ABSTRACT
Objective. To determine the possibility of partial clamping and maintaining small arteriesflow within them with a modffied clip. To perform an end to side anastomosis in an artery partially clamped and demonstrate its permeability.
Method. Partial carotid clamping in rats and intraluminalflow measurement. End to side anastomosis suture of the vessels clamped. Histopathologic study of the brains.
Results. The persistence offlow during partial clamping of the vessel. Anastomosis remained permeable after the procedures. Eas confirmed no signs of ischemia in brainsfixed were reported.
Conclusion. This modffication in the clip allows an end to side anastomosis with partial clamping of the recipient vessel, keeping the flow within it, in small vessels.
Key words: vascular anastomosis, modjicated clip, partial campling

]]> Bibliografía

  1. Yasargil MG. Microsurgery applied to Neurosurgery. GeorgThieme, Stuttgart.1969.
  2. Cure GC, García N, Gómez H, Quiñones GP, Bermúdez JC. Entrenamiento en LAboratorio de Microcirugía para la revascularización Cerebral. Rey Chil Neurocirug 2010; 34: 58-65.
  3. Lavine SD, Masri LS, Levy ML, Giannotta SL. Temporary occlusion of the middle cerebral artery in intracranial aneurysm surgery: time limitation and advantage of brain protection. J
  4. Neurosurg 1997; 87: 817-24.
  5. Samson D, Hunt B, Bowman G, Mootz L, Krippner W, Meyer Y et al. A clinical study of the parameters and effects of temporary arterial occlusion in the management of intracranial
  6. aneurysms. Neurosurgery 1994; 34: 22-7.
  7. Charbel FT, Ausman J, Días FG, Nakik JM, Dujovni M, Sanders J. Temporary clipping in aneurysm surgery: techniques and results. Surg Neurol 1991; 36: 83-90.
  8. Jabre A, Symon L. Temporary vascular occlusion during aneurysm surgery. Surg Neurol 1987; 27: 47-63.
  9. Suzuki J, Kwak R, Okudaira Y. The safety time limit of temporary clamping of cerebral arteries in the direct surgical treatment of the intracranial aneurysm under moderate hypotermia. Brain
  10. Nerve 1973; 25:407-16.
  11. Akay KM. End-to-Side Anastomoses in Sivall Arteries with Partial Lateral Clipping. An Experimental Study. Minim Invas Neurosurg 2003; 46: 22-8.
  12. Tulleken CA, Verdaasdonk RM, beck RJ, Mali WP: The modified excimer lasser-assited high-flow bypass operation. Surg Neurol 1996; 46: 424-9.
  13. Krishnan KG, Tsirekidze P, Pinzer T, Schackert G. A novel Mínimally Occlusive Microvascular Anastomosis Technique Using a Temporary Intraluminan Shunt: A Prospective Brain
  14. Ischemia Time During Suferficial Temporal Artery-To-Middle Cerebral Artery Bypass. Neurosurg 2005; 57: 191-8.
]]> ABSTRACT

Objective. To analyze our experter~trr brain pial arteriovenousfistulae in paediatric patients and review the modern concepts about this pathology.
Materials and method. Between 2004 and 2011, 6 cases of pial arteriovenousfistulae were diagnosed and treated at the National Hospital of Paediatrics "Juan P.Garrahan", defining them as arteriovenous malformations with one or more arterial connections with one single venous drainage, without interposed nidus. We reviewed the medical records and neuroimaging. The main method for diagnosis was cerebral angiography.
Results. There were 4 male and 2female patients, ages rangingfrom 1 month to 14 years old. 3patients presented brainhemorrhage, 2 had seizures as the initial symptom, and one was diagnosed because of his congenital hydrocephalus. 2 were treated with open surgery and 4 with embolisation. There were no important complications or rebleeding.
Conclusion. Brain pialfistulas are infrequent vascular malformations importantfor their high risk of bleeding and relativefrequency in paediatrics. The management of these patients needs a multidisciplinary teamfor analysis, discussion, choosing the most suitable treatment, and follow up.

