Surveillance of avian influenza and Newcastle disease viruses in backyard poultry raised near migratory bird sites in Mato Grosso state, Brazil.

The Pantanal and Cerrado biomes in the state of Mato Grosso contain migratory bird sites in the municipalities of Cáceres and Araguaiana, respectively. The levels of avian influenza (AI) and Newcastle disease (ND) viral activity in backyard poultry at these sites are unknown owing to a lack of studies. Considering the risk of introduction of AI and ND to Brazil from migratory birds, as well as the importance of active surveillance in the detection and prevention of diseases for official control, monitoring in these poultry populations is faster, more practical and cheaper for official service veterinarians. The objective of this study was to verify the presence of AI and ND viral activity in backyard poultry reared near these migratory bird sites in the years 2016 and 2019. Serum samples and cloacal and tracheal swab samples collected from chickens, turkeys, quails, ducks and geese were evaluated by indirect diagnostic methods including enzyme-linked immunosorbent assay and haemagglutination inhibition tests and direct detection of viral sequences using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). No positive samples were detected by qRT-PCR.The frequencies of birds seropositive for AI and ND were 0.7% and 19.6% in 2016 and 0.5% and 17.2% in 2019, respectively, in Araguaiana and 0.8% and 32.3% in 2016 and 7.0% and 38.1% in 2019, respectively, in Cáceres. Antibodies belonging to AI subtypes H1, H4, H6 and H14 were identified in Cáceres in 2019. Spatial analysis showed an agglomeration of farms with seropositive poultry within the urban area of Cáceres, suggesting AI and ND virus activity in this area. This study showed no circulation of the notifiable AI subtypes H5 and H7 or the ND virus in backyard poultry raised around migratory bird sites in the state of Mato Grosso. The results of the present study support evidence indicating that the circulation of strains with low pathogenicity in urban areas enables backyard poultry to serve as a source of infection for other birds; thus, increased surveillance is necessary in this population.

Les biomes du Pantanal et du Cerrado dans l'état du Mato Grosso contiennent deux sites accueillant des oiseaux migrateurs, situés respectivement dans les comtés de Cáceres et d'Araguaiana. Faute d'études de terrain, le niveau d'activité virale de l'influenza aviaire et de la maladie de Newcastle chez les volailles de basse-cour de ces deux sites était jusqu'à présent inconnu. Compte tenu du risque d'introduction au Brésil de l'influenza aviaire et de la maladie de Newcastle par les oiseaux migrateurs, et de l'importance de la surveillance active pour détecter et prévenir ces maladies dans le cadre des activités de lutte conduites par les Services vétérinaires, il est plus pratique, moins onéreux et plus rapide pour les vétérinaires des services officiels d'axer la surveillance sur les populations de volailles de basse-cour. Les auteurs présentent les résultats d'une étude conduite en 2016 et en 2019 pour déterminer le niveau de circulation des virus de l'influenza aviaire et de la maladie de Newcastle chez les volailles de basse-cour élevées à proximité des sites d'oiseaux migrateurs. Des échantillons sériques et des écouvillons cloacaux et trachéaux prélevés sur des poulets, des dindes, des cailles, des canards et des oies ont été soumis à des méthodes de diagnostic indirectes telles que les épreuves immuno-enzymatique et d'inhibition de l'hémagglutination, et à une méthode de détection directe des séquences virales par amplification en chaîne par polymérase quantitative en temps réel couplée à une transcription inverse (qRT-PCR). Aucun échantillon positif n'a été détecté par qRT-PCR. Les taux de séropositivité respectivement à l'influenza aviaire et à la maladie de Newcastle étaient, chez les volailles prélevées à Araguaiana, de 0,7 % et 19,6 % en 2016, et de 0,5 % et 17,2 % en 2019 ; chez les volailles prélevées à Cáceres, ils étaient de 0,8 % et 32,3 % en 2016, et de 7,0 % et 38,1 % en 2019. Les anticorps détectés à Cáceres en 2019 appartenaient aux sous-types H1, H4, H6 et H14 du virus de l'influenza aviaire. L'analyse spatiale a révélé une concentration importante d'élevages ayant des volailles séropositives dans la zone urbaine de Cáceres, indiquant une activité des virus de l'influenza aviaire et de la maladie de Newcastle dans cette région. Aucune circulation des sous-types H5 et H7 à déclaration obligatoire du virus de l'influenza aviaire ni du virus de la maladie de Newcastle n'a été mise en évidence chez les volailles de basse-cour élevées autour des sites d'oiseaux migrateurs dans l'état du Mato Grosso. Les résultats de cette étude étayent les données d'après lesquelles les volailles de basse-cour des zones urbaines deviennent des sources d'infection pour d'autres espèces d'oiseaux à la faveur d'une circulation de souches faiblement pathogènes ; il est donc nécessaire de renforcer la surveillance dans cette population.

