[Adult medulloblastomas: our experience]. / Meduloblastomas del adulto: serie quirúrgica de 11 casos.

INTRODUCTION: Medulloblastomas are malignant, invasive and highly cellular tumours from the cerebellum, rarely seen in adults. We describe the experience in the treatment of this entity in our institution. MATERIALS AND METHODS: A retrospective study was made including 11 adult patients with medulloblastomas confined to the craniospinal axis treated between 1984-2010. Clinical, radiological and therapeutic data were assessed during the evolution of this entity. RESULTS: Mean age of patients was 30.2 years (9 women/2 men). Over 80% of the patients presented intracranial hypertension, while 54.5% presented cerebellum syndrome. Gross total surgical resection was achieved in 8 patients (72.7%) and subtotal resection in the other 3 (27.3%). All patients received craniospinal radiotherapy. After primary surgical resection, 6 patients received chemotherapy with cisplatin (CDDP) and etoposide (VP-16). During the follow up period and after a median time of 35.2 months, 4 patients (36.4%) presented with relapse, mainly in the posterior cranial fossa, managed in the majority of cases with surgical resection plus additional chemotherapy. Mean survival time was 100.3 months with a 5- and 8- year overall survival rate of 84 and 56% respectively. CONCLUSIONS: In the treatment of this malignancy, gross surgical resection has a crucial role, followed as soon as possible by oncological therapy, specially radiotherapy if needed.

Meduloblastomas del adulto: serie quirúrgica de 11 casos / No disponible

Introducción. Los meduloblastomas son tumores malignos, invasivos, altamente celulares, del cerebelo, infrecuentes en el adulto. En el presente trabajo describiremos la experiencia en el manejo de esta patología en nuestro centro.Material y métodos. Se trata de un trabajo retrospectivo que incluyó 11 pacientes adultos con diagnóstico de meduloblastoma del eje craneoespinal atendidos entre 1984-2010. Se evaluaron datos clínicos, radiológicos y terapéuticos durante la evolución de la enfermedad.Resultados. La edad media de los pacientes fue 30,2 años (9 mujeres y 2 varones). Más del 80% de los pacientes manifestaron clínica de hipertensión intracraneal, mientras el 54,5% presentaron síndrome cerebeloso. El grado de resección quirúrgica fue total en 8 pacientes (72,7%) y subtotal en 3 (27,3%). Todos los pacientes recibieron tratamiento radioterápico adyuvante. Posterior a la exéresis tumoral inicial, 6 pacientes recibieron quimioterapia adyuvante con cisplatino (CDDP) y etopósido (VP-16). Durante el seguimiento, después de un tiempo medio de 35,2 meses, se observaron recidivas en el 36,4% de los pacientes (n= 4), con mayor frecuencia en la fosa posterior, empleando en todos ellos tratamiento con cirugía y quimioterapia. El tiempo medio de supervivencia fue 100,3 meses, con un índice de supervivencia estimado a los 5 y 8 años de seguimiento del 84 y 56 % respectivamente.Conclusiones. La máxima resección quirúrgica forma parte crucial del tratamiento, seguida de adyuvancia oncológica tan pronto sea posible, con radioterapia seguida o no de quimioterapia (AU)

Introduction. Medulloblastomas are malignant, invasive and highly cellular tumours from the cerebellum, rarely seen in adults. We describe the experience in the treatment of this entity in our institution.Materials and methods. A retrospective study was made including 11 adult patients with medulloblastomas confined to the craniospinal axis treated between 1984-2010. Clinical, radiological and therapeutic data were assessed during the evolution of this entity.Results. Mean age of patients was 30,2 years (9 women/2 men). Over 80% of the patients presented intracranial hypertension, while 54,5% presented cerebellum syndrome. Gross total surgical resection was achieved in 8 patients (72,7%) and subtotal resection in the other 3 (27,3%). All patients received craniospinal radiotherapy. After primary surgical resection, 6 patients received chemotherapy with cisplatin (CDDP) and etoposide (VP-16). During the follow up period and after a median time of 35,2 months, 4 patients (36,4%) presented with relapse, mainly in the posterior cranial fossa, managed in the majority of cases with surgical resection plus additional chemotherapy. Mean survival time was 100,3 months with a 5- and 8- year overall survival rate of 84 and 56% respectively. Conclusions. In the treatment of this malignancy, gross surgical resection has a crucial role, followed as soon as possible by oncological therapy, specially radiotherapy and chemotherapy if needed (AU)

[Linear accelerator radiosurgery for the treatment of vestibular schwannoma]. / Radiocirugia con acelerador lineal en el tratamiento del schwannoma vestibular.

