[Tumours in the pineal region in the paediatric age. Reports of 23 cases and a review of the literature]. / Tumores de la region pineal en la edad pediatrica. Presentacion de 23 casos y revision de la bibliografia.

INTRODUCTION: Tumours in the pineal region are located at a meeting point of several neurovascular structures that are difficult to reach surgically and for which the possibility of resection is limited; as a result the management of these lesions usually requires associated adjunctive treatment with radiotherapy and/or chemotherapy. PATIENTS AND METHODS: This study is a retrospective analysis of the epidemiological, clinical, neuroimaging and pathological characteristics of 23 patients with tumours in the pineal region who were treated between the years 1997 and 2010 in the Hospital Infantil Niño Jesús. The factors involved in the prognosis of this cohort following surgical or adjunctive treatment are also discussed. RESULTS: Subjects included in the study were 6 girls and 17 boys with ages ranging from 4 months to 18 years. It was found that the initial symptoms in 95% of the patients were signs of acute or subacute hydrocephalus, which required the placement of a ventriculoperitoneal shunt (82%). A histological sample of the tumour tissue was collected in all cases. Biopsy samples were taken in the case of five patients and 18 underwent surgery involving a craniotomy. Germinoma (eight cases) and mature teratoma (one case) were the tumours with the longest survival times; non-germinomatous tumours (three cases), those of the pineal parenchyma (four cases) and gliomas (five cases) presented the highest rates of recurrence and a poorer prognosis. CONCLUSIONS: The study of tumour markers can be used to guide the diagnosis of certain tumours of the pineal region. At present, the recommended procedure involves taking a histological sample of the tumour in order to establish an accurate diagnosis and a specific oncological treatment.

Tratamiento quirúrgico de los quistes aracnoideos sintomáticos en niños / Surgical treatment of symptomatic arachnoid cysts in children

Introducción. Los quistes aracnoideos (QA) deben tratarse quirúrgicamente cuando son sintomáticos. Actualmente persiste todavía la controversia sobre la mejor técnica quirúrgica: derivación cistoperitoneal (CPS) o fenestración del quiste, bien mediante craneotomía o por técnicas endoscópicas. Pacientes y métodos. Se presentan los resultados de una serie de 18 pacientes con edad inferior a los 10 años que se han tratado de QA sintomáticos. 12 pacientes presentaron aumento del perímetro craneal, 4 cefaleas y 2 niños crisis comiciales. La localización ha sido supratentorial en 11 casos y 7 intratentorial. Resultados. En 12 casos el tratamiento realizado ha sido la derivación cistoperitoneal o ventriculoperitoneal. En 5 pacientes se ha realizado tratamiento endoscópico del quiste y en 1 caso desbridamiento mediante craneotomía. De los 18 niños, 7 han precisado una segunda intervención para resolver la clínica, bien por mal funcionamiento valvular o por insuficiencia del tratamiento endoscópico. Como complicaciones se han producido 2 hematomas subdurales, que han precisado tratamiento quirúrgico. No se ha producido mortalidad ni morbilidad. Conclusiones. Los avances en técnicas endoscópicas pueden ser el tratamiento ideal frente al desbridamiento por craneotomía, aunque hay que tener en cuenta el alto porcentaje de no resolución en niños de menos de 15 meses. La CPS soluciona el problema de estos quistes con menor riesgo quirúrgico, pero tiene un alto índice de reintervenciones, además de la dependencia del shunt. En la revisión bibliográfica realizada se comprueba que se publican todavía series tratadas tanto con fenestración del quiste como mediante derivación (AU)

