[Childhood spinal tumours]. / Tumores espinales infantiles

We report a large series of 48 childhood spine tumors diagnosed and treated at our Hospital between 1986 and 2006. Spinal tumors in children are a rare and heterogeneous condition that frequently are diagnosed late because of their uncharacteristic clinical picture. Symptoms are usually limited to diffuse back pain or spinal deformities, prior to leg paresis or sphincter dysfunction. Diagnosis is usually made with MRI or CT. Treatment is surgical in most cases. The prognosis is variable due to the diverse histological findings and it may require the use of complementary treatments as chemotherapy or radiation.

[Brain-stem tumors in children]. / Tumores de tronco cerebral en la población pediátrica.

We report a large series of brain-stem tumors seen during 18 years of at our hospital. We diagnosed and treated a total of 42 patients between 1988 and 2006; 36 of them were operated with partial resection in most cases. Brain-stem tumors constitute a rare condition with very bad prognosis. A surgical complete resection of the mass is not possible in most cases, so the principal surgical objective is reduction and decompression. The best prognosis is seen in patients with low grade tumors with minimal neurologic deficit. Most of these tumors cause death in a short period, usually one year or less.

Cerebral fluid edema: an unusual complication of ventriculoperitoneal shunts.

INTRODUCTION: A case of accumulation of CSF into the brain parenchyma simulating a brain tumor, secondary to an obstructed ventriculoperitoneal shunt, is presented. Until now, only seven cases of this rare complication have been described. CASE REPORT: Magnetic resonance showed an expansive, low-density intracranial lesion on the right frontal and parietal lobe. This mass was biopsied, but no tumor was found and the diagnosis was brain edema. CONCLUSION: The mistake in the diagnosis was due to the clinical symptoms and to the MR images.

Trigeminal neurinomas in infants: report of two cases.

Two cases of trigeminal neurinoma in two infant girls aged 3 and 6 months are reported. Both presented with temporal cranial vault bulging at birth. The 6-month-old patient suffered onset of focal fits 1 month before admission and her neurological examination revealed no abnormalities. The 3-month-old patient had right exophthalmus and a subcutaneous fronto-orbital plexiform neurofibroma at birth. Neurological examination disclosed a sensory deficit of the first trigeminal nerve division. She also had a family medical history of von Reckling-hausen's disease. The incidence of trigeminal neurinomas in children is reviewed. The patients in these two cases are the youngest recorded; the cases are the only ones reported in infants. Clinical, radiological, and therapeutic aspects are discussed.

Injection injury of the sciatic nerve (370 cases).

Injury to peripheral nerves due to injections of therapeutic and other agents is common. The postulated mechanisms of injury include direct needle trauma, secondary constriction by scar, and direct nerve fiber damage by neurotoxic chemicals in the injected agent. Neurological sequelae can range from minor transient sensory disturbance to severe sensory disturbance and paralysis with poor recovery. The recommended treatment has ranged from a conservative approach to immediate operative exposure and irrigation, and has also included early neurolysis or delayed exploration with neurolysis or resection and anastomosis. We present 370 cases of injection injury of the sciatic nerve in children treated during the last 20 years at the Neurosurgical Department of the Hospital La Paz in Madrid, Spain. Pathology, clinical course, treatment, and results are discussed.

Melanotic neuroectodermal tumor of the skull and meninges in infancy.

Three cases of melanotic neuroectodermal tumors of infancy are presented. Two were localized on the midline, involving the skull and extending subdurally. One was located on the inner aspect of the dura and developed intracranially. Two had a benign course following gross total removal. One had a malignant course, recurring locally and spreading within the brain. The difficulties of removing these tumors when they are implanted on the midline are stressed. Histological features of prognostic value are pointed out. Further support for neural crest origin of these tumors is given.

Cryptic arteriovenous malformation of the choroid plexus of the third ventricle.

A patient with a history of subarachnoid hemorrhage is reported. CT scan evidenced a high-density, round lesion in the anterior part of the third ventricle. A full angiographic study demonstrated no vascular malformation. After removal of a circumscribed hematoma in the anterior part of the third ventricle, an arteriovenous malformation of the choroid plexus was excised.

Tumoural antigens on experimental and human glioblastoma.

The fact that glioblastoma multiforme possesses antigens differing from those of normal brain has been stressed in early papers from Scheimberg, Mahaley, Eggers, and Brooks. In our work the presence of specific cytoplasmic and nuclear antigens in neoplastic cells has been demonstrated. These specific antigens are present not only in experimental tumours from the rat, but also in human glioblastoma, and are easily demonstrated by immunodiffusion and immunofluorescence techniques. From our work differences between intracellular and membrane antigens are clear, as the latter do not react with IgG immunoglobulin. On the other hand, tumoural antigens in glioblastoma have similar antigenic qualities to those of histocompatible antigens in normal brain. Experimental and human glioblastomas have weak antigens, as demonstrated by frequent tumour recurrence following amputation and the positive cross-reaction of antibody with normal brain in experimental models. Glioblastoma multiforme may have a common antigen as its antibodies easily cross-react positively with different human tumours with similar, histological features. As tumoural membranes did not react as cytoplasm and nuclei, we cannot say that membrane antigens resemble those of intracellular contents. The fact that viral-induced tumours may have common antigens should point to aetiological possibilities in this group of tumours. Delayed cellular response is very useful during the follow-up of these patients. Positive DNCB and intradermal reactions could be elicited in those patients in whom the antigenic overload has been reduced as a consequence of a surgical procedure. On the other hand, patients with extensive and infiltrating tumoural masses exhibited weak or negative delayed cellular responses. Humoral responses from the patient's sera may not have the prognostic value of cellular responses.

[Ventriculo-atrial vs. cerebral-peritoneal shunts in the treatment of hydrocephalus (author's transl)]. / Estudio comparativo entre las derivaciones ventriculoatriales y ventriculoperitoneales en el tratamiento de las hidrocefalias infantiles.

Results and complications during the first two years after shunting are compared in two groups of 100 consecutively operated hydrocephalus children having either ventriculo-peritoneal or ventriculo-atrial shunt. One of the major reasons for revision of both types of shunts was obstruction at the ventricular end. This accounted for 18 out of 72 atrial shunt revisions and 20 out of 51 peritoneal shunt revisions. Atrial shunts required 21 revisions because of problems with cardiac end and peritoneal shunts required 17 revisions because of problems with peritoneal end. 25 patients with atrial shunt and 12 with peritoneal shunts died to shunt-related complications during first two years of placement. After this comparative study author feels that peritoneal shunt should be first choice in most forms of hydrocephalus in children due to its lower incidence of revision, serious infection and morbidity.

Postoperative ventriculitis in hydrocephalus: treatment with external ventricular drainage.

Twenty hydrocephalic children with postoperative ventriculitis were treated with External Ventricular Drainage after removal of the infected shunt. The advantages and disadvantages of this treatment are discussed.