Renal biopsy with 16G needle: a safety study.

INTRODUCTION AND OBJECTIVE: The development of percutaneous renal biopsy as a routinary diagnostic procedure for renal masses is topic of discussion for the last few years. However, this technique has been associated with some complications, although infrequent, and morbidity. Our objective is to carry out a descriptive study about complications and outcomes of orthotopic kidney biopsies with 16 G needle. MATERIAL AND METHODS: A retrospective review of 180 orthotopic ultrasound-guided renal biopsies performed in our service among January 2008 to May 2010 was carried out. The procedure was developed using an automated biopsy gun (16G needle). Multiple clinical variables, early post-procedure complications and its management were collected. Complication rates as well as the relationship between risk factors and occurrence of complications were studied. RESULTS: Mean age was 55.8 years. The average number of biopsy cylinders per intervention was 2.49. The overall complication rate was 5.6%. An interventionist attitude derived from complication of the procedure was necessary in only 3 patients (1.67%). No surgical interventions were required and no death as consequence of procedure was registered. No relationship between hypertension (P=.09) previous anticoagulation (P=.099) or previous antiaggregation (P=.603) and complications were demonstrated. In 2.8% of biopsies the material obtained was insufficient for diagnosing. CONCLUSIONS: Percutaneous ultrasound-guided renal biopsy with 16G needle is a safe technique with high diagnostic performance.

Leg fat might be more protective than arm fat in relation to lipid profile.

PURPOSE: The objective of this study was to determine the independent relationships of trunk fat, leg fat and arm fat to cardiovascular (CVD) risk factors, after controlling for relevant confounders such as fat mass index, cardiorespiratory fitness and objectively measured physical activity. METHODS: This is a cross-sectional study involving 683 university students, aged 18-30 years. Total and regional body fat distribution was measured using dual-energy X-ray absorptiometry. The associations of trunk, leg and arm fat with CVD risk factors (triglycerides-TG-, high-density lipoprotein cholesterol-HDL-c-, TG/HDL-c ratio, HOMA(IR), mean arterial pressure, C-reactive protein) were examined using regression linear models, controlling for age, sex, fat mass index [total body fat(kg)/height(m(2))], maximal oxygen consumption and physical activity by accelerometer. RESULTS: After controlling for fat mass index, and other confounders, higher levels of trunk fat were found to be associated with a poorer lipid profile, while higher levels of leg fat were found to be associated with a better lipid profile. We did not find any association between arm fat and lipid profile after controlling for total fatness and other confounders. Neither trunk, leg or arm fat was found to be related to insulin resistance, blood pressure or inflammation markers. CONCLUSIONS: Our data suggest that the region where fat is accumulated might have a differential effect on lipid profile: trunk fat has an adverse effect, leg fat has a protective effect, and arm fat has no effect. The differences observed between upper- and lower-body peripheral fat depots should be further explored.

Prehipertensión arterial en adultos jóvenes / Arterial pre-hypertension in young adults

Antecedentes y objetivos. La prehipertensión es una nueva categoría de presión arterial, y se considera un factor de riesgo vascular. Hemos estimado la prevalencia de prehipertensión y la asociación entre esta condición y otros factores de riesgo vascular en adultos jóvenes. Sujetos y métodos. Invitamos a participar a los universitarios del primer curso de todas las titulaciones que se imparten en el Campus Universitario de Cuenca. Se consideró prehipertensión a una presión arterial sistólica de 120-139mmHg y/o presión arterial diastólica de 80-89mmHg. Se midieron las variables antropométricas, lipídicas y metabólicas. Se valoró la presencia del síndrome metabólico, y se cuantificó en función de la suma de las puntuaciones estandarizadas del perímetro de cintura, la razón triglicéridos/c-HDL, presión arterial media y R-HOMA (índice de resistencia a la acción hipoglucemiante de la insulina). Resultados. Se incluyeron en el análisis 545 universitarios (edad media [±DE] 20,4±3,9 años; 74,7% mujeres). La prevalencia global de prehipertensión fue del 24% (IC del 95%: 21-27%), (varones: 56,5%; mujeres: 13,0%). La condición de prehipertensión se asoció de forma directa al índice de masa corporal (OR: 1,194; IC del 95%: 1,124-1,311), resistencia al efecto hipoglucemiante de la insulina (R-HOMA, OR: 2,638; IC del 95%: 1,263-4,926) y al índice o cuantificación de la severidad del síndrome metabólico (OR: 4,868; IC del 95%: 3,846-8,328). Por el contrario, la prehipertensión se asoció de forma inversa con la concentración de c-HDL (OR: 0,981; IC del 95%: 0,957-0,993). Conclusiones. Uno de cada 4 adultos jóvenes presenta prehipertensión. Esta condición se asocia a los factores de riesgo vasculares bien establecidos(AU)