Introduction. When symptomatic, arachnoid cysts (AC) must be treated surgically. The best surgical technique, however, is at the present time still subject to controversy –implantation of a cyst-peritoneal shunt (CPS) or fenestration of the cyst, either by means of a craniotomy or by using endoscopic techniques. Patients and methods. This paper reports the findings from a series of 18 patients under 10 years of age who were treated for symptomatic ACs. An increase in the cranial perimeter was observed in 12 patients, 4 had headaches and 2 children suffered convulsive crises. In 11 cases the location was supratentorial and in 7 it was found to be infratentorial. Results. Treatment involved a cyst-peritoneal or ventriculo peritoneal shunt in 12 cases. Endoscopic treatment of the cyst was carried out in 5 of the patients and in 1 case craniotomy debridement was performed. Seven of the 18 children required a second intervention to resolve the clinical condition, either due to poor valve functioning or because the endoscopic treatment was insufficient. Complications included 2 subdural haematomas, which required surgical treatment. No mortality or morbidity occurred. Conclusions. The progress being accomplished in endoscopic techniques can make them the ideal form of treatment rather than craniotomy debridement techniques, although the high percentage of no-resolution in children below the age of 15 months must be taken into account. CPS solves the problem of these cysts with a lower degree of surgical risk, but it has a high rate of reintervention, as well as the dependence on the shunt. In the review of the literature we carried out it was seen that reports are still published concerning series treated by both cyst fenestration and by means of shunts (AU)

[Surgical treatment of symptomatic arachnoid cysts in children]. / Tratamiento quirúrgico de los quistes aracnoideos sintomáticos en niños.

INTRODUCTION: When symptomatic, arachnoid cysts (AC) must be treated surgically. The best surgical technique, however, is at the present time still subject to controversy -implantation of a cyst-peritoneal shunt (CPS) or fenestration of the cyst, either by means of a craniotomy or by using endoscopic techniques. PATIENTS AND METHODS: This paper reports the findings from a series of 18 patients under 10 years of age who were treated for symptomatic ACs. An increase in the cranial perimeter was observed in 12 patients, 4 had headaches and 2 children suffered convulsive crises. In 11 cases the location was supratentorial and in 7 it was found to be infratentorial. RESULTS: Treatment involved a cyst-peritoneal or ventriculoperitoneal shunt in 12 cases. Endoscopic treatment of the cyst was carried out in 5 of the patients and in 1 case craniotomy debridement was performed. Seven of the 18 children required a second intervention to resolve the clinical condition, either due to poor valve functioning or because the endoscopic treatment was insufficient. Complications included 2 subdural haematomas, which required surgical treatment. No mortality or morbidity occurred. CONCLUSIONS: The progress being accomplished in endoscopic techniques can make them the ideal form of treatment rather than craniotomy debridement techniques, although the high percentage of no-resolution in children below the age of 15 months must be taken into account. CPS solves the problem of these cysts with a lower degree of surgical risk, but it has a high rate of reintervention, as well as the dependence on the shunt. In the review of the literature we carried out it was seen that reports are still published concerning series treated by both cyst fenestration and by means of shunts.

[Lumbar disc disease in adolescents]. / Hernia discal lumbar en adolescentes.

INTRODUCTION: Intervertebral disc herniation is a very common neurosurgical pathology. Most commonly disc disease occurs in adults and series published in children are only few and each reports only few cases. A genetic factor has been considered but in none of our patients there was a family history of disc disease. PATIENTS AND METHODS: We report ten patients with disc herniations in adolescents occurring among 1920 patients operated of herniated discs between 1988 and 1998. These herniations in adolescents were all related to some sport activities, and they occurred in the age range of 12 to 16 years. Symptoms were back pain and lower extremities pains of roots L5 or S1. All were studied with magnetic resonance imaging and in all patients the herniated disc was either in L4 L5 or L5 S1 intervertebral spaces. All disc were subligamental and 81.5% were posterolateral in position. Pathological studies of the herniated discs showed elastic consistency with high water content without degenerative changes. RESULTS: After microscopic removal of the herniated discs pain disappeared and remained so in the follow up. It was not necessary to reoperate in any of these patients and the postoperative follow up was between 2 and 5 years. CONCLUSIONS: Herniated disc disease is very infrequent in adolescents and all recovered completely after surgery, and the localization is posterolateral and subligamental.