]]> ]]> Bibliografía

  1. Weon YC. Yoshida Y. Sachet M. Mahadevan J. Alvarez H. Rodesch G. Lasjaunias P. Supratentorial cerebral arteriovenous fistulas (AVFs) in children: review of 41 cases with 63 non choroidal single-hole AVFs. Acta Neurochir (Wien). 2005;147(1):17-31; discussion 31.
  2. Lv X. Li Y. Jiang C. Wu Z. Endovascular treatment of brain arteriovenous fistulas. Am J Neuroradiol 2009; 30: 851-56.
  3. Lv X. Jiang C. Li Y. Yang X. Wu Z. Clinical outcomes of endovascular treatment for intracranial pial arteriovenous fistulas. World Neurosurg. 2010 ;73(4): 385-90.
  4. Garel C, Azarian M, Lasjaunias P, Luton D. Pial arteriovenous fístulas: dilemmas in prenatal diagnosis, counseling and postnatal treatment. Report ofthree cases. Ultrasound Obstet Gynecol. 2005; 26(3): 293-6.
  5. García-Mónaco R, Taylor W, Rodesch G. Alvarez H, Burrows P, Coubes P, Lasjaunias P. Pial arteriovenous fistula in children as presenting manifestation of Rendu-Osler-Weber disease. Neuroradiology. 1995 ;37(1): 60-4.
  6. Hoh BL. Putman CM. Budzik RF. Ogilvy CS. Surgical and endovascular flow disconnection of intracranial pial single-channel arteriovenous fistulae. Neurosurgery. 2001; 49(6): 1.351-63; discussion 1.363-4.
]]> ABSTRACT
Objective. To present a case of Calqfying Pseudoneoplasm of the Neuraxis (CPN).
Description. A 17-years-old woman, with menstrual disorders and a mild hyperprolactinemia. She suffered from a chronic and moderate headache with normal clinic and neurologic examination. Brain non-contrast CT showed a hyperdense mass in the right frontal lobe with dura! relationship. In MRI it was a non-enhancing T1 weighted hyperintense lesion , and a T2 weighted hypointense mass. The sellar region was clean.
Intervention. Surgery with total excision was performed. The lesion was an off-white an avascular tumor with meningeal adherence. It revealed a calcjiyed part and a soft mucoid portion. Histologically it presented amorphous, acellular chondromixoid matrix surrounded by pallisading spindle to polygonal epitheloid cells. These were tipically EMA positive and negative to GFAP. All these features led to the diagnosis of Calqfying Pseudoneoplasm of the Neuraxis.
Icjied lesion.
Conclusion. The CPN must be considered in the diagnosis and management of any patient with calcffyied, ossysyied mass of the Central Nervous System.
Key words: calci fyied tumor, pseudoneoplasm of CNS, Ossyled neoplasm of neuraxis.

]]> Bibliografía

  1. Tatke M, Singh A, Gupta V. Calcifying pseudoneoplasm of the CNS. British J. Neurosurgery 2001; 15(6): 521-8.
  2. Serrano Pardo R, Enguita Valls A, Santos Benitez H, Sánchez Bustos A. Pseudoneoplasia calcificante del sistema nervioso central. A propósito de un caso y revisión de la literatura. Rey Esp Patol 2009; 42(2): 155-8.
  3. Aiken A, Akgun H, Tihan, Barbaro N, Glastonbury C. Calcifying pseudoneoplarns of the neuraxis: CT, MR imaging and histologic features. Am J Neuroradiology 2009; 33: 1256-60.
  4. Montibeller G, Stan A, Krauss J, Nakamura M. Calcifying pseudoneoplasm of the inferior colliculus: an unusual location for a rare tumor: case report. Neurosurgery 2009; 65(5): 1005-8.
  5. Donev K, Scheithauer B. Pseudoneoplasms of the nervous system. Arch of Pathology Lab Med, 2010; 134: 404-16.
]]> ABSTRACT
Objective. We report a case of a medulloblastoma; a cerebellar malignant tumor, veryfrequent in childhood and whose presentation is rare in adults; the arefew papers published of adult medulloblastoma.
Description. Young adult, whith right hemisphere cerebellar tumor, with perilesional edema, local mass effect ant supratentorial hydrocephalus.
Intervention. Suboccipital craniectomy, intraoperative biopsy diagnosis of medulloblastoma, planning and achieving total tumor resection.
Conclusion. It should be highlighted the importance of tumor resection as extensive as possible, supplemented by radiation therapy to the whole craniospinal axis with the help of an exhautive, clinical and imaging serial follow-up.
Key words: medulloblastoma/ surgery, medulloblastoma / radiotherapy cerebellar tumors.

