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1.
Childs Nerv Syst ; 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31950248

RESUMO

Multinodular and vacuolating neuronal tumor (MVNT) is a rare newly identified benign lesion, firstly included in the World Health Organization classification of tumors of the central nervous system in 2016, whose neoplastic or dysplastic nature remains unclear but with a distinctive cytoarchitectural pattern and radiological features. It is usually discovered as late-onset refractory epilepsy, headache related, or an incidental lesion of adulthood. As it is typically a stable disease, many opt for follow-up, as long as it keeps remaining asymptomatic, leaving surgery for refractory epilepsy, neurological deficits, or intracranial hypertension symptoms. A subtotal or complete resection seems to control seizures and neurological manifestations. We herein present the case of a child with refractory epilepsy related to MVNT and focal cortical dysplasia, a dual pathology case in a less frequent age group and without the typical radiological imaging. We report its radiologic features, histologic description, and management, and we present a brief literature review on MVNT focusing on the pediatric cases reported. MVNT should now be another probable low-grade epilepsy-associated lesion (LEAT) in patients of all ages, with a benign and stable course as it constitutes a curable cause of focal epilepsy. As all the refractory cases, surgery should be indicated after a comprehensive evaluation of a multidisciplinary epilepsy surgery team.

2.
Acta Neurochir (Wien) ; 160(12): 2489-2500, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30413938

RESUMO

BACKGROUND: Stereoelectroencephalography (SEEG) is an effective technique to help to locate and to delimit the epileptogenic area and/or to define relationships with functional cortical areas. We intend to describe the surgical technique and verify the accuracy, safety, and effectiveness of robot-assisted SEEG in a newly created SEEG program in a pediatric center. We focus on the technical difficulties encountered at the early stages of this program. METHODS: We prospectively collected SEEG indication, intraoperative events, accuracy calculated by fusion of postoperative CT with preoperative planning, complications, and usefulness of SEEG in terms of answering preimplantation hypothesis. RESULTS: Fourteen patients between the ages of 5 and 18 years old (mean 10 years) with drug-resistant epilepsy were operated on between April 2016 and April 2018. One hundred sixty-four electrodes were implanted in total. The median entry point localization error (EPLE) was 1.57 mm (1-2.25 mm) and the median target point localization error (TPLE) was 1.77 mm (1.2-2.6 mm). We recorded seven intraoperative technical issues. Two patients suffered complications: meningitis without demonstrated germ in one patient and a right frontal hematoma in the other. In all cases, the SEEG was useful for the therapeutic decision-making. CONCLUSION: SEEG has been useful for decision-making in all our pediatric patients. The robotic arm is an accurate tool for the insertion of the deep electrodes. Nevertheless, it is an invasive technique not risk-free and many problems can appear at the beginning of a robotic arm-assisted SEEG program that must be taken into account beforehand.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia/métodos , Complicações Pós-Operatórias/epidemiologia , Robótica/métodos , Técnicas Estereotáxicas/efeitos adversos , Adolescente , Criança , Pré-Escolar , Tomada de Decisão Clínica , Epilepsia Resistente a Medicamentos/diagnóstico , Eletrodos Implantados/efeitos adversos , Eletrodos Implantados/normas , Eletroencefalografia/efeitos adversos , Eletroencefalografia/instrumentação , Eletroencefalografia/normas , Feminino , Humanos , Masculino , Robótica/instrumentação , Robótica/normas , Técnicas Estereotáxicas/instrumentação , Técnicas Estereotáxicas/normas
3.
J Neurosurg Pediatr ; 22(6): 678-683, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30192215

RESUMO

OBJECTIVEDiffuse intrinsic pontine glioma (DIPG) is a highly aggressive and lethal brainstem tumor in children. In the 1980s, routine biopsy at presentation was abandoned since it was claimed "unnecessary" for diagnosis. In the last decade, however, several groups have reincorporated this procedure as standard of care or in the context of clinical trials. Expert neurosurgical teams report no mortality and acceptable morbidity, and no relevant complications have been previously described. The aim of this study was to review needle tract dissemination as a potential complication in DIPG.METHODSThe authors retrospectively analyzed the incidence of dissemination through surgical tracts in DIPG patients who underwent biopsy procedures at diagnosis in 3 dedicated centers. Clinical records and images as well as radiation dosimetry from diagnosis to relapse were reviewed.RESULTSFour patients (2 boys and 2 girls, age range 6-12 years) had surgical tract dissemination: in 3 cases in the needle tract and in 1 case in the Ommaya catheter tract. The median time from biopsy to identification of dissemination was 5 months (range 4-6 months). The median overall survival was 11 months (range 7-12 months). Disseminated lesions were in the marginal radiotherapy field (n = 2), out of the field (n = 1), and in the radiotherapy field (n = 1).CONCLUSIONSAlthough surgical tract dissemination in DIPG is a rare complication (associated with 2.4% of procedures in this study), it should be mentioned to patients and family when procedures involving a surgical tract are proposed. The inclusion of the needle tract in the radiotherapy field may have only limited benefit. Future studies are warranted to explore the benefit of larger radiotherapy fields in patients with DIPG.