Los biomas de Pantanal y Cerrado, situados en el estado de Mato Grosso, albergan espacios frecuentados por aves migratorias en los municipios de Cáceres y Araguaiana, respectivamente. Debido a la falta de estudios al respecto, se desconocen los niveles de actividad de los virus de la influenza aviar (IA) y de la enfermedad de Newcastle (EN) en las aves de corral caseras de estas zonas. Teniendo en cuenta el riesgo de introducción en el Brasil de la IA y la EN por conducto de aves migratorias, así como la importancia de una vigilancia activa para la detección y prevención de enfermedades con fines de control oficial, para los veterinarios de los servicios públicos resulta más rápido, práctico y barato vigilar esas poblaciones de aves de corral. Los autores describen un estudio encaminado a comprobar, en los años 2016 y 2019, la actividad de los virus de la IA y la EN en bandadas caseras de aves de corral criadas cerca de los antedichos espacios de aves migratorias. Tras obtener muestras séricas e hisopados cloacales y traqueales de pollos, pavos, codornices, patos y gansos, se analizaron las muestras con técnicas de diagnóstico indirecto (ensayo inmunoenzimático y prueba de inhibición de la hemaglutinación) y de detección directa de secuencias víricas (retrotranscripción acoplada a reacción en cadena de la polimerasa cuantitativa en tiempo real: qRT-PCR). No se detectó ninguna muestra positiva por qRT-PCR. En cuanto a las tasas de seropositividad para la IA y la EN, en Araguaiana resultaron positivas el 0,7% y el 19,6%, respectivamente, de las aves analizadas en 2016, por un 0,5% y un 17,2% en 2019, mientras que en Cáceres lo fueron el 0,8% y el 32,3% en 2016 y el 7,0% y el 38,1% en 2019. En 2019 se identificaron en Cáceres anticuerpos correspondientes a los subtipos H1, H4, H6 y H14 del virus de la influenza aviar. El análisis espacial puso de relieve una aglomeración de fincas con aves de corral seropositivas en la zona urbana de Cáceres, hecho indicativo de que en la zona hay actividad de los virus de la IA y la EN. El estudio no evidenció circulación alguna de los subtipos H5 y H7 del virus de la IA, que son de declaración obligatoria, ni del virus de la EN en las aves de corral caseras criadas en los alrededores de los espacios del estado de Mato Grosso que albergan aves migratorias. Los resultados del estudio parecen avalar los datos que indican que la circulación de cepas poco patógenas en zonas urbanas hace de las bandadas caseras una posible fuente de infección para otras aves, razón por cual es tanto más necesario redoblar la vigilancia de estas poblaciones de aves de corral.

Rosette-forming glioneural tumor in the tectal plate: Endoscopic diagnosis and conservative management.

We present the case of a 29 year-old male with a tumor involving the mesencephalic tectum with associated hydrocephalus. Third ventriculocisternostomy was performed along with endoscopic biopsy; this provided adequate sampling of the tumor and enabled diagnosis of rosette-forming glioneural tumor (RGNT). The patient was followed for 48 months without progression of the disease. We review the features of the previous eight cases described in the literature and discuss the advantages of a minimally invasive approach and conservative management.

De novo hepatocellular carcinoma post-multivisceral transplantation in a child.

