Recurrent meningitis and persistence of craniopharyngeal canal: case report.

OBJECTS: Craniopharyngeal Canal is a rare malformation of the sphenoid bone described in up to 0.42% of the asymptomatic population. It's been related to the development of the Rathke's pouch during embrionary period although some authors think it's a vestige of a former vascular channel. METHODS: This report details a case of a four and a half years old child that developed recurrent meningitis associated with this anomaly. Its origin, clinical manifestations and treatment options are discussed. CONCLUSION: Due to its low incidence and diagnostic difficulties, a high suspicion index is required while studying a case of recurrent meningitis or CSF leakage. Surgical approach is still controversial.

Recurrent meningitis and persistence of craniopharyngeal canal: case report

Objects. Craniopharyngeal Canal is a rare malformationof the sphenoid bone described in up to 0.42%of the asymptomatic population. It’s been related to thedevelopment of the Rathke’s pouch during embrionaryperiod although some authors think it’s a vestige of aformer vascular channel.Methods. This report details a case of a four and ahalf years old child that developed recurrent meningitisassociated with this anomaly. Its origin, clinical manifestationsand treatment options are discussed.Conclusion. Due to its low incidence and diagnosticdifficulties, a high suspicion index is required whilestudying a case of recurrent meningitis or CSF leakage.Surgical approach is still controversial (AU)

Objetivos. El Canal Craneofaríngeo es una raramalformación del esfenoides que ha sido descrito hastaen el 0,42% de la población asintomática. Se le ha relacionadocon la formación de la Bolsa de Rathke duranteel desarrollo embrionario aunque existen autores queopinan que se trata de un vestigio de un canal vascularprimitivo.Métodos. Presentamos el caso de un niño de cuatroaños y medio que desarrolló un cuadro de meningitisde repetición asociado a esta anomalía. Revisamos laliteratura para discutir su formación, manifestacionesclínicas y opciones de tratamiento.Conclusión. Dada su baja incidencia y las dificultadesdiagnósticas es necesario un alto índice de sospecha durante el estudio de un caso de meningitis de repeticióno fístula espontánea de líquido cefalorraquídeo.Existe una gran controversia en lo referente al abordajequirúrgico idóneo (AU)

[Immunotherapy in high grade astrocytomas: principles and current state]. / Immunoterapia en astrocitomas de alto grado: principios y estado actual

It is generally accepted that tumour development promotes a systemic response leading to protect the host against cancer. However, tumours may as well elicit a partial immunodeficiency to avoid the development of a complete and active immune response. Since Bloom's first studies on immunotherapy to treat high grade gliomas in 1960, many attempts have been made from different medical specialties to use the immune system as a weapon against a great diversity of cancers. Main objective of this study is to outline the basic features of the immune response inside the Central Nervous System, the strategies employed by astrocytic tumours to evade body defences, and to provide an extended literature review on research on immunotherapy, especially concerning its patho-physiology and the clinical results achieved till date.

Inmunoterapia en astrocitomas de alto grado: principios y estado actual / Immunotherapy in high grade astrocytomas: principles and current state

Desde hace tiempo se conoce que la presencia de un tumor origina en el organismo una reacción del sistema inmune enfocada a eliminar la amenaza que el desarrollo tumoral implica. Sin embargo, se van averiguando diferentes mecanismos por los cuales los tumores provocan un estado de inmunosupresión que dificulta el desarrollo de una reacción inmunitaria eficaz. La utilización del sistema inmune como arma frente a los astrocitomas de alto grado constituye una de las principales estrategias de investigación desde los primeros ensayos de Bloom en 1960, siendo hoy en día una práctica habitual en la terapia antineoplásica de múltiples disciplinas médicas. El objetivo de este estudio es describir las características de las reacciones inmunológicas del sistema nervioso central, los mecanismos utilizados por los tumores astrocitarios para despistar las defensas del organismo y las diferentes líneas de investigación llevadas a cabo hasta la fecha, mostrando sus bases fisiopatológicas y los resultados obtenidos, basándonos en una extensa revisión bibliográfica

It is generally accepted that tumour development promotes a systemic response leading to protect the host against cancer. However, tumours may as well elicit a partial immunodeficiency to avoid the development of a complete and active immune response. Since Bloom´s first studies on immunotherapy to treat high grade gliomas in 1960, many attempts have been made from different medical specialties to use the immune system as a weapon against a great diversity of cancers. Main objective of this study is to outline the basic features of the immune response inside the Central Nervous System, the strategies employed by astrocytic tumours to evade body defences, and to provide an extended literature review on research on immunotherapy, especially concerning its patho-physiology and the clinical results achieved till date

[Ruptured aneurysms presenting with subdural hematoma: management without angiography]. / Hematomas subdurales de causa aneurismática: estrategia terapéutica sin angiografía diagnóstica.