Background and objectives. Prehypertension is a new category of blood pressure and is considered a cardiovascular risk factor. This study has aimed to estimate the prevalence of prehypertension and the association between prehypertension and other vascular risk factors in young adults. Material and methods. First year university students from all areas of study in the University of Cuenca were invited to participate. Prehypertension was defined as systolic blood pressure between 120-139mmHg and/or diastolic blood pressure between 80-89mmHg. Anthropometric, lipid and metabolic variables were measures. The presence of metabolic syndrome was evaluated and quantified based on the sum of the standardized scores of the waist circumference, the triglyceride/c-HDL ratio, mean blood pressure and R-HOMA (Index of insulin resistance to glucose lowering effect). Results. A total of 545 university students were included in the analysis (mean age 20.36±3.9 years, 74.7% women). Prehypertension prevalence was 24% (95% CI: 21-27%), (56.5% in men and 13% in women). The condition of prehypertension was directly associated to the body mass index (OR:1.194; 95% CI:1.124-1.311), insulin resistance (R-HOMA, OR:2.638; 95% CI:1.263-4.926) and to the index or quantification of the severity of the metabolic syndrome (OR:4-868; 95% CI:3-846-8-328). On the other hand, HDL-c showed an inverse relationship with prehypertension (OR:0.981; 95% CI:0.957-0.993). Conclusions. One out of every four young adults presents prehypertension. This condition is associated to well-established vascular risk factors(AU)

[Arterial pre-hypertension in young adults]. / Prehipertensión arterial en adultos jóvenes.

BACKGROUND AND OBJECTIVES: Prehypertension is a new category of blood pressure and is considered a cardiovascular risk factor. This study has aimed to estimate the prevalence of prehypertension and the association between prehypertension and other vascular risk factors in young adults. MATERIAL AND METHODS: First year university students from all areas of study in the University of Cuenca were invited to participate. Prehypertension was defined as systolic blood pressure between 120-139 mmHg and/or diastolic blood pressure between 80-89 mmHg. Anthropometric, lipid and metabolic variables were measures. The presence of metabolic syndrome was evaluated and quantified based on the sum of the standardized scores of the waist circumference, the triglyceride/c-HDL ratio, mean blood pressure and R-HOMA (Index of insulin resistance to glucose lowering effect). RESULTS: A total of 545 university students were included in the analysis (mean age 20.36±3.9 years, 74.7% women). Prehypertension prevalence was 24% (95% CI: 21-27%), (56.5% in men and 13% in women). The condition of prehypertension was directly associated to the body mass index (OR: 1.194; 95% CI: 1.124-1.311), insulin resistance (R-HOMA, OR: 2.638; 95% CI: 1.263-4.926) and to the index or quantification of the severity of the metabolic syndrome (OR: 4-868; 95% CI: 3-846-8-328). On the other hand, HDL-c showed an inverse relationship with prehypertension (OR: 0.981; 95% CI: 0.957-0.993). CONCLUSIONS: One out of every four young adults presents prehypertension. This condition is associated to well-established vascular risk factors.