De novo hepatocellular carcinoma (HCC) post-transplantation in patients without viral hepatitis is extremely rare, with only three reported adult cases in the English literature. Here, we present a case of de novo HCC that developed in a 7-year-old female, who at 8 months of age received a liver, small bowel, spleen, and pancreas transplantation 6.5 years ago for gastroschisis and total parenteral nutrition (TPN)-related cirrhosis. The post-transplant course was complicated by Epstein-Barr virus (EBV) infection, post-transplant lymphoproliferative disease, and subsequent development of multifocal EBV-associated post-transplant smooth muscle tumors (EBV-PTSMT) in the small bowel 1 year and 10 months after transplantation, respectively. This was managed by reducing immunosuppression with rituximab and EBV-specific cytotoxic T-cell therapy. She was noted to have a new lesion in her transplanted liver graft 6.5 years post-transplantation that was diagnosed as HCC. The HCC was resected, and the patient remained clinically stable for 7 months. At that time, recurrence of the HCC was discovered on MRI. She passed away 6 months after. To the best of our knowledge, this is the first reported occurrence of de novo HCC post-transplantation in the pediatric population that is unrelated to viral hepatitis in either recipient or donor.

Effect of neoadjuvant chemotherapy on resectability of stage III and IV hepatoblastoma.

BACKGROUND: The potential for surgical resection of primary hepatoblastoma tumours was assessed at diagnosis, and after two and four cycles of neoadjuvant chemotherapy. METHODS: Available radiographic images for patients with stage III and IV hepatoblastoma diagnosed between 1991 and 2008 were reviewed. The extent of disease was determined at diagnosis using the PRETEXT staging system, and after two and four cycles of therapy by POST-TEXT staging. Tumour resectability based on radiographic studies was assessed independently by two surgeons with expertise in hepatic surgery who were blinded to treatment and clinical outcome. RESULTS: Radiographic images from 20 patients with hepatoblastoma were reviewed. Six of 20 tumours were downstaged after two cycles, and three additional tumours were downstaged following four cycles. All PRETEXT stage III and IV tumours were determined to be surgically unresectable at diagnosis. The number of tumours considered unresectable decreased from 16 of 20 at diagnosis to seven of 20 after two cycles, and to four of 20 after four cycles. Five of the seven tumours that were unresectable after two cycles, and all four tumours that were unresectable after four cycles would have qualified for liver transplant based on radiographic studies. CONCLUSION: The majority of stage III and IV hepatoblastomas achieved radiographic resectability after two cycles of chemotherapy. There may be an opportunity for earlier surgical intervention and potential for a reduction in chemotherapy in a considerable number of patients.

Radiological features of Gorham's disease.

AIM: To describe the key findings on plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) of Gorham's disease. MATERIALS AND METHODS: Eight children diagnosed with Gorham's disease between 1999 and 2009 were included. All imaging studies performed on each patient were reviewed with special attention to the extent of bone, soft tissue, and visceral involvement. RESULTS: All patients had bone lesions at diagnosis, most commonly in the vertebrae. CT showed generalized osteopenia, multiple lytic lesions, and heterogeneous bone density. MRI demonstrated altered signal intensity in bone marrow that was hyperintense on T1 imaging. Seven patients had soft-tissue lymphangiomatous lesions adjacent to identified osseous lesions. Four patients had chylous pleural effusions: three with bilateral and one with unilateral involvement. The spleen was involved in six patients. CONCLUSION: Splenic lesions and soft-tissue involvement are common in patients with Gorham's disease. The presence of extra-osseous lesions along with characteristic bone lesions on plain radiography may be pathognomonic of Gorham's disease.

Vitamin D receptor gene polymorphisms and sex steroid secretion in girls with precocious pubarche in Southern Brazil: A pilot study.

BACKGROUND: Evidence suggests that precocious pubarche (PP) girls may have higher risk of developing polycystic ovary syndrome (PCOS) at later ages. Vitamin D receptor (VDR) gene polymorphisms have been implicated in the risk of diabetes and PCOS, but little is known about the role of VDR in PP. AIM: To assess the frequencies of VDR gene ApaI, TaqI, BsmI, and FokI polymorphisms and to determine whether these variants are associated with sex hormone concentrations in patients with PP and controls from southern Brazil. SUBJECTS AND METHODS: Blood was collected from 36 girls with PP and 197 controls for genotyping of BsmI and FokI polymorphisms using real-time PCR and of ApaI e TaqI polymorphisms using restriction fragment length polymorphism. Hormone levels were also determined. RESULTS: Genotype GG of the ApaI single nucleotide polymorphism (SNP) was more frequent in PP (30.6%) than in controls (16.2%) [odds ratio (OR): 2.269; confidence interval 95% (95%CI): 1.015-5.076; p=0.042]. This genotype was also associated with lower estradiol [35.30 (14.80-50.48) pg/ml vs 12.22 (6.49-23.69) pg/ml; p=0.025] and total testosterone levels (0.52 (0.39-0.84) ng/ml vs 0.20 (0.11-0.47) ng/ml; p=0.005) as compared with the TT + TG genotypes in girls with PP. The distribution of TaqI, BsmI, and Fokl SNP was similar in PP and controls, and no association was found between these polymorphisms and sex steroid levels. CONCLUSIONS: The ApaI SNP of the VDR gene was associated with PP in the studied population and may modulate ovarian steroid secretion in these girls.