INTRODUCTION AND AIM: Radiosurgery is among the treatment options for patients with vestibular schwannoma. We present the experience in our institution in the treatment of this disease with this technique. PATIENTS AND METHODS: A retrospective study was made including 20 patients (11 women and 9 men; median age: 55.15 years-old) with vestibular schwannoma who received linear accelerator radiosurgery treatment since April 2005 until December 2008. Follow-up period was between 12 and 42 months, considering clinical examination of cranial nerves VII (House-Brackmann scale) and VIII (Gardner-Robertson scale) as well as radiological findings (considering tumor volume). For statistical analysis, the Fisher's exact test and logistic regression test were used. RESULTS: Certain worsening of hearing function was present in 25% of the patients. Five patients had large tumors at the moment of the treatment (equal or larger than 3.5 cm3), from which four deteriorated from headache, unsteady gait, dizziness/vertigo, facial numbness and tinnitus, with statistical significance (p < 0.05). From the first year of treatment on, there was a tumor volume decrease tendency, with no tumor growth in the medium/long term follow-up, achieving a local control rate of 100%. CONCLUSIONS: Radiosurgery has become an alternative in the treatment of patients with vestibular schwannoma of appropriate size, with high safety level, using low radiation doses, low rate of complications and good tumor control rate in the medium term follow-up.

[Lumboperitoneal shunt in an outpatient setting for the treatment of chronic hydrocephalus in adults. A study and follow-up of 30 cases]. / Derivación lumboperitoneal en régimen ambulatorio en el tratamiento de la hidrocefalia crónica del adulto. Estudio y seguimiento de 30 casos.

INTRODUCTION AND AIMS: One of the therapeutic options for chronic adult hydrocephalus that has become widely used in our service is the lumboperitoneal shunt with low-pressure Spetzler catheter and in an outpatient regimen. We report on the first 30 patients treated in this way with a follow-up of between one and five years. PATIENTS AND METHODS: Diagnosis was reached after studying the patient history and a clinical examination; Hakim and Adams' triad was found to be a primary and highly predictive factor, together with flow magnetic resonance imaging and the use of the ambulatory tap test. Patients who responded to the latter were submitted to placement of a shunt in a short operation performed with local anaesthetic and sedation. An evaluation of the three symptoms was carried out before and after the intervention according to a mixed scale (Rankin-Stein and Langfitt-Vall d'Hebron) and graphic tests based on the minimental test. RESULTS: At three months, 21 patients (70%) had improved and 14 of them (65%) maintained this improvement at three years; eight of these have been monitored for four and five years. Five patients died due to intercurrent illnesses. CONCLUSIONS: After comparing the complications that occurred with other case mixes involving both lumboperitoneal and ventriculoperitoneal shunts, we discuss the usefulness of this method (which is preferred by patients and relatives) in comparison to ventriculoperitoneal shunts, where the complications are more severe because they invade the brain and due to the need for general anaesthesia and longer hospitalisation. In addition, the method is more economical than the alternatives.

Derivación lumboperitoneal en régimen ambulatorio en el tratamiento de la hidrocefalia crónica del adulto. Estudio y seguimiento de 30 casos / Lumboperitoneal shunt in an outpatient setting for the treatment of chronic hydrocephalus in adults. A study and follow-up of 30 cases