Relative value of magnetic resonance spectroscopy, magnetic resonance perfusion, and 2-(18F) fluoro-2-deoxy-D-glucose positron emission tomography for detection of recurrence or grade increase in gliomas.

In a consecutive series of 26 previously operated patients diagnosed with cerebral glioma, magnetic resonance spectroscopy (MRS), 2-((18)F) fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), and perfusion MRI (MRP), were performed at follow-up to distinguish recurrence from radiation necrosis, and to identify tumour upgrading. Discrepancy between techniques was observed in 9 cases. The positive predictive value (PPV) and the negative predictive value (NPV) of each technique to detect the presence of high grade glioma was: MRI, PPV=50%; MRS, PPV=91.6%, NPV=100%; FDG-PET, PPV=75%, NPV=61.1%; MRP, PPV=100%, NPV=100%. In the selected group of nine cases studied to differentiate viable tumour from radiation necrosis, MRS and MRP reached a PPV and a NPV of 100%, whereas for FDG-PET, PPV and NPV were 66.6% and 60%, respectively. To distinguish between viable high-grade glioma and radiation necrosis, gadolinium-enhanced MRI gives a high false-positive rate, while MRS and MRP are superior to FDG-PET in discriminating tumour recurrence, grade increase and radiation necrosis.

Pain improvement in patients with syringomyelia and Chiari I malformation treated with suboccipital decompression and tonsillar coagulation.

Pain experienced by patients who have syringomyelia associated with Chiari I malformation (SACM) includes headache, cervicalgia and radiculalgia. We studied the correlation of clinical and imaging factors with the evolution of pain and surgical outcome at 12 months. We performed a prospective study of 13 patients who presented with SACM and who underwent suboccipital decompression, C1 laminectomy, tonsillar coagulation and duraplasty. The Bidzinski Outcome Scale was used. Post-operatively, pain improvement was observed in 11 patients and the syrinx resolved in 6 patients and reduced in 7. Eleven patients had a good or very good outcome, while 2 patients had a poor outcome. A post-operative medullary axial occupation of the syrinx less than 75% of the spinal canal was associated with improved post-operative pain. Longer duration of symptomatology was associated with a poor outcome and failed pain control. The size and form of the syrinx, as well as early surgical treatment, are the factors that most influence the control of pain post-surgery in patients with SACM.

[Endoscopy-assisted surgery of the sellar region]. / Cirugía de la región selar asistida por endoscopia.

OBJECTIVE: To evaluate the usefulness of endoscopic assisted surgery of pituitary adenomas in transesphenoidal surgery, and in surgery of craneopharyngiomas using either minimally invasive approaches to the cranial base or transventricular approaches. MATERIAL AND METHODS: We present our preliminary experience in eleven patients operated of sellar region tumor by endoscopic assisted resection: 6 pituitary adenoma via transesphenoidal approach, 4 craneopharyngiomas 3 through supraciliar approach and 1 by transcortical transventricular approach, and 1 suprasellar cyst. RESULTS: By using the 30 degrees optic the use of endoscope allowed complete resection, confirmed by postoperative MRI, of all six pituitary macroadenomas providing control of resection of supraselar remnants. Complete resection was achieved in three out of four craneopharyngiomas, 2 of them being recurrences. Three were operated by using a supraciliar approach to the cranial base and in one case transcortical transventricular resection of a recurrent intraventricular craneopharyngioma was performed. In the case with partial resection remnant were let in place due to the close adherence to peritumoral structures. In the three craneopharyngiomas operated via supraciliar approach endoscope allowed better control of inferior aspect of ipsilateral optic nerve and internal carotid artery. In the case of intraventricular craneopharyngioma, the use of 30 degrees endoscope provide control of resection of the anterior part of third ventricle through the foramen of Monro with no additional opening. The suprasellar cyst was fenestrated. CONCLUSIONS: No matter which approach is going to be used in the resection of sellar tumors, endoscopy can play a crucial role in achieve complete resection with minimal morbidity by using minimally invasive procedures.