]]> Bibliografía

  1. Figols Ladrón de Guevara J. Lafuente Sanchez JV. El Meduloblastoma. Rev Neurologia 2006; 43:213-7.
  2. Yazigi Rivard L, Masserot C. Lachenaud J. Diebold Pressac I. Aprahamtan A. Avran D. et. al. Chudhood medulloblastoma. Archive de Pediatric 2008; 15: 1794-804.
  3. Rilfaud L. Salkali S , Leray E, Hamlat A, Haegelen C. Vauleon E. et. al. Survival and prognostic factor in a series of adults with medulloblastoma. Clinical article. J Neurosurgery 2009; 11: 478-87.
  4. Brandes AA, Franceschi E. Tosoni A. Renl M. Gatta G. Vecht C. et. al. Adult neuroectodermal tumors of posterior fossa (Medulloblastoma) and of supratentorial sities (StPNET) Critical Reviews in Oncology Hematology 2009; 71: 165-79.
  5. Gulino A. Arcella A, Giangaspero F. Pathological and molecular heterogenety of medulloblastoma. Current Opinion Oncology 2008; 20: 668-75.
  6. Dhall G. Medulloblastoma. Journal of Child Neurology 2009; 24 :1418-30.
]]> ABSTRACT
Objectíve. Our objective is to analyze the patients that presented supratentorial metastases.
Material and Methods. We studied 170 patients with medulloblastoma from the year 1991 to 2005. Twenty seven presented supratentorial metastases. We considered age at presentation, pathology, staging, dissemination to other places and outcome.
Results. Twenty seven patients (15,8%) with medulloblastoma presented supratentorial metastases, the average age was 5,87 years range from 3 to 11 years. 13 / 27 were staged high risk and 14/27 standard. The average time between surgery and presence of recurrence was 12,65 month. 12 / 27 presented desmoplasia. 25 / 27 patients died.
Conclusion. 15,8% of patients with medulloblastoma presented supratentorial metastases before 16 months of thefirst surgery. Al! the patients were younger than 12 years. The appearance of supratentorial metastases is not related with the stage or the presence of desmoplasia. The outcome was unfavorable once the dissemination was diagnosed.
Key words: medulloblastoma, metastases, recurence.

]]> Bibliografía

  1. Christos D. Katsetos, Luis Del Valle, Agustin Legido, Jean-Pierrede Chadarévian, Elías Perentes and Sverre J. Mórk; On theneuronal /neuroblastic nature of medulloblastomas: a tribute to Pio del Rio Hortega and Moises Polak; Acta Neuropathol. 2003;105(1):1-13,
  2. Yazigi-Rivard L, Masserot C, Lachenaud J, Diebold-Pressac I, Aprahamian A, Avran D, Doz F.; Childhood medulloblastoma; Arch Pediatr. 2008; 15(12): 1794-804.
  3. Eberhart CG, Kepner JL, Goldthwaite PT, Kun LE, Duffner PK, Friedman HS, Strother DR, Burger PC., Histopathologic grading of medulloblastomas: a Pediatric Oncology Group study; Cancer. 2002; 15; 94(2):552-60.
  4. Perry A., Medulloblastomas with favorable versus unfavorable histology: how many small blue cell tumor types are there in the brain?, Adv Anat Pathol 2002; 9(6): 345-50.
  5. Roka YB, Bista P, Sharma GR, Adhikari D, Kumar P., Frontal recurrence ofmdeulloblastoma five years after excision and craniospinal irradiation; Indian J Pathol Microbiol. 2009;52(3): 383-5.
]]> ABSTRACT

