A diagnosis of hydatid cyst was then presumed on the basis of the neuroradiological findings. Empiric chemotherapy with albendazole was instituted and surgical en bloc removal of the cyst was obtained, allowing the patient to recover without complications. Diagnosis of brain echinococcosis was confirmed by laboratory tests. CONCLUSIONS: HE is still an endemic manifestation in some rural areas of the world, and it should be included in the differential diagnosis of children living in or coming from an endemic country who present with an intracerebral cyst. Early diagnosis and complete surgical removal of the intact cyst are the main factors that determine a favourable outcome

Recurrent acute obstructive hydrocephalus as clinical onset of cerebral Whipple's disease.

Whipple’s disease is a rare multisystemic infection caused by the intracellular bacteria Thropheryma whippelii. Central nervous system (CNS) involvement is not rare. The most frequent CNS manifestations are cognitive and behavioural changes, sopranuclear ophtalmoplegia, myoclonus, epilepsy, ataxia, meningitis and focal cerebral palsy. We report one case of cerebral localization of Whipple’s disease with a clinical presentation of recurrent endocranic hypertension and hydrocephalus, and uncommon neurological symptoms, successfully treated by endoscopic third ventriculostomy and antibiotic therapy with ceftriaxone and Trimethoprim–Sulfamethoxazole

Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: A single-center experience

OBJECTIVE: Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull defects. Optimal skull reconstruction is a challenge for neurosurgeons, and the strategy used to achieve the best result remains a topic of debate, especially in pediatric patients for whom the continuing skull growth makes the choice of material more difficult. When the native bone flap, which is universally accepted as the preferred option in pediatric patients, is unavailable, the authors' choice of prosthetic material is a polymethylmethacrylate (PMMA) implant designed using a custom-made technique. In this paper the authors present the results of their clinical series of 12 custom-made PMMA implants in pediatric patients. METHODS: A retrospective study of the patients who had undergone cranioplasty at Gaslini Children's Hospital between 2006 and 2013 was conducted. A total of 12 consecutive cranioplasties in 12 patients was reviewed, in which a patientspecific PMMA implant was manufactured using a virtual 3D model and then transformed into a physical model using selective laser sintering or 3D printing. All patients or parents were administered a questionnaire to assess how the patient/parent judged the aesthetic result. RESULTS: Patient age at craniectomy ranged from 5 months to 12.5 years, with a mean age of 84.33 months at cranioplasty. The mean extension of the custom-made plastic was 56.83 cm2. The mean time between craniectomy and cranioplasty was 9.25 months. The mean follow-up duration was 55.7 months. No major complications were recorded; 3 patients experienced minor/moderate complications (prosthesis dislocation, granuloma formation, and fluid collection). CONCLUSIONS: In this patient series, PMMA resulted in an extremely low complication rate and the custom-made technique was associated with an excellent grade of patient or parent satisfaction on long-term follow up

With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas

High-grade gliomas (HGGs) are the most frequent primary malignant brain tumors in adults, which lead to death within two years of diagnosis. Maximal safe resection of malignant gliomas as the first step of multimodal therapy is an accepted goal in malignant glioma surgery. Gross total resection has an important role in improving overall survival (OS) and progression-free survival (PFS), but identification of tumor borders is particularly difficult in HGGS. For this reason, imaging adjuncts, such as 5-aminolevulinic acid (5-ALA) or fluorescein sodium (FS) have been proposed as superior strategies for better defining the limits of surgical resection for HGG. 5-aminolevulinic acid (5-ALA) is implicated as precursor in the synthetic pathway of heme group. Protoporphyrin IX (PpIX) is an intermediate compound of heme metabolism, which produces fluorescence when excited by appropriate light wavelength. Malignant glioma cells have the capacity to selectively synthesize or accumulate 5-ALA-derived porphyrins after exogenous administration of 5-ALA. Fluorescein sodium (FS), on the other hand, is a fluorescent substance that is not specific to tumor cells but actually it is a marker for compromised blood-brain barrier (BBB) areas. Its effectiveness is confirmed by multicenter phase-II trial (FLUOGLIO) but lack of randomized phase III trial data. We conducted an analytic review of the literature with the objective of identifying the usefulness of 5-ALA and FS in HGG surgery in adult patients

Psychometric properties of the Italian version of the Assessment of Identity Development in Adolescence (AIDA)

Identity diffusion is a core element of the borderline personality organization. A valid and reliable assessment tool is needed to identify at-risk adolescents in the Italian context. In this study, we investigated the psychometric properties of the Assessment of Identity Development in Adolescence (AIDA), a self-report questionnaire designed to assess identity diffusion vs. identity integration, in an Italian sample (N = 1,102) of clinical and nonclinical adolescents. Explorative structural equation modeling supported the expected bi-factor structure with one general factor and six descriptive factors. Scale reliability was good, with Cronbach’s α = .94 for the AIDA total scale. The results supported convergent validity with measures of borderline personality features as well as discriminant validity with identity dimensions in ideological and interpersonal domains. The AIDA total score identity diffusion differed highly significantly and with a large effect size between the general population sample and patients diagnosed with borderline personality disorder (n= 55). The Italian version of the AIDA proved to be a valid and reliable measure to assess adolescents’ identity pathology within the Italian context