Cirugía de la región selar asistida por endoscopia / Endoscopy-assisted surgery of the sellar region

Objetivos: El estudio pretende evaluar la utilidad del uso del endoscopio en la cirugía de la región selar a través del abordaje transesfenoidal transnasal en los adenomas hipofisarios y a través de abordajes mínimamente invasivos a la base de cráneo o el sistema ventricular en el caso de craneofaringiomas. Material y métodos: Presentamos la experiencia preliminar en once casos intervenidos mediante cirugía asistida con endoscopia. Seis pacientes presentaban macroadenomas hipofisarios y fueron intervenidos por vía transesfenoidal transnasal. Cuatro pacientes presentaban craneofaringiomas, 2 de ellos recidivantes, que fueron abordados, 3 a través de un acceso supraciliar y uno mediante un abordaje transcortical transventricular, abordaje utilizado en un quiste supraselar intraventricular. Resultados : Se consiguió la exéresis completa confirmada por RM de los adenomas hipofisarios en los que el uso del endoscopio con óptica de 30° fue de utilidad en el control de la exéresis de los tumores con expansión supraselar. En el caso de los craneofaringiomas se alcanzó la exéresis completa en 3 de ellos uno de los cuales era recidivante, 2 por vía supraciliar y otro transcortical transventricular. En el caso restante, un craneofaringioma recidivante, la exéresis fue parcial por la íntima adherencia de la cápsula tumoral a las estructuras circundantes. En los 3 casos de acceso supraciliar, el endoscopio fue útil para el control de la exéresis del tumor localizado inferior al nervio óptico y la carótida interna ipsilaterales. En el acceso intraventricular el craneofaringioma que ocupaba el tercio anterior y medio del tercer ventrículo pudo resecarse a través del foramen de Monro, mediante una óptica de 30° que permitió controlar y resecar el resto tumoral del tercio anterior. El quiste fue fenestrado. Conclusiones: En cualquiera de las posibles vías de abordaje a la región selar, el uso de la cirugía asistida por endoscopia favorece una mayor radicalidad en la resección mediante el uso de abordajes mínimamente invasivos (AU)

Objective: To evaluate the usefulness of endoscopic assisted surgery of pituitary adenomas in transesphenoidal surgery, and in surgery of craneopharyngiomas using either minimally invasive approaches to the cranial base or transventricular approaches. Material and methods:We present our preliminary experience in eleven patients operated of sellar region umor by endoscopic assisted resection: 6 pituitary adenoma via transesphenoidal approach, 4 craneopharyngiomas 3 throung supraciliar approach and 1 by transcortical transventricular approach, and 1 suprasellar cyst. Results: By using the 30 degrees optic the use of endoscope allowed complete resection, confirmed by postoperative MRI, of all six pituitary macroadenomas providing control of resection of supraselar remnants. Complete resection was achieved in three out of four craneopharyngiomas, 2 of them being recurrences. Three were operated by using a supraciliar approach to the cranial base and in one case transcortical transventricular resection of a recurrent intraventricular craneopharyngioma was performed. In the case with partial resection remnant were let in place due to the close adherence to peritumoral structures. In the three craneopharyngiomas operated via supraciliar approach endoscope allowed better control of inferior aspect of ipsilateral optic nerve and internal carotid artery. In the case of intraventricular craneopharyngioma, the use of 30 degrees endoscope provide control of resection of the anterior part of third ventricle through the foramen of Monro with no additional opening. The suprasellar cyst was fenestrated. Conclusions: No matter which approach is going to be used in the resection of sellar tumors, endoscopy can play a crucial role in achieve complete resection with minimal morbidity by using minimally invasive procedures (AU)

Asociación de meningioma y aneurisma cerebral en un paciente con intoxicación crónica por plomo / Association between meningioma and brain aneurysm in a patient with chronic lead poisoning

No disponible

Giant occipital intradiploic epidermoid cyst associated with iatrogenic puncture.