Vitamin D receptor gene polymorphisms and sex steroid secretion in girls with precocious pubarche in Southern Brazil: a pilot study.

BACKGROUND: Evidence suggests that precocious pubarche (PP) girls may have higher risk of developing polycystic ovary syndrome (PCOS) at later ages. Vitamin D receptor (VDR) gene polymorphisms have been implicated in the risk of diabetes and PCOS, but little is known about the role of VDR in PP. AIM: To assess the frequencies of VDR gene ApaI, TaqI, BsmI, and FokI polymorphisms and to determine whether these variants are associated with sex hormone concentrations in patients with PP and controls from southern Brazil. SUBJECTS AND METHODS: Blood was collected from 36 girls with PP and 197 controls for genotyping of BsmI and FokI polymorphisms using real-time PCR and of ApaI e TaqI polymorphisms using restriction fragment length polymorphism. Hormone levels were also determined. RESULTS: Genotype GG of the ApaI single nucleotide polymorphism (SNP) was more frequent in PP (30.6%) than in controls (16.2%) [odds ratio (OR): 2.269; confidence interval 95% (95%CI): 1.015-5.076; p=0.042]. This genotype was also associated with lower estradiol [35.30 (14.80-50.48) pg/ml vs 12.22 (6.49-23.69) pg/ml; p=0.025] and total testosterone levels (0.52 (0.39-0.84) ng/ml vs 0.20 (0.11-0.47) ng/ml; p=0.005) as compared with the TT + TG genotypes in girls with PP. The distribution of TaqI, BsmI, and Fokl SNP was similar in PP and controls, and no association was found between these polymorphisms and sex steroid levels. CONCLUSIONS: The ApaI SNP of the VDR gene was associated with PP in the studied population and may modulate ovarian steroid secretion in these girls.

Illustration of the impact of antiplatelet drugs on the genesis and management of chronic subdural hematoma.

The case of a 76-year-old male with a large chronic subdural hematoma that showed total regression with the mere suspension of aspirin, its only apparent causal factor, and that of an 81 year-old male on aspirin and clopidogrel with a chronic subdural hematoma who succumbed after burr holes due to two simultaneous severe hemorrhagic complications (cerebellar hemorrhage and ipsilateral acute subdural hematoma) are presented. The cases may provide support for the following management strategies: (i) if conservative management and drug suspension are feasible, they may well be worth trying and lead to a favorable outcome; (ii) if a patient is at risk of developing a chronic subdural hematoma, namely because of a minor acute subdural hematoma, withdrawal of antiplatelet agents should be considered; (iii) if surgery is necessary, its delay allows for the metabolization of the drug and platelet renewal, thereby minimizing the risk of hemorrhage; (iv) if urgent burr holes are indicated, measures to improve platelet function should be undertaken.

Spine trauma due to diving: main features and short-term neurological outcome.

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The aim of this study is to examine the main features and short-term neurological outcomes associated with injuries to the spine due to diving into water in a Latin American country. SETTING: Salvador, Brazil. PATIENT SAMPLE: A total of 1324 subjects were admitted with spinal trauma between 1991 and 2006 (inclusive). Subjects aged between 14 and 65 years who sustained diving injuries corresponded to 10.6% (N=140) of the cases. OUTCOME MEASURES: Neurological status was determined by the Frankel Functional Scale (FFS) on admission and discharge. The FFS was secondarily converted to the American Spinal Injury Association impairment scale. METHODS: This study is a patient record database review that examines demographic and injury-related characteristics, details of hospital treatment and neurological status at the time of discharge. RESULTS: Males (N=129) outnumbered females (N=11) in a proportion of 12:1 (mean age: 28.62 years). The cervical spine region was the most affected area (92.1%) and 45% of the cases presented with tetraplegia. On admission, neurologically complete lesions accounted for 32.1% of the overall cases and 45.7% were neurologically intact. The mean length of stay (7.7 weeks) did not differ with regard to treatment option (P=0.83). During hospitalization, patients with incomplete neurological impairment had shorter lengths of stay and showed more neurological improvement than those with complete lesions (P=0.26 and 64.5 versus 2.2%, P<0.0001). CONCLUSION: Diving spine injuries have a high tetraplegia rate. Neurological recovery and shorter length of stay are associated with incomplete lesions.