Objective. To describe and anal yse a case of intrapetrous facial schwannoma, with intraparotid extension.
Description. A 37-year-oldfemale carne to examination presenting afacial palsy consequent to a previous surgery of a tumor in the left parotid region. Pathology revealed a schwannoma. CT-scanning and MRI showed an intratemporal left region mass.
Intervention. Through a retro-auricular, transmastoid approach, it was observed that the tumor affected the labyrinthine and tympanic segments of the facial nerve. The intrapetrous mass lesion was removed but it was impossible to isolate a healthy portion of the nerve; intraparotid involvement was also observed. It was decided to perform a hypoglossal facial anastomosis using an autologous sural nerve grafting. Pathology of the intrapetrous lesion revealed a facial nerve schwannoma.
Conclusion. The choice of a retro-auricular, transmastoid approach allowed us to remove the facial nerve schwannoma, at the intrapetrous levet. Due to the simultaneous intratemporal and intraparotid nerve involvement, a hypoglossalfacial anastomosis was performed to treat the patient's facial palsy.
Key words: facial nerve, Schwannoma, surgery, hypoglossal facial anastomosis

]]> Bibliografía

  1. Zernotti ME, Ojeda A, Zernotti M. Schwannomas intrapetrosos del nervio facial. Acta Otorrinolaringol Esp 2005; 56: 434-7.
  2. Sherman JD, Dagnew E, Pensak ML, van Loveren H, Tew J. Facial Nerve Neuromas: Report of 10 Cases and Review of the Literature. Neurosurgery 2002; 50: 450-6.
  3. Lipkin AF, Coker NJ, Jenkins HA, Alford BR. Intracranial and intratemporal facial neuroma. Otolaryngol Head Neck Surg 1987;96: 71-9.
  4. Pulec JL. Facial nerve neuroma. Ear Nose Throat J 1994; 73:721-52.
  5. Monte S, Araus R. Tumores del nervio facial. Boletín de O.R.L.1996; 1: 6-8.
  6. Presutti L, Grammatica A, Alicandri-Ciufelli M, Marchioni D, Cunsolo EM. Facial Nerve Schwannoma. Otolaryngology. Otology & Neurotology 2009; 30: 683-5.
  7. Chung SY, Kim DI, Lee BH, et al. Facial nerve schwannomas: CT and MR findings. Yonsei Med J 1998; 39: 148-53.
  8. Campero A, Socolovsky M, Campero A, Torino R, Rivadeneira C. Estudio anatómico de los pares XII y VII extracraneanos en la anastomosis hipogloso-facial. Rev Argent Neuroc 2006; 20: 55-60.
  9. Martins RS, Socolovsky M, Siqueira MG, Campero A. Hemihypoglossal-facial neurorrhaphy after mastoid dissection of the facial nerve: results in 24 patients and comparison vvith the classic technique. Neurosurgery 2008; 63: 310-7.
  10. Campero A, Socolovsky M. Facial reanimation by means of the hypoglossal nerve: anatomic comparison of different techniques.Neurosurgery 2007; 61: 41-50.
]]> ABSTRACT

Objective. To present a case report of glioblastoma multiforme in an elderly patient, simulating a brain abscess.
Description. A 79 year-old woman presented initially withfacial cellulitis. 72 hours later, she developed mental status changes and language disorders. Neurological examination revealed disorientation, confusion, mixed dysphasia, dyslexia and writing disorders. CT and MRI sowed a mass lesion with midline shift, consistent with brain abscess.
Intervention. We performed a craniotomy, evacuation of the cystic lesion, drainage and biopsy of the wall cavity. The culture of sample obtained during surgery was negative. The pathology report corresponded to a glioblastoma. A reoperation was achievedfor tumor removal. The postoperative course wasfavorable, without complications. Adjuvant radiochemotherapy was well tolerated. The clinical course was uneventful until 18 months postoperatively, when the patient had a generalízed seizure and neurological deterioration. The MRI showed tumor recurrence. Despite support treatment and corticotherapy, a rapid progression to a comatose state and death occurred.
Conclusion. Glioblastoma multiforme should always be considered in the differential diagnosis of cerebral mass lesions in elderly
patients. Clinical and radiological aspects may be similar to those of brain abscess. Agressive treatment should be postulated even
in elderly patients with glioblastoma, who have a good performance status and acceptable operative risk.
Key-words: brain abscess, elderly patient, glioblastoma multiforme, surgical treatment.