The origin of cranial epidermoid cysts (EC) remains controversial, and although generally considered to be congenital, acquired origin has been reported. EC represent 0.2 to 1.8% of all brain tumours, and only one fourth are intradiploic in location. We report of a 44-year-old woman with a giant intradiploic EC of the occipital bone with intracranial extension confirmed on brain MRI. Three years previously, in the same location, she underwent resection of an intradermal melanocytic naevus of the skin under local anaesthesia with lidocaine infiltration of skin and periosteum. Brain CT scan performed at the time of naevus surgery because of associated headache did not show a lesion of the cranial vault. Iatrogenic epidermoid tumours are extremely rare, and although seeding of epidermal cells has been classically described only after lumbar puncture, the same mechanism may be involved after head injury, cranial surgery or cranial periosteal iatrogenic puncture.

[Association between cerebral infarction and malignant glioma]. / Asociación de infarto cerebral y glioma maligno.

INTRODUCTION: It is very rare for cerebral infarction to be the first symptom of an intracranial tumour. Only three cases have been reported in which cerebral infarction is thought to have been caused by the arterial compromise triggered by incipient high grade gliomas that are not yet visible in radiological tests. CASE REPORT: A 46-year-old male with no relevant medical history or cardiovascular risk factors who presented with acute hemiplegia on the right-hand side of the body and a significantly impaired level of consciousness. Computerised axial tomography of the brain showed a left frontal malignant ischemic infarct that exerted an important mass effect. The patient was submitted to a left-side frontoparietal decompressive craniectomy. Post-operative progress was good and the patient even recovered his normal level of consciousness, although he was left with right hemiparesis and conduction dysphasia. Seven months after the craniectomy the patient experienced a progressive deterioration with symptoms of endocranial hypertension. Magnetic resonance imaging of the brain revealed the presence of a highly malignant tumour in the previously infarcted territory. A histological study of the excised lesion showed it to be a glioblastoma multiforme. CONCLUSIONS: The proximity in time, as well as the identical location of the two lesions, led us to think that the glioblastoma, although not yet visible in radiological explorations, affected a branch of the middle cerebral artery and gave rise to the infarct. Therefore, in the presence of a cerebral infarct in patients with no risk factors for suffering a brain vascular pathology, it is advisable to carry out a radiological follow-up so as to be able to diagnose a possible lesion due to a tumour.

Asociación de infarto cerebral y glioma maligno / Association between cerebral infarction and malignant glioma

Introducción. La primera manifestación de un tumor intracraneal raramente es la aparición de un infarto cerebral. Tan sólo se han documentado tres casos en los que se considera como causa de un infarto cerebral la afectación arterial provocada por gliomas incipientes de alto grado aún no visibles radiológicamente. Caso clínico. Se trata de un varón de 46 años sin antecedentes médicos de interés ni factores de riesgo cardiovasculares que presentó de manera aguda una manifiesta hemiplejía derecha y deterioro importante del nivel de conciencia. En la tomografía axial computarizada craneal se demostró un infarto isquémico maligno frontal izquierdo que ejercía un gran efecto de masa. Se practicó una craniectomía descompresiva frontoparietal izquierda. El posoperatorio fue favorable y el paciente recuperó hasta la normalidad su nivel de conciencia, aunque quedó con una hemiparesia derecha y disfasia de conducción. Siete meses después de la craniectomía, experimentó un deterioro progresivo con clínica de hipertensión endocraneal. La resonancia magnética cerebral demostró la presencia de un tumor de alto grado de malignidad sobre el territorio previamente infartado. El estudio histológico de la lesión resecada determinó que se trataba de un glioblastoma multiforme. Conclusión. La cercanía en el tiempo, así como la idéntica localización de ambas lesiones, hace pensar que el glioblastoma, no siendo aún visible radiológicamente, comprimió o invadió una rama de la arteria cerebral media y originó el infarto. Por tanto, ante la presencia de un infarto cerebral en un paciente sin factores de riesgo para sufrir patología vascular cerebral, sería recomendable realizar un seguimiento radiológico posterior con el fin de diagnosticar una posible lesión tumoral