INTRODUCTION: Ruptured aneurysms on rare occasions cause subdural hematomas as described in literature. Sudden deterioration and coma is a common feature in those patients and a emergent surgical attitude is prompt required, even without confirmation with angiography. CASE REPORTS: We described three cases with acute subdural hematomas and little or no subarachnoid hemorrhage caused by ruptured aneurisms who presented with rapid neurologic deterioration. Urgent craniotomy and evacuation of the hematoma was performed without previous angiography in the three patients. In two patients the aneurysm was found during surgical exploration and subsequently clipped; in the remaining patient the aneurysm was embolized postoperatively. CONCLUSIONS: The occurrence of a subdural hematoma caused by the rupture of an intracranial aneurysm must be suspected in spontaneous subdural hematomas, especially in association with disproportioned conscious deterioration. All the three patients we report debuted with sudden conscious deterioration. If a ruptured aneurysm causing subdural hematoma is suspected, early surgical intervention is required even if angiography is not available. Severe neurological deficit and uncal herniation might still be reversible if provided decompression can be carried out in promptly. Angiography availability should not postpone surgery. Aneurysm presence should be ruled out whether by surgical exploration or by delayed angiography. Posterior communicating aneurysm are related to formation of subdural hematoma.

Hematomas subdurales de causa aneurismática: estrategia terapéutica sin angiografía diagnóstica / Ruptured aneurysms presenting with subdural hematoma: management without angiography

Introducción. Ocasionalmente, la ruptura de un aneurisma puede producir hemorragias subdurales, tal como se describe en la literatura. Es característica en estos pacientes la presencia de un deterioro neurológico rápido y coma, lo que obliga a realizar una intervención quirúrgica urgente, incluso en ausencia de confirmación angiográfica de la causa de la hemorragia. Casos clínicos. Describimos tres pacientes con hematomas subdurales (HSD) agudos en ausencia de hemorragia subaracnoidea, causados por ruptura de aneurismas y que se presentaron con deterioro neurológico rápido y signos de herniación uncal. En los tres pacientes se realizó una craneotomía urgente con evacuación del hematoma, sin angiografía previa. En dos pacientes se localizó intraoperatoriamente el aneurisma responsable de la hemorragia y se realizó el clipaje del mismo, mientras que en otro paciente el aneurisma se embolizó de forma posquirúrgica. Conclusiones. En los HSD espontáneos debe sospecharse un posible origen aneurismático, especialmente cuando se asocian a un deterioro desproporcionado del nivel de conciencia para el grado de compresión. Ante la sospecha de la ruptura de un aneurisma, es necesario intervenir quirúrgicamente, incluso si no se dispone de forma rápida de la posibilidad de realizar una arteriografía cerebral urgente. Los déficit neurológicos graves y los signos de herniación uncal pueden revertir si se evacua urgentemente el hematoma y se resuelve el efecto compresivo. La localización y el subsiguiente tratamiento del aneurisma pueden realizarse mediante la exploración quirúrgica de los vasos del polígono de Willis o por angiografía cerebral posoperatoria. Los aneurismas de la arteria comunicante posterior se relacionan con la formación de HSD (AU)

Introduction. Ruptured aneurysms on rare occasions cause subdural hematomas as described in literature. Sudden deterioration and coma is a common feature in those patients and a emergent surgical attitude is prompt required, even without confirmation with angiography. Case reports. We described three cases with acute subdural hematomas and little or no subarachnoid hemorrhage caused by ruptured aneurisms who presented with rapid neurologic deterioration. Urgent craniotomy and evacuation of the hematoma was performed without previous angiography in the three patients. In two patients the aneurysm was found during surgical exploration and subsequently clipped; in the remaining patient the aneurysm was embolized postoperatively. Conclusions. The occurrence of a subdural hematoma caused by the rupture of an intracranial aneurysm must be suspected in spontaneous subdural hematomas, especially in association with disproportioned conscious deterioration. All the three patients we report debuted with sudden conscious deterioration. If a ruptured aneurysm causing subdural hematoma is suspected, early surgical intervention is required even if angiography is not available. Severe neurological deficit and uncal herniation might still be reversible if provided decompression can be carried out in promptly. Angiography availability should not postpone surgery. Aneurysm presence should be ruled out whether by surgical exploration or by delayed angiography. Posterior communicating aneurysm are related to formation of subdural hematoma (AU)