Rapid Brainstem Infiltration of a Cerebellar Glioblastoma.

A 79-year-old female complained of a one-month history of imbalance and headache. Brain MRI showed an irregular rim enhancing solid and cystic mass centered in the superomedial left cerebellar hemisphere. Resection of the lesion was recommended; however, the patient opted to undergo the procedure the following month because of the nearby Christmas holidays. When the patient returned 30 days later, a new brain MRI showed an enlargement of the cerebellar mass, extending to the brainstem and infiltrating the left brachium pontis, left posterior aspect of the tegmentum of the pons, and posterolateral medulla oblongata. Subtotal resection was performed without complications, and pathology was compatible with a primary cerebellar glioblastoma negative for IDH1/2 gene mutation. Because of the poor prognosis, the patient and her family members opted for hospice treatment, with the patient dying three weeks later. This case illustrates that cerebellar glioblastoma can rapidly infiltrate the brainstem.

Negative Cultures for Cerebrospinal Fluid Samples taken from the Myelomeningocele Sac on the Day of Repair.

OBJECTIVE: Our goal was to evaluate the intraoperative laboratory analysis of cerebrospinal fluid (CSF) aspirated from the myelomeningocele (MMC) sac prior to the repair to determine if there was bacterial growth in the culture. METHODS: This was a retrospective analysis of the CSF cultures of 45 MMC patients operated on during the years of 2002 to 2013 at the University Pediatric Hospital. Before repairing the defect, the sac area was cleaned and three milliliters of CSF were drawn and sent for analysis for red blood cells, white blood cells, glucose level, protein level, chloride level, gram stain and culture. The CSF sample results were analyzed for irregularities in the values before proceeding with placement of a ventricular shunt. RESULTS: All the CSF samples that were studied had at least 1 abnormal value in their results, even though none grew any pathogens in the cultures analyzed. CONCLUSION: Upon CSF analysis, we found increased levels of CSF protein and other abnormal values in this population; however, none of the cultures grew any pathogens. This finding is an important tool in the evaluation of the possible etiologies of and therapeutic approaches for future shunt problems in this group of patients.

Risk Factors for Developing Hydrocephalus in Neonatal Intraventricular Hemorrhage.

OBJECTIVE: More than 50% of the premature infant survivors of intraventricular hemorrhage (IVH) develop serious neurological sequelae, including progressive posthemorrhagic hydrocephalus (PPHH) requiring a ventriculo-peritoneal (VP) shunt. Little is known about the risk factors associated with the development of PPHH in the neonatal population of Puerto Rico and thus the purpose of this study was to learn more about those risk factors. METHODS: We performed a retrospective analysis on neonates born from 2013 through 2017 who had been diagnosed with IVH. The data extracted included gender, gestational age at birth, birth weight, IVH grade, and whether the child had required a VP shunt. RESULTS: Two hundred and sixty-one survivors of neonatal IVH were included in the study. The overall mortality rate was 19.4%, and the incidence of PPHH was 7.7% (N = 20). The results from the Fisher's exact test for the association between the development of PPHH and the independent variables of gender (p = 0.06), birth weight (p = 0.18), and gestational age (p = 0.21) were not statistically significant. Binomial logistic regression showed that subjects with IVH (grades 3 and 4) were 20 times more likely to exhibit PPHH. CONCLUSION: The incidence of PPHH secondary to IVH was slightly lower in our population compared to such incidence in other populations reported in the literature; however, the overall mortality rate was similar. The only statistically significant associated risk factor for PPHH was the severity of the IVH.

Efficacy of Hydromer-Coated and Antibiotic- Impregnated Shunt Systems in Reducing Early Shunt Infections in the Pediatric Population.

OBJECTIVE: Shunt infection is the most common complication following a Cerebrospinal fluid (CSF) diversion procedure with devastating consequences. This study analyzes the efficacy of different shunt systems in reducing early shunt infections in the pediatric population. METHODS: Retrospective case study analysis of 177 pediatric patients with hydrocephalus de novo shunted using hydromer-coated (HC) shunt systems, antibiotic-impregnated (AI) shunt systems and standard non impregnated shunt systems was performed and compared for the incidence of shunt infection in the early postoperative period. RESULTS: Group A consisted of standard shunt systems with 63 patients, Group B were HC shunt systems with 67 patients and group C consisted of 47 patients with antibiotic-impregnated shunt systems. Mean age in Group A was 1.36 +/- 3.36 years Mean age in Group B was 2.32 +/- 4.69 years. Mean age in Group C: 0.64 +/- 1.70 years. In terms of shunt infections, HC group had 4 shunt infections (6.25%), as compared to the control group, where 7 patients (10.45%) had infections. The AI group had 1 infection (2.13%). When comparing HC systems versus Standard Non-Impregnated There were 3 shunt malfunction in Group A (4.8%), 2 shunt malfunction in group B (3.3%) and 0 shunt malfunction in Group C (0%). CONCLUSION: Hydromer-coated shunt systems and antibiotic-impregnated shunt system represent a superior alternative to standard shunt systems for the reduction of shunt infection in the early post operative period.

Circumferential Stabilization of the Thoracolumbar Junction Via Posterior-Only Approach for the Management of Burst Fractures.