Introduction. It is very rare for cerebral infarction to be the first symptom of an intracranial tumour. Only three cases have been reported in which cerebral infarction is thought to have been caused by the arterial compromise triggered by incipient high grade gliomas that are not yet visible in radiological tests. Case report. A 46-year-old male with no relevant medical history or cardiovascular risk factors who presented with acute hemiplegia on the right-hand side of the body and a significantly impaired level of consciousness. Computerised axial tomography of the brain showed a left frontal malignant ischemic infarct that exerted an important mass effect. The patient was submitted to a left-side frontoparietal decompressive craniectomy. Post-operative progress was good and the patient even recovered his normal level of consciousness, although he was left with right hemiparesis and conduction dysphasia. Seven months after the craniectomy the patient experienced a progressive deterioration with symptoms of endocranial hypertension. Magnetic resonance imaging of the brain revealed the presence of a highly malignant tumour in the previously infarcted territory. A histological study of the excised lesion showed it to be a glioblastoma multiforme. Conclusions. The proximity in time, as well as the identical location of the two lesions, led us to think that the glioblastoma, although not yet visible in radiological explorations, affected a branch of the middle cerebral artery and gave rise to the infarct. Therefore, in the presence of a cerebral infarct in patients with no risk factors for suffering a brain vascular pathology, it is advisable to carry out a radiological follow-up so as to be able to diagnose a possible lesion due to a tumour

[Multiseptated arachnoid cyst treated with fenestration after valvular insufficiency in an adult. ]. / Quiste aracnoideo multitabicado tratado con fenestración tras insuficienci valcular en un adulto.

Treatment of symptomatic arachnoid cysts is based on two procedures: cyst fenestration versus derivation of CSF. Multiseptated cysts represent a very special group. We present the case of a 75 year old woman with a symptomatic multiseptated arachnoid cyst, developing subacute bleeding in one of the cavities. Final diagnosis was obtained after MRI. CSF derivation became insufficient with clear improvement after fenestration and communication to subarachnoid space.

Quiste aracnoideo multitabicado tratado con fenestración tras insuficiencia valvular en un adulto / Multiseptated arachnoid cyst treated with fenestration after valvular insufficience in an Adult

El tratamiento de los quistes aracnoideos sintomáticos se basa en dos opciones principalmente: su fenestración y comunicación con las cisternas subaracnoideas o la derivación mediante un sistema valvular. Los quistes multitabicados por su propia naturaleza, suponen un grupo con características particulares. Presentamos el caso de una paciente de 75 años con un quiste aracnoideo multitabicado sintomático, con sangrado subagudo en una de sus cavidades. El diagnóstico final se alcanzó tras la realización de una RM. El quiste cambió poco con una derivación cisto-peritoneal, observándose una posterior mejoría clínica tras su fenestración al espacio subaracnoideo (AU)

[Cauda syndrome due to spinal stenosis and diskytis in two different spinal levels. Diagnosis using myelo-TC]. / Síndrome de cause secundario a estenosis y discitis en dos diferentes niveles raquídeos, diagnóstico por mielo-TC

We report a case of a 75 year old man presenting with paraparesis, urinary incontinence and saddle anesthesia evolving after several months and severe lumbalgia and bad general status which developed fewdays before admission. CT-scan showed spondilosis with lytic lesion at L5-S1 level. MR1 was not performed because the patient had a pacemaker. A myelo-CT study was performed showing a complete stop at L4-L5 level together with L5-S1 diskytis. Laminectomy of L5 and discectomy L5-S1 was performed obtaining tissue sample diagnostic of diskytis and osteomyelitis. Our patient had two lesions at two different levels with two independent syndromic appearence. Myelo-CT played an important diagnostic role in this case because MRI study could not be obtained.