Assuntos
Biópsia/efeitos adversos , Neoplasias do Tronco Encefálico/patologia , Glioma/patologia , Invasividade Neoplásica/patologia , Ponte/patologia , Criança , Feminino , Humanos , Masculino
4.
Clin Toxicol (Phila) ; 56(8): 795-797, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29343133

RESUMO

INTRODUCTION: Prenatal methamphetamine exposure is related to prematurity, fetal growth restriction, neurobehavioral effects and long-term motor and cognitive sequelae. PATIENT PRESENTATION: We report the case of a newborn from a Filipina with no prenatal care with a complex brain malformation. Methamphetamine was identified in maternal and neonatal urine and in maternal hair, raising our suspicion of methamphetamine as a cause of this malformation. DISCUSSION: Methamphetamine abuse is a growing problem worldwide. There are little data on its effect on the fetus. To our knowledge, no fetal brain abnormalities have been associated with its use. In our case, the lack of antenatal control does not allow us to date when this malformation appeared. CONCLUSION: The aim of our report is to generate awareness of the possible association between methamphetamine abuse during pregnancy and central nervous system malformations.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/complicações , Estimulantes do Sistema Nervoso Central/envenenamento , Malformações Vasculares do Sistema Nervoso Central/etiologia , Desenvolvimento Fetal/efeitos dos fármacos , Metanfetamina/envenenamento , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/fisiopatologia , Feminino , Cabelo/química , Humanos , Recém-Nascido , Metanfetamina/urina , Gravidez , Efeitos Tardios da Exposição Pré-Natal
5.
An. pediatr. (2003. Ed. impr.) ; 84(6): 311-317, jun. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-152163

RESUMO

Introducción: Es conocido que la presencia de determinadas manifestaciones clínicas en los niños portadores de una válvula ventrículo-peritoneal (VDVP) se asocia a un mayor riesgo de disfunción valvular (DV), sin embargo, ninguna de estas es suficientemente sensible y específica por sí sola para diferenciar los pacientes que presentan una DV de los que no, y permitir así una actuación diagnóstica y terapéutica más adecuada. Objetivo: Elaborar una escala diagnóstica que permita seleccionar en el Servicio de Urgencias a los niños con riesgo de DV. Material y métodos: Estudio prospectivo. Se incluyó a los pacientes portadores de VDVP con edad comprendida entre 1 y 18 años que consultaron con sintomatología potencialmente asociada a DV en un Servicio de Urgencias durante 3 años (1 de abril del 2010-31 de marzo del 2013). Mediante regresión logística se determina qué variables se consideran factores de riesgo independientes de DV; con ellos se elabora una escala diagnóstica. Resultados: Se obtiene una escala basada en 9 variables (eritema, tumefacción o secreción en el trayecto del catéter; somnolencia; rigidez de nuca; cefalea; ausencia de fiebre; edad mayor a 4 años; vómitos; focalidad neurológica reciente y tiempo desde la última intervención quirúrgica menor o igual a 2 años) con una puntuación máxima de 20 puntos. Puntuaciones de la escala de 7 o más puntos se asocian a un mayor riesgo de DV (OR 34,0; IC del 95%, 15,4-74,9; sensibilidad 88,3%; especificidad 81,1%; VPP 53,4%; VPN 96,7%). Discusión: La escala diagnóstica para la valoración del riesgo de DV presentada permite seleccionar los pacientes con riesgo de DV. Su uso podría ayudar a mejorar la indicación de las pruebas complementarias que reciben los niños portadores de una VDVP y disminuir la irradiación a la que son sometidos estos pacientes (AU)