Introducción y objetivo. Dentro de las opciones terapéuticas de la hidrocefalia crónica del adulto, ha ido imponiéndoseen nuestro servicio la derivación lumboperitoneal con catéter de baja presión de Spetzler y en régimen ambulatorio.Presentamos los primeros 30 pacientes así tratados con un seguimiento de entre uno y cinco años. Pacientes y métodos. Realizamosel diagnóstico mediante la anamnesis y exploración clínica, constatando la tríada de Hakim y Adams como factor primordialy de gran valor predictivo, así como la resonancia magnética de flujo y el uso de la punción lumbar de prueba (taptest) ambulatoria. Los pacientes que respondieron a ésta fueron sometidos al implante del shunt en una breve intervención conanestesia local y sedación. Se realizó antes y después una valoración de los tres síntomas según una escala mixta (Rankin-Stein y Langfitt-Vall d’Hebron) y pruebas gráficas basadas en el test minimental. Resultados. A los tres meses habían mejorado21 pacientes (70%) y mantuvieron la mejoría a los tres años 14 pacientes (65%); ocho de éstos han sido controlados cuatroy cinco años. Cinco pacientes fallecieron por enfermedades intercurrentes. Conclusiones. Tras compararse las complicacioneshabidas con otras casuísticas tanto de derivación lumboperitoneal como de derivación ventriculoperitoneal, se comentala utilidad del método, preferido por los pacientes y familiares, frente al de derivación ventriculoperitoneal, donde las complicacionestienen mayor gravedad al invadir el cerebro y ante la necesidad de anestesia general e ingreso más prolongado.El método, además, es más económico que los alternativos(AU)

Introduction and aims. One of the therapeutic options for chronic adult hydrocephalus that has become widely usedin our service is the lumboperitoneal shunt with low-pressure Spetzler catheter and in an outpatient regimen. We report on thefirst 30 patients treated in this way with a follow-up of between one and five years. Patients and methods. Diagnosis wasreached after studying the patient history and a clinical examination; Hakim and Adams’ triad was found to be a primary andhighly predictive factor, together with flow magnetic resonance imaging and the use of the ambulatory tap test. Patients whoresponded to the latter were submitted to placement of a shunt in a short operation performed with local anaesthetic andsedation. An evaluation of the three symptoms was carried out before and after the intervention according to a mixed scale(Rankin-Stein and Langfitt-Vall d’Hebron) and graphic tests based on the minimental test. Results. At three months, 21patients (70%) had improved and 14 of them (65%) maintained this improvement at three years; eight of these have beenmonitored for four and five years. Five patients died due to intercurrent illnesses. Conclusions. After comparing thecomplications that occurred with other case mixes involving both lumboperitoneal and ventriculoperitoneal shunts, we discussthe usefulness of this method (which is preferred by patients and relatives) in comparison to ventriculoperitoneal shunts, wherethe complications are more severe because they invade the brain and due to the need for general anaesthesia and longerhospitalisation. In addition, the method is more economical than the alternatives(AU)

[Tension pneumocephalus in a patient with a scalp wound and ventriculo-peritoneal shunt: case report and literature review]. / Neumoencefalo a tensión tras herida en cuero cabelludo en portadora de válvula de derivación ventrículo-peritoneal: caso clínico y revisión de la literatura.

Skull defects and even meningeal defects are responsible for the majority of pneumocephalus cases. Sometimes, several factors can produce intracranial gas under pressure (tension pneumocephalus) with severe neurological impairment. We present a case of a 66 year old woman with a double ventriculo-peritoneal shunt that was admitted to the emergency service with an intracranial hypertension syndrome. A scalp wound was found on the physical examination and a brain CT showed a tension pneumocephalus. The scalp wound was just located on the border of a cranioplasty made after surgical removal of a parasagital meningioma eight years ago. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and modification of factors contributing to the tension pneumocephalus (ventricular-peritoneal shunts programmed to low pressure) were performed. When we found a patient with a tension pneumocephalus we must think not only about a skull or meningeal defect but also look for other elements that produce gas inside skull under pressure (shunts, cerebrospinal fluid leak between others). Therefore, therapeutic approach has three parts: pneumocephalus drainage, to find and repair entrance of gas and to modify factors that turn pneumocephalus in a tension pneumocephalus.

Neumoencefalo a tensión tras herida en cuero cabelludo en portadora de válvula dederivación ventrículo-peritoneal: caso clínico y revisión de la literatura / Tension pneumocephalus in a patient with a scalp wound and ventriculo-peritoneal shunt: case report and literature review