OBJECTIVE: The management of thoracolumbar burst fractures often includes combined anterior/posterior approaches with prolonged operative time and complications. The transpedicular approach offers a posterior only approach with circumferential reconstruction and decompression. We aim to present the experience of a single center in the management of thoracolumbar burst fractures using a posterior-only approach for circumferential stabilization and report on this technique's effectiveness in restoring the alignment of the thoracolumbar junction. METHODS: A case review of the medical records of patients admitted to the adult neurosurgery service (from January 2011 through June 2014) with traumatic non-pathological thoracolumbar burst fractures and subsequently treated with a transpedicular corpectomy (including the placement of an expandable cage) was performed, retrospectively. RESULTS: A total of 20 patients underwent a posterior transpedicular corpectomy consisting of anterior column reconstruction using an expandable cage with supplementary posterior fixation within 72 hours of injury. The average pre-operative canal compromise was 69%. The average pre-operative kyphotic angle was 21.6°. The average post-operative kyphotic angle was 5.15°, with an average correction of 16.45°. There were 11 patients with pre-operative neurological compromises, of which patients, 8 experienced variable degrees of recovery. The average operating time was 410.5 minutes (range, 240-550 min). The average blood loss was 880 mL (range, 650-1500). Three patients experienced complications during surgery; 1 patient died. CONCLUSION: The transpedicular approach for circumferential reconstruction and stabilization provides an alternative technique for the management of thoracolumbar fractures, having an acceptable risk and the associated lower morbidity of a posterioronly approach.

Pediatric brain tumors in Puerto Rico.

OBJECTIVE: To determine the frequency of pediatric brain tumors treated at the University Pediatric Hospital of Puerto Rico over a 6-year period and examine the demographic data and tumor histology of patients in different age groups. METHODS: A retrospective study was undertaken at the University Pediatric Hospital. We included patients with brain tumors that had been newly diagnosed during the period covering from January 2002 to December 2007. All cases were analyzed by age, gender, histologic diagnosis, and affected area. RESULTS: One hundred thirty-six patients were included in the study. Overall, males were more frequently affected than were females. Children in the 1 to 4 years old age group had the highest number of newly diagnosed brain tumors. Regarding anatomic location, supratentorial tumors were more frequent than were infratentorial tumors. The most common single tumor was the pilocytic astrocytoma (WHO grade I), representing 31% of the total pediatric brain tumors. CONCLUSION: Our results provide an objective platform for further epidemiological studies and for the development of local health strategies for the timely diagnosis and treatment of the most common pediatric tumors in Puerto Rico.

Pilomyxoid astrocytoma in unusual location in a child with neurofibromatosis type 1: case report and review of the literature.

Pilomyxoid astrocytoma (PMA) is a recently defined brain tumor believed to be a variant of pilocytic astrocytoma (PA), but with a more aggressive course. Most PMAs occur in the optic-chiasmatic/hypothalamic (OCH) region but they have also been described in the posterior fossa, temporal lobe, and in the spinal cord. We report a girl with history of neurofibromatosis type 1 (NF-1) who presented with a PMA located in the left lateral ventricle. Despite the fact that most of PMAs occur in the hypothalamic region, high awareness should be given to lesions in unusual locations, thus expanding the current epidemiologically known locations for this tumor.

Lesiones y prevención en el snowboard / Injuries and prevention in snowboard

En los últimos años está aumentando la popularidad de este deporte, y por ella se están sucediendo numerosos estudios relacionados con este tema, así como el interés por todo lo concerniente a ello.En este trabajo intentaremos referenciar estudios de diversos autores, acerca de este actual tema. El material ha sido los artículos revisados durante 2003 en las bases de datos Medline, Embase, CINHAL, PEDRO, Cochrane y MANITS . Los métodos se describen más adelante(elección de artículos, criterios debúsqueda...). Los artículos tenían que cumplir los siguientes criterios: - Haber sido publicado en una revista científica. - Estar publicado en lengua inglesa. - El artículo debía ser un ensayo clínico o un estudio con personas; los estudios con animales fueron descartados. Resultados: Las lesiones son muy frecuentes dentro de este deporte, y por ello hay que conocer su mecanismo. Los nuevos practicantes de este deporte, debido a su desconocimiento general sobre los principales aspectos del snowboard, sufren gran cantidad de lesiones.El perfil de lesión ha ido cambiando en los últimos años, debido la introducción de equipamiento nuevo, y a la educación sobre este deporte. Como conclusión, destacar el papel importantísimo de la prevención para evitar posibles lesiones, por ello el uso de los protectores obligatorios están siendo introducidos, así como la educación y el conocimiento de las técnicas de este deporte. Destacar que además del conocimiento de los aspectos básicos y más importantes de este deporte, como la técnica, mecanismo lesional, tampoco hay que olvidarse de aspectos relevantes como la condición psicológica, la nutrición, el tipo de nieve... que pueden influir en gran medida en las posibles lesiones

Recently there is a increasing of popularity of this sport. This is the reason why there are a lot of researches that are studying.The aim of this paper is to analyse researches in the scientific literature about this actual subject. Material were the review of articles during 2003 on Medline, Embase, CINHAL, PEDRO, Cochrane and MANTIS data base. Method will be described after (election of articles, search criteries...). The articles have to reach these chriteries: - Published in scientific review. - Published in English language. - The artic1e have to be a trial clinic or study with humans; studies with animal s were descarted. Results: Injuries are very important in these sports, so is very useful know their injury' s mechanisms, and the profile of this injuries. The new snowboarders, due to their general ignorance on the main aspects of snowboard, undergo great amount of injuries. Conclusions: prevention are very important to prevent posible injuries; so use of binding protectors are being introduced, as well as education and knowledge of techniques To emphasize that in addition to the knowledge of the basic and more important aspects of this sport, like the technique, lesional mechanism, is not either necessary to forget excellent aspects like the psychological condition, the nutrition, the type of snow... that can influence to a great extent in the possible injuries