Plasmocytoma of C1 in a child. Case report.

BACKGROUND AND AIM: Vertebral involvement is a common occurrence in myelomas, but isolated involvement of the high cervical spine is exceptionally rare. This factor, together with the pediatric age of our patient, makes this case the first report of a plasmocytoma involving C1. CASE REPORT: A 14-year-old boy, without neurological involvement, presented with cervical pain and a palpable posterior neck mass. Cervical spine radiographs showed an osteolytic lesion at C1 compressing the cervical spinal canal and instability of the craniocervical junction. After a complete study, the patient was diagnosed with solitary plasmocytoma. A sequential treatment was instituted that consisted of radiotherapy after craniocervical junction stabilization with an halo-jacket, followed by occipitocervical stabilization with instrumented arthrodesis that was accompanied by resection of the residual C1 tumor and, finally, with consolidation of the oncological treatment with further radiotherapy. CONCLUSION: The treatment of choice for a cervical solitary plasmocytoma consists of a combination of chemotherapy, corticosteroids, radiotherapy, and immunotherapy, but the main neurosurgical problem is the craniocervical instability as occurred in other tumor of the cervical column.

[Combined anterior-posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case report and review of literature]. / Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa. Caso clínico y revisión de la literatura.

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateral-mass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome.

Supraorbital trans-eyebrow craniotomy and fluorescence-guided resection of fronto-basal high grade gliomas.

OBJECT: To determine the effectiveness of fluorescence-guided resection of fronto-basal high grade gliomas by using the supraorbital trans-eyebrow craniotomy. METHODS: We present a single-institution experience of 6 consecutive patients presenting high grade brain glioma located on the fronto-basal area that were operated through a supraorbital trans-eyebrow craniotomy. Previous to surgery all patients were administered 20mg/kg of 5 aminolevulic acid so microscopic fluorescence-guided resection could be accomplished. Tumors were located on gyrus rectus (3 patients), medial orbital gyrus (2 patients), and anterior orbital gyrus (1 patient). RESULTS: Despite the narrow surgical corridor, fluorescence was useful in all cases. Fluorescence-guided resection allowed inclusion into the margins of resection of areas previously considered as normal under white light. Complete resection was obtained in 5 patients. No neurological postoperative new deficit was observed in this series. All six cases corresponded to glioblastoma. Only one case of superficial infection with delayed wound healing was reported as complication. All patients expressed a high level of satisfaction related to cosmetic result. CONCLUSIONS: Fluorescence-guided resection of fronto-basal high grade gliomas can be successfully achieved through supraorbital trans-eyebrow craniotomy. Benefits of supraorbital craniotomy in the management of fronto-basal high grade gliomas as well as usefulness of fluorescence-guided resection through a very narrow corridor are exposed.

[Pediatric craniopharyngioma: long-term results in 61 cases]. / Craniofaringioma pediatrico: risultati a lungo termine in 61 casi.

AIM: The aim of this study was to analyze the long-term results of the surgical management of craniopharyngioma in children by reviewing a series of patients consecutively treated in a single institution, and to assess the efficacy of intratumoral chemotherapy with interferon-alpha. METHODS: Sixty-one paediatric patients (38 males and 23 females; mean age: 8 years) have been surgically treated in the last 20 years. The goal of surgery was to remove the tumour as much as possible. Postoperative radiotherapy was administered only to children aged more than 4 year old and with postsurgical evolutive remnant. Three patients were treated with intratumoral administration of interferon-alpha. The mean follow-up is 8.4 years (median: 7 years). RESULTS: All the 55 surviving patients enjoy a normal social life, except for 3 of them (visual and/or neurological deficits); endocrine function, compromised in 3/5 of cases, is managed by chronic hormone replacement; neuropsychological assessment is satisfactory in almost all the cases. Although obesity does not seem to be an important social limit, it represents a real management problem. Interferon-a was useful in transitorily arresting the growing cystic craniopharyngiomas. CONCLUSION: The current experience confirms the still remarkable challenges in the treatment of craniopharyngioma in childhood. Surgery should aim not only at removing the tumour, but also at preserving the late neuro-endocrinological functions. Intracystic chemotherapy with interferon-alpha might represent an effective option to postpone the surgical operation until the maturation of the hypothalamic-hypophyseal pathway is completed. However, it can not replace the traditional surgical management.