Doing more with less: surgical results of pediatric posterior fossa tumors from a single center in Latin America.

OBJECTIVE: We aim to report the epidemiology, surgical outcomes, and survival rates of pediatric patients with posterior fossa tumors in a large single-center case series. METHODS: A retrospective analysis was conducted on pediatric patients who underwent surgical treatment for posterior fossa tumors between January 2011 and January 2019. RESULTS: A total of 135 pediatric patients, with an average age of 7.5 years at diagnosis and a mean follow-up of 35.7 months, were included in the study. Most tumors were located within the midline, with ventriculomegaly observed in 71.4% of the patients. Pilocytic astrocytomas encompassed the majority of tumors (34.1%), followed by medulloblastomas (27.4%) and ependymomas (11.8%). Gross total resection (GTR) was achieved in 71.8% of the patients, with a recurrence rate of 20%. Surgical complications were observed in 25.9% of the patients. GTR significantly impacted 5-year overall survival (OS) and 4-year progression-free survival (PFS) in patients with posterior fossa tumors. Patients who underwent GTR had a 5-year OS of 89.7%, compared to 72.7% for near-total resection and 70.8% for subtotal resection. The 4-year PFS for patients who underwent GTR was 82.5%, whereas it was 63.6% for patients who underwent near-total resection and 54.2% for patients who underwent subtotal resection. CONCLUSION: Surgical resection remains the main treatment for pediatric posterior fossa tumors, and higher resection rates are linked to better survival outcomes. Despite limited resources for molecular diagnosis, our institution has demonstrated that a specialized neurooncological center with a high surgical volume can still achieve favorable survival outcomes for these patients.

Posterior fossa decompression with duraplasty in Chiari surgery: A technical note / Descompressão de fossa posterior com duroplastia no tratamento cirúrgico do Chiari: nota técnica

Summary Chiari malformation (CM) is the most common and prevalent symptomatic congenital craniocervical malformation. Radiological diagnosis is established when the cerebellar tonsils are located 5 mm or more below the level of the foramen magnum on magnetic resonance imaging (MRI). Surgical treatment is indicated whenever there is symptomatic tonsillar herniation or syringomyelia/hydrocephalus. The main surgical treatment for CM without craniocervical instability (such as atlantoaxial luxation) is posterior fossa decompression, with or without duraplasty. The authors describe in details and in a stepwise fashion the surgical approach of patients with CM as performed at the State University of Campinas, emphasizing technical nuances for minimizing the risks of the procedure and potentially improving patient outcome.

Resumo A malformação de Chiari (MC) é a malformação craniocervical congênita sintomática mais comum e prevalente. O diagnóstico radiológico é definido quando as tonsilas cerebelares estão localizadas pelo menos 5 mm abaixo do nível do forame magno na ressonância magnética (RM). Quando há hérnia tonsilar sintomática, siringomielia ou hidrocefalia, o tratamento cirúrgico é indicado. O principal tratamento cirúrgico para MC sem instabilidade craniocervical (como a luxação atlantoaxial) é a descompressão da fossa posterior com ou sem duroplastia. Os autores descrevem detalhadamente a abordagem cirúrgica de pacientes com MC realizada na Universidade Estadual de Campinas, enfatizando nuances técnicas para minimizar os riscos relacionados ao procedimento e melhorar os resultados pós-operatórios.

Immediate intra and post-surgery complications of the orthotopic liver transplantation in pigs

Objective: to analyze immediate organic modifications and complications subsequent to orthotopic liver transplantation in pigs. Method: fourteen female pigs, specie Sus domesticus, were utilized in this study, with body mass between 5 and 8 Kg, considering that we evaluated the main immediate intra and post-surgery complications of the liver transplantation. Results: in the donor, we highlighted as the main complication the occurrence of bleedings, considering that this was observed in all procedures. In addition, such situation occurred during surgery involving the receptor, in which the bleeding was also perceived as the most frequent complication. However, it is valid to highlight that the hemodynamic instability was present in 5 procedures involving the receptor. Conclusion: among trans surgery complications we may cite: difficulty of oro-tracheal intubation, intra surgery hemorrhages, hemodynamic and respiratory instability and anesthetic complications. In the immediate post-surgery, thus, we observed as the most frequent complications: hemodynamic instability and small anastomotic bleedings

Objetivo: analisar as modificações orgânicas e complicações imediatas subseqüentes ao transplante hepático ortotópico em suínos. Método: foram utilizados no estudo, 14 porcos fêmeas espécie Sus domesticus, com massa corporal entre 5 e 8 Kg, sendo que avaliou-se as principais complicações intra e pós-operatórias imediatas no transplante hepático. Resultados: no doador, destacou-se a ocorrência de sangramentos como principal complicação, tendo em vista que esta foi observada em todos os procedimentos. Tal situação também ocorreu no ato cirúrgico envolvendo o receptor, no qual se percebeu o sangramento como a complicação, também, mais freqüente. Entretanto é valido destacar a instabilidade hemodinâmica, que esteve presente em 5 procedimentos envolvendo o receptor. Conclusão: dentre as complicações trans operatórias podem ser citadas: dificuldade de intubação oro-traqueal, hemorragias intra operatórias, instabilidade hemodinâmica e respiratória e complicações anestésicas. Já no pós-operatório imediato observamos como complicações mais frequentes: instabilidade hemodinâmica e pequenos sangramentos anastomóticos.