Unexpected angiographic and visual findings after clipping of a carotid-ophthalmic aneurysm.

A 56-year-old woman underwent surgery for a ruptured carotid-ophthalmic artery aneurysm. Intraoperative visual inspection confirmed that the ophthalmic artery was left intact. She had no light perception on the operated side right after surgery. Angiography one week after surgery confirmed exclusion of the aneurysm, no filling of the proximal portion of the ophthalmic artery, and a very faint filling of its distal orbital part. She gradually recovered from this deficit and 9 months after surgery she is capable of counting fingers. At this time angiography displayed filling of all the portions of the ophthalmic artery, absence of recruitment of collateral blood supply, and exclusion of the aneurysm as before. Surgical manipulation seems to either have induced vasospasm or thrombosis of the ophthalmic artery. Regression of vasospasm or secondary recanalization of the thrombus without development of collateral blood supply may account for the gradual improvement of vision. A risk of monocular blindness is associated with the surgical treatment of para-clinoid aneurysms. Nevertheless, when it occurs, a perspective of recovery may exist if certain etiologies are involved.

Unexpected angiographic and visual findings after clipping of a carotid-ophthalmic aneurysm

A 56-year-old woman underwent surgery for a rupturedcarotid-ophthalmic artery aneurysm. Intraoperativevisual inspection confirmed that the ophthalmicartery was left intact. She had no light perception on theoperated side right after surgery. Angiography one weekafter surgery confirmed exclusion of the aneurysm, nofilling of the proximal portion of the ophthalmic artery,and a very faint filling of its distal orbital part. She graduallyrecovered from this deficit and 9 months aftersurgery she is capable of counting fingers. At this timeangiography displayed filling of all the portions of theophthalmic artery, absence of recruitment of collateralblood supply, and exclusion of the aneurysm as before.Surgical manipulation seems to either have inducedvasospasm or thrombosis of the ophthalmic artery.Regression of vasospasm or secondary recanalizationof the thrombus without development of collateralblood supply may account for the gradual improvementof vision. A risk of monocular blindness is associatedwith the surgical treatment of para-clinoid aneurysms.Nevertheless, when it occurs, a perspective of recoverymay exist if certain etiologies are involved (AU)

Una mujer de 56 años fue intervenida de un aneurismacarotido-oftálmico roto. La inspección visualintraoperatoria confirmaba que la arteria oftálmicaestaba intacta. Tras la cirugía la paciente no percibía luzpor dicho ojo y la angiografía una semana después de lacirugía confirmó la exclusión del aneurisma, con falta derelleno de la porción proximal de la arteria oftálmica, yun relleno muy débil de la porción orbitaria distal. Lapaciente se fue recuperando progresivamente del déficity 9 meses después de la cirugía es capaz de contar dedos.La angiografía actual demuestra un relleno de todas lasporciones de la arteria oftálmica, con ausencia de circulacióncolateral, y exclusión del aneurisma. La manipulaciónquirúrgica parece haber inducido vasoespasmoo trombosis de la arteria oftálmica. La regresión delvasoespasmo o la recanalización secundaria del trombosin desarrollo de circulación colateral pueden justificarla mejoría gradual de la visión. Hay un riesgo de amaurosisunilateral asociado al tratamiento quirúrgico delos aneurismas paraclinoideos, aunque existe posibilidadde mejoría en algunos casos (AU)

Giant cell glioblastoma: review of the literature and illustrated case.

Giant cell glioblastoma is an infrequent variety of glioblastoma (5% of the cases). It has deserved a separate category in the World Health Organization classification of grade IV tumors. The clinical, imaging, histological and immunohistochemical characteristics, and the genetic alterations are reviewed. Treatment and prognosis are discussed and updated. The case of a patient that survived 19 months and died of spinal leptomeningeal metastases is illustrated.