Introduction: It is well known that some symptoms in children with ventriculoperitoneal shunt are associated with a higher risk of developing shunt malfunction. However none of those symptoms are sensitive or enough specific enough to diagnose the shunt malfunction. Objective: To develop a diagnostic scale to identify children with an increased risk of shunt malfunction in the Emergency Department. Material and methods: This is a prospective study including children aged one to eighteen years old admitted to the Emergency Department between April 2010 and March 2013 with symptoms of ventriculoperitoneal shunt malfunction. Logistic regression Analysis was used to determine whether or not the variables were considered independent risk factors for shunt malfunction. The results led to the development of a diagnostic scale. Results. A scale was developed using 9 variables (erythema, swelling or discharge from the catheter trajectory, drowsiness, stiff neck, headache, afebrile, age>4 years, vomiting, recent neurological deficit, and time since last surgery ≤ 2 years) with a maximum score of 20 points. It was found that Scale scores ≥ 7 points were associated with an increased risk of shunt malfunction (OR 34.0, 95% CI 15.4-74.9; sensitivity 88.3%, specificity 81.1%, PPV 53.4%, NPV 96.7%). Discussion: A diagnostic scale is designed for assessing the risk of shunt malfunction, selecting those patients with a higher risk. The use of this scale could help the management of these patients, reducing complementary tests, as well the usual radiation suffered by these children (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/métodos , Fatores de Risco , Disfunção Ventricular/complicações , Disfunção Ventricular/diagnóstico , Disfunção Ventricular/prevenção & controle , Emergências/epidemiologia , Serviços Médicos de Emergência , Estudos Prospectivos , Modelos Logísticos , Curva ROC
6.
An Pediatr (Barc) ; 84(6): 311-7, 2016 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-26231440

RESUMO

INTRODUCTION: It is well known that some symptoms in children with ventriculoperitoneal shunt are associated with a higher risk of developing shunt malfunction. However none of those symptoms are sensitive or enough specific enough to diagnose the shunt malfunction. OBJECTIVE: To develop a diagnostic scale to identify children with an increased risk of shunt malfunction in the Emergency Department. MATERIAL AND METHODS: This is a prospective study including children aged one to eighteen years old admitted to the Emergency Department between April 2010 and March 2013 with symptoms of ventriculoperitoneal shunt malfunction. Logistic regression Analysis was used to determine whether or not the variables were considered independent risk factors for shunt malfunction. The results led to the development of a diagnostic scale. RESULTS: A scale was developed using 9 variables (erythema, swelling or discharge from the catheter trajectory, drowsiness, stiff neck, headache, afebrile, age>4 years, vomiting, recent neurological deficit, and time since last surgery ≤ 2 years) with a maximum score of 20 points. It was found that Scale scores ≥ 7 points were associated with an increased risk of shunt malfunction (OR 34.0, 95% CI 15.4-74.9; sensitivity 88.3%, specificity 81.1%, PPV 53.4%, NPV 96.7%). DISCUSSION: A diagnostic scale is designed for assessing the risk of shunt malfunction, selecting those patients with a higher risk. The use of this scale could help the management of these patients, reducing complementary tests, as well the usual radiation suffered by these children.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Derivação Ventriculoperitoneal , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Estudos Prospectivos , Avaliação de Sintomas , Falha de Tratamento
8.
Rev. neurol. (Ed. impr.) ; 54(11): 673-676, 1 jun., 2012. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-100095

RESUMO

Introducción. Los tumores del plexo coroideo son tumores poco frecuentes, con un pico de incidencia en los primeros años de vida. Clínicamente suelen producir hipertensión intracraneal. Histológicamente se dividen en papilomas y carcinomas. Es rara la existencia de metástasis en los papilomas. Caso clínico. Niña de 11 años con lesión intracraneal en el IV ventrículo y lesión intradural sacra. Se practica craneotomía suboccipital con resección total de la lesión ventricular, y en un segundo tiempo exéresis parcial de la lesión espinal. El estudio histológico determina el diagnóstico de papiloma típico del plexo coroideo en la lesión intracraneal y de metástasisde papiloma del plexo coroideo en la lesión espinal. Al revisar la bibliografía, se comprueba que en la edad pediátrica es muy raro encontrar papilomas del plexo coroideo con lesiones metastásicas. No existe consenso en el tratamiento de las metástasis de plexopapilomas en la edad pediátrica, adoptándose una conducta expectante en dos casos y tratamiento quirúrgico mediante laminectomía en otro. Conclusiones. Los papilomas del plexo coroideo son lesiones raras, benignas y con buen pronóstico. Es poco frecuente la existencia de metástasis. El tratamiento de elección es la resección total de la lesión. Para el tratamiento de las metástasis no hay evidencias de cuál es la mejor actitud, y se han propuesto distintas alternativas (AU)