[Posterior fossa venous epidural hematoma. Based on 2 cases]. / Hematoma epidural de fosa posterior de origen venoso. A propósito de 2 casos.

We present two rare cases of posterior fossa epidural hematoma (PFEH) due to occipital fracture and tearing of transverse sinus. One of the patients showed supratentorial and infratentorial extension, which is found in half of the PFEH cases. Both cases experienced clinical worsening within 48 h of the head injury, with control CT showing increase of haematoma volume. Both patients were elected for surgery consisting of suboccipital craniectomy, control of sinus bleeding and sealing of epidural space with dural fixation. Sources of bleeding of PFEH are, by order of frequency, transverse sinus, small dural arteries and sigmoid sinus. PFEH may cause fatal clinical outcome with less volume than supratentorial ones. PFEH have high mortality if not treated. Patients with PFEH and GCS <15 should be admitted to hospital and a control CT should be done if there is deterioration or in the first 24 hours. The treatment of choice is surgery, conservative therapy being an alternative for small PFEH and good clinical evolution.

Hematoma epidural de fosa posteriorde origen venoso. A propósito de 2 casos / Posterior fossa venous epidural hematoma. Based on 2 cases

Presentamos dos casos poco frecuentes de hematoma epidural de fosa posterior (HEFP) secundario a fractura de la escama occipital y lesión del seno transverso. Uno de los pacientes presentó extensión del hematoma supra e infratentorial, hecho que se aprecia en la mitad de los HEFP. Ambos pacientes presentaron deterioro clínico antes de las 48 horas del traumatismo con incremento del volumen del hematoma en las tomografías computarizadas (TC) seriadas. La cirugía practicada en ambos casos consistió en la realización de una craniectomía suboccipital, control del sangrado del seno transverso y sellado del espacio epidural con anclaje dural. Los orígenes del sangrado de los HEFP son por orden de frecuencia el seno transverso, las pequeñas arterias durales y el seno sigmoide. Los HEFP pueden presentan una evolución clínica fatal con volúmenes inferiores a los supratentoriales. Dejados a su libre evolución presentan una alta mortalidad. Se recomienda el ingreso de los pacientes con HEFP y GCS < 15 y la realización de TC de control ante deterioro neurológico o en las primeras 24 h. El tratamiento de elección es el quirúrgico reservándose el tratamiento conservador a casos con pequeños volúmenes y buena evolución clínica (AU)

[Cerebral neuroblastomas: diagnosis and treatment]. / Neuroblastoma cerebral: diagnóstico y tratamiento.

AIMS: To review the literature on cerebral neuroblastomas (CN), including their anatomopathological filiation, clinical characteristics together with those they display in imaging studies, and the different therapeutic options with their prognosis. METHOD: Cerebral neuroblastomas belong to the group of primitive neuroectodermal tumours (PNET), also known as cerebral meduloblastomas or supratentorial PNET. They originate in the supratentorial compartment and histologically they are in the WHO grade IV. They display unspecific clinical features and in imaging studies they behave like solid masses with a cystic or necrotic component, often with calcifications. Microscopically they are made up of undifferentiated or poorly differentiated neuroepithelial cells. CN express synaptophysin and other neuroendocrine markers, which can only be studied by performing neuronal differentiation analyses. First choice treatment is surgery performed as radically as possible associated with chemotherapy or whole brain radiotherapy. Results vary greatly according to age and the degree to which the lesion has spread. Worse prognoses have been described for children under 2 years old than for those above that age. Survival rate at 3 years of age, including paediatric patients, is 60%. CONCLUSIONS: CN are not very frequent tumours, whose clinical characteristics and those displayed by imaging techniques are unspecific. Treatment must involve radical excision associated with chemotherapy or radiotherapy.