Giant cell glioblastoma: review of the literature and illustrated case

El glioblastoma de células gigantes es una variante rara dentro de los glioblastomas (5% delos casos). En la clasificación de la Organización Mundial de la Salud esta entidad ha merecido una categoría aparte en los tumores de grado IV. Se revisan las características clínicas, radiológicas, histológicas, inmunohistoquímicas y las alteraciones genéticas que caracterizan este tumor. El tratamiento y el pronóstico son discutidos aportando información actualizada. Finalmente se presenta un caso clínico ilustrado, en el cual el paciente sobrevivió durante 19 meses, falleciendo como consecuencia de una diseminación espinal leptomeníngea

Giant cell glioblastoma is an infrequent variety of glioblastoma (5% of the cases). It has deserved a separate category in the World Health Organization classification of grade IV tumors. The clinical, imaging, histological and immunohistochemical characteristics, and the genetic alterations are reviewed. Treatment and prognosis are discussed and updated. The case of a patient that survived 19 months and died of spinal leptomeningeal metastases is illustrated

Histologically malignant solitary fibrous tumor of the orbit.

An intra-conical histologically malignant solitary fibrous tumor of the orbit presented in a 28 year-old female with intact vision and exophthalmos. Total resection was achieved by means of a frontal craniotomy and orbital roof osteotomy. Evidence of a beneficial role for adjuvant treatments in this particular tumor is controversial and vision impairment is a possible side effect. Therefore they were not employed. The patient is well after two years of follow-up.

Cavernous malformation of the trigeminal nerve.

A cavernous malformation involving the Gasserian ganglion, 2nd and 3rd divisions of the trigeminal nerve on the left side was resected via an extradural route in a 54 year old male. Cavernous malformations of the cranial nerves are rare. Specific origin from the trigeminal nerve has not been previously reported.

Analysis of the influence of the variable size on the characteristics and behavior of meningiomas.

Seventy-two patients submitted to meningioma surgery at Pedro Hispano Hospital from 1997 to 2001 were reviewed to analyze the association between size (largest diameter of the lesion obtained from imaging examinations) and other variables regarding the biological behavior and clinical outcome of these patients. Statistically significant associations were found between tumor size and location, type of first symptom, type of physical examination, histological grade, surgical complications, postoperative CSF bursae and the need for blood transfusion. Patient's age, gender, duration of first symptom, clinical status at discharge and persistent complaints were not associated to tumor size. There was a trend towards a statistically significant association between tumor size and both grade of resection and persistent deficits. The causes and implications of the findings are discussed. Tumor size is a parameter that may interfere with the neurosurgeon's capacity to treat these patients as well as with their recovery.

Analysis of the influence of the variable size on the characteristics and behavior of meningiomas

Se han revisado setenta y dos enfermos sometidos a cirugía de meningioma en el Hospital Pedro Hispano entre 1997 y 2001, para evaluar la asociación entre el tamaño (mayor diámetro de la lesión obtenido a partir de los exámenes de imagen) y otras variables concernientes a la caracterización y comportamiento de la lesión. Se han encontrado asociaciones, con significación estadística, con la localización, tipo de primer síntoma, tipo de examen físico, grado histológico, aparición de complicaciones, bolsas de LCR y transfusiones de sangre. La edad, el sexo, la duración de primer síntoma, el estado al alta hospitalaria y los síntomas persistentes no se relacionan con el tamaño. Se encontró alguna relación con el tipo de exéresis y señales persistentes. Se discuten las causas e implicaciones de los hallazgos. El tamaño es un parámetro que puede interferir en la capacidad del neurocirujano para tratar estos pacientes y en la capacidad de recuperación de los mismos

Seventy-two patients submitted to meningioma surgery at Pedro Hispano Hospital from 1997 to 2001 were reviewed to analyze the association between size (largest diameter of the lesion obtained from imaging examinations) and other variables regarding the biological behavior and clinical outcome of these patients. Statistically significant associations were found between tumor size and location, type of first symptom, type of physical examination, histological grade, surgical complications, postoperative CSF bursae and the need for blood transfusion. Patient’s age, gender, duration of first symptom, clinical status at discharge and persistent complaints were not associated to tumor size. There was a trend towards a statistically significant association between tumor size and both grade of resection and persistent deficits. The causes and implications of the findings are discussed. Tumor size is a parameter that may interfere with the neurosurgeon’s capacity to treat these patients as well as with their recovery