Introduction. Tumours of the choroid plexus are uncommon, with a peak incidence in the early years of life. Clinically they usually produce intracranial hypertension. Histologically, they can be divided into papillomas and carcinomas. Metastasis rarely occurs in the case of papillomas. Case report. An 11-year-old female with an intracranial lesion in the 4th ventricle and a sacral intradural lesion. A suboccipital craniotomy with total resection of the ventricular lesion was performed and this was followed later by partial exeresis of the spinal lesion. The histological study provides the diagnosis of typical choroid plexus papilloma in the intracranial lesion and choroid plexus papilloma metastasis in the spinal lesion. A review of the literature showed that choroid plexus papillomas with metastatic lesions are very rarely found at the paediatric age. There is no general agreement on the treatment of plexus papilloma metastasis at the paediatric age, expectant management being adopted in two cases and surgical treatment involving a laminectomy in the other. Conclusions. Choroid plexus papillomas are rare, benign lesions with a good prognosis. Metastasis seldom exists. Preferred treatment is total resection of the lesion. For the treatment of metastases, there is no evidence as to which is the best approach and different alternatives have been suggested (AU)


Assuntos
Humanos , Feminino , Criança , Papiloma do Plexo Corióideo/cirurgia , Craniotomia , Neoplasias da Medula Espinal/cirurgia , Metástase Neoplásica/patologia , Hipertensão Intracraniana/complicações , Neoplasias Encefálicas/cirurgia , Neuroimagem
9.
Rev Neurol ; 54(11): 673-6, 2012 Jun 01.
Artigo em Espanhol | MEDLINE | ID: mdl-22627748

RESUMO

INTRODUCTION: Tumours of the choroid plexus are uncommon, with a peak incidence in the early years of life. Clinically they usually produce intracranial hypertension. Histologically, they can be divided into papillomas and carcinomas. Metastasis rarely occurs in the case of papillomas. CASE REPORT: An 11-year-old female with an intracranial lesion in the 4th ventricle and a sacral intradural lesion. A sub-occipital craniotomy with total resection of the ventricular lesion was performed and this was followed later by partial exeresis of the spinal lesion. The histological study provides the diagnosis of typical choroid plexus papilloma in the intracranial lesion and choroid plexus papilloma metastasis in the spinal lesion. A review of the literature showed that choroid plexus papillomas with metastatic lesions are very rarely found at the paediatric age. There is no general agreement on the treatment of plexus papilloma metastasis at the paediatric age, expectant management being adopted in two cases and surgical treatment involving a laminectomy in the other. CONCLUSIONS: Choroid plexus papillomas are rare, benign lesions with a good prognosis. Metastasis seldom exists. Preferred treatment is total resection of the lesion. For the treatment of metastases, there is no evidence as to which is the best approach and different alternatives have been suggested.


Assuntos
Papiloma do Plexo Corióideo/patologia , Papiloma/patologia , Sacro , Neoplasias da Medula Espinal/secundário , Criança , Feminino , Humanos
10.
Acta Neurochir (Wien) ; 152(2): 355-60, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19997945

RESUMO

PURPOSE: Cranial nerve microvascular decompression is a habitual neurosurgical procedure. Authors describe a new application of the Dextroscope (Volume Interactions, Ltd.), a virtual reality environment, to plan and properly simulate this kind of procedures. METHODS: In three cases of hemifacial spasm refractory to drugs and botulinum toxin treatment, the authors used a virtual reality workstation (Dextroscope) to develop an interactive simulation of craniotomy, approach, and Gore-Tex implant optimal size and position in order to reach vascular decompression of facial nerve. RESULTS: Three-dimensional interactive environment allowed the authors to virtually carry out craniotomy, to visualize vascular and nerve relationship, and finally, to select and to simulate best Gore-Tex graft positioning in each case. During surgical procedures, facial nerve vascular compressions were exposed and Gore-Tex grafts were successfully placed as it was virtually planned. Patient outcomes were excellent, with an average improvement of two units (0-4 grades of severity scale). CONCLUSION: Virtual reality environment can help the neurosurgeon to plan and train vascular decompression procedures. Use of appropriate craniotomy, knowledge of vascular and nerve relationship, and selection of optimum paddy size and position are the main useful applications of the Dextroscope in these procedures.


Assuntos
Craniotomia/métodos , Descompressão Cirúrgica/métodos , Espasmo Hemifacial/cirurgia , Neuronavegação/métodos , Interface Usuário-Computador , Procedimentos Cirúrgicos Vasculares/métodos , Artéria Basilar/patologia , Artéria Basilar/fisiopatologia , Artéria Basilar/cirurgia , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/cirurgia , Projeto Auxiliado por Computador/instrumentação , Craniotomia/instrumentação , Descompressão Cirúrgica/instrumentação , Nervo Facial/patologia , Nervo Facial/fisiopatologia , Nervo Facial/cirurgia , Feminino , Espasmo Hemifacial/patologia , Espasmo Hemifacial/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Microvasos/patologia , Microvasos/fisiopatologia , Microvasos/cirurgia , Neuronavegação/instrumentação , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/métodos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Procedimentos Cirúrgicos Vasculares/instrumentação
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