El neumoencéfalo se produce la mayoría de lasveces por una solución de continuidad en el cráneo eincluso en las meninges. En ocasiones, ciertos factorespueden hacer que éste adopte las características deun neumoencéfalo a tensión provocando una clínicaneurológica severa. Presentamos el caso de una pacientede 66 años portadora de una doble válvula de derivaciónventrículo-peritoneal que acude a Urgencias con uncuadro de hipertensión intracraneal y que tras la exploraciónfísica y la tomografía computarizada se detectauna herida en cuero cabelludo y un neumoencéfalo atensión. Este defecto en piel se hallaba justo en la zonadel borde de una plastia craneal colocada tras la resecciónde un meningoma parasagital 8 años antes. Se realizódrenaje, reparación de la solución de continuidady modificación de los factores que agravaban el cuadrodel neumoencéfalo (la presencia de unas válvulas dederivación con presiones de salida muy bajas).La presencia de un neumoencéfalo a tensión debehacernos pensar en encontrar no sólo el punto deacceso del aire al interior del cráneo sino también lascausas que han favorecido que el neumoencéfalo adoptecaracterísticas de alta presión (sistemas de derivacióno fístulas de LCR entre otros). De esta forma la orientaciónterapéutica adecuada tiene que ir destinada a lamodificación de estos factores agravantes, además dehacia el drenaje del neumoencéfalo y cierre del defectocraneal (AU)

Skull defects and even meningeal defects are responsiblefor the majority of pneumocephalus cases.Sometimes, several factors can produce intracranialgas under pressure (tension pneumocephalus) withsevere neurological impairment. We present a case of a66 year old woman with a double ventriculo-peritonealshunt that was admitted to the emergency service withan intracranial hypertension syndrome. A scalp woundwas found on the physical examination and a brain CTshowed a tension pneumocephalus. The scalp woundwas just located on the border of a cranioplasty madeafter surgical removal of a parasagital meningiomaeight years ago. Evacuation of pneumocephalus, reparationof cranial and meningeal defects and modificationof factors contributing to the tension pneumocephalus(ventricular-peritoneal shunts programmed to lowpressure) were performed.When we found a patient with a tension pneumocephaluswe must think not only about a skull or meningealdefect but also look for other elements that producegas inside skull under pressure (shunts, cerebrospinalfluid leak between others). Therefore, therapeuticapproach has three parts: pneumocephalus drainage,to find and repair entrance of gas and to modify factorsthat turn pneumocephalus in a tension pneumocephalus (AU)

Fatal outcome related to carmustine implants in glioblastoma multiforme.

Following the resection of newly diagnosed or recurrent glioblastomas, local implantation of carmustine-impregnated biodegradable wafers (Gliadel) in the resection cavity constitutes an adjuvant therapy that can improve the possibilities of survival. However, some precautions should be taken regarding Gliadel implantation. We report three cases in whom patients with glioblastoma multiforme were implanted with fibrin glue-secured Gliadel after the lateral ventricles had been opened, and who later developed severe hydrocephalus leading to death. Although Gliadel may be an important adjunct to treatment, opening of the ventricles during surgery as part of its application should be considered a contra-indication.

[Meningiomas: immunohistochemical analysis of 26 cases]. / Meningiomas: análisis inmunohistoquímico de 26 casos.

We have analyzed, with immunohistochemical staining techniques 26 meningiomas of CNS. Vimentin intermediate filaments was present in all cases in the cytoplasm of tumoral cells. Single epithelium cytokeratin was positive in only 19% cases, same that was obtained with S-100 protein. Whereas 69% of cases expressed epithelial membrane antigen. No case was stained positively with Actin, Desmin and GFAP. The results obtained for others authors are analyzed.

[Intracerebral gangliocytoma: a histological and immunohistochemical study]. / Gangliocitoma intracerebral: estudio histológico e inmunohistoquímico.

We present a case of cerebral gangliocytoma placed on the right frontal lobe in a young adult, analyzing its morphological and clinical features. The immunohistochemical study defines it as a tumor with a neuronal population NSE and NFP positive, and a glial population with positivity for the GFAP. We emphasize the presence of neurosecretion in the mature neurones, typified by the positivity to the sinaptophisine and VIP. In the discussion we compare our immunohistochemical results, analyzing the histogenesis of this rare neoplasm.

Meningiomas: karyotypes and histological patterns.

The cytogenetic findings, based on G-banding, in six meningiomas are reported. Normal karyotypes were found in three cases and monosomy of chromosome 22 in the remaining three. In one of these three cases, a malignant meningioma, several chromosomes were lost, gonosome Y included. The possible significance of the association of chromosome alterations in meningiomas with the histology of the tumor and its biological aggressivity is discussed.