Hernia discal lumbar en adolescentes / Lumbar disc disease in adolescents

Introducción. Las hernias discales son una patología habitual dentro de la Neurocirugía, pero la presentación suele producirse en la edad adulta y las series publicadas en niños son pocas y con un número de casos pequeño. Se ha invocado un factor genético, pero en ninguno de nuestros casos existía antecedente familiar de hernia de disco. Pacientes y métodos. Se presentan 10 hernias discales lumbares (HDL) en adolescentes en una serie de 1.920 HDL, que abarca desde 1988 hasta 1998. Todos los casos de la serie se presentaron asociados a la realización de algún tipo de deporte. Las edades estaban comprendidas entre los 12 y los 16 años. La clínica fue un cuadro de dolor lumbar con irradiación por el territorio radicular asociado (L5 o S1). Todos los casos se estudiaron con resonancia magnética y su localización fue, en el 100 por ciento, entre L4-L5 y L5-S1; todas eran hernias subligamentosas y el 81,5 por ciento aparecieron en posición posterolateral. La anatomía patológica demostró una consistencia elástica y alto contenido en agua, sin fenómenos degenerativos. Resultados. En todos los casos desaparecía el cuadro doloroso y se hacían asintomáticas tras la realización de extirpación por el procedimiento de microdisectomía. No se precisó reintervención en ningún caso, y el control postoperatorio fue de entre 2 y 5 años. Conclusiones. La HDL del adolescente es una patología poco frecuente y en todos los casos los resultados fueron buenos después de la intervención quirúrgica. La localización generalmente es subligamentosa posterolateral (AU)

Introduction. Intervertebral disc herniation is a very common neurosurgical pathology. Most commonly disc disease occurs in adults and series published in children are only few and each reports only few cases. A genetic factor has been considered but in none of our patients there was a family history of disc disease. Patients and methods. We report ten patients with disc herniations in adolescents occurring among 1920 patients operated of herniated discs between 1988 and 1998. These herniations in adolescents were all related to some sport activities, and they occurred in the age range of 12 to 16 years. Symptoms were back pain and lower extremities pains of roots L5 or S1. All were studied with magnetic resonance imaging and in all patients the herniated disc was either in L4-L5 or L5-S1 intervertebral spaces. All disc were subligamental and 81.5% were posterolateral in position. Pathological studies of the herniated discs showed elastic consistency with high water content without degenerative changes. Results. After microscopic removal of the herniated discs pain disappeared and remained so in the follow up. It was not necessary to reoperate in any of these patients and the postoperative follow up was between 2 and 5 years. Conclusions. Herniated disc disease is very infrequent in adolescents and all recovered completely after surgery, and the localization is posterolateral and subligamental (AU)

[Treatment of sagital craniosynostosis (scaphocephaly) by means of immediate surgical correction]. / Tratamiento de la craneosinostosis sagital (escafocefalia), por medio de la corrección quirúrgica inmediata.

INTRODUCTION: From 1983 to 1994, a total of 86 patients having scaphocephaly were studied and treated in our Craniofacial Unit. The present study involves 60 patients treated between 1988 and 1994 which were operated upon with the same surgical technique and that which is currently being used in our department. The surgical approach and results are analyzed. CLINICAL MATERIAL AND METHODS: Patients having scaphocephaly represented 47.51% out of the total 181 children having craniosynostosis and craniofacial synostosis during this period. All of the patients were studied with computerized tomography, with 10 of them having continuous monitoring of their intracranial pressure. All children in this series were treated according to a new surgical technique that achieves an "immediate correction" of the malformation. RESULTS: No patient had abnormal neurological findings and intracranial pressure (ICP) was within normal limits in 0 out of 10 patients having continuous ICP monitoring. CONCLUSIONS: The minimal complications and the excellent cosmetic results have resulted in an optimal surgical technique. The importance of an early diagnosis and surgical treatment of sagittal synostosis is emphasized.

[Symptomatic Chiari type-II malformation in the neonatal period: a review of 4 cases]. / Malformación de Chiari tipo II sintomática en periodo neonatal: revisión de cuatro casos.

Four newborn patients with symptomatic Chiari II malformations were studied retrospectively. Clinical manifestations and surgical results are presented. All of these patients had hydrocephalus, which was symptomatic in two patients from the first day of life. Three of them had bradycardia and apnea spells. Two patients had lower cranial nerve palsies. Cranial sonography was the first neuroimaging procedure used and it played an important role during the follow-up period, especially for the study of the hydrocephalus. Two newborns could be studied with Magnetic Resonance Imaging (MRI). It defined the level of the decent of the fossa posterior structures and the associated malformations. All of the patients were treated with surgical repair of the spinal dysraphism, ventricular shunt and decompressive surgery. Two patients died before the age of three months. Two other patients showed better evolution after their two year and four year check-ups, respectively. Bradycardia and apnea spells are features that worsen the prognosis as compared with other manifestations.