]]> Bibliografía

  1. Ohgaki H, Kleihues P. Epidemiology and etiology of gliomas. Acta Neuropathol 2005; 109: 93-108.
  2. Moscote SLR, Meneses García C, Sáenz Amuruz M, Penagos P, Zubieta C, Romero A. Manejo actual del glioblastoma multiforme. Rey Cienc Biomed 2010; 1: 237-45.
  3. Álvarez-Linera Prado J, Benito-León J, Escribano J, Amérigo J, Ruiz-Galiana J. Diferenciación entre absceso cerebral y tumor necrótico o quístico mediante secuencias de difusión. Rey Neurol 2001; 32: 137-40,
  4. Lai PH, Hsu SS, Lo YK, Ding SW. Role of diffusion-weighted imaging and proton MR spectroscopy in distinguishing between pyogenic brain abscess and necrotic brain tumor. Acta Neurol Taiwan 2004; 13: 107-13.
  5. Scott JG, Suh JH, Elson P, Barnett GH, Vogelbaum MA, Peereboom DM, Stevens GH, Elinzano H, Chao ST. Aggressive treatment is appropriate for glioblastoma multiforme patients 70 years old or older: a retrospective review of 206 cases. Neuro Oncol 2011; 13: 428-36.
  6. Ewelt C, Goeppert M, Rapp M, Steiger HJ, Stummer W. Sabel M. Glioblastoma multiforme of the elderly: the prognostic effect of resection on survival. J Neurooncol 2011; 103: 611-8.
]]> ABSTRACT

Objetive. To describe a patient with radicular pain secondary to a psoas muscle hematoma.
Description. A 76 years oldfemale, suffering from hypertension and medicated with anticoagulants after a triple coronary stent, complained of lumbar pain treated with analgesics and physiotherapy. The pain persisted and the condition worsened with the appearance of proximal crural paresia. An MRI showed an increased volume of the right psoas iliac muscle due to a hematoma.
Intervention. Anticoagulants were suspended and a neurological evaluation was done. The pain, paresia and hematoma receded.
Conclusion. Spontaneous hematoma of the psoas muscle is an infrequent cause of radicular syndrome although it should be taken into consideration in patients medicated with anticoagulants.
Key words: radicular syndrome, psoas hematoma, anticoagulation.

]]> Bibliografía

  1. Debolt WL, Jordan JC. Femoral neuropathy from heparin hematoma: report of two cases. Bull Los Angeles Neurol Soc 1966; 31: 45-50.
  2. Butterfield WC, Neviaser RJ, Roberts MP. Femoral neuropathy and anticoagulants. Ann Surg 1972; 176: 58-61.
  3. Niakan E, Carbone JE, Adams M, Schroeder FM. Anticoagulants, Iliopsoas hematoma and femoral nerve compression. Am Fam Physician 1991; 44: 2100-2.
  4. Nakao A, Sakagami K, Mitsuoka S, Uda M, Tanaka N. Retroperitoneal hematoma associated with femoral neuropathy: a complication under antiplatelets therapy. Acta Med Okayama 2001; 5: 363-6.
]]> Objective. To evaluate the usefulness of PET in patients with refractory non-lesional temporal lobe epilepsy.
Material and methods.We present three patients with features of temporal lobe epilepsy refractory to medication, where high definition MRI was normal.
Results. These patients had PET hypometabolism in the temporal areas related to clinical and neurophysiological findings. Two of these patients were implanted with subdural grids to confirm the diagnosis and the third was operated directly based on the findings of PET. Encourage the presentation of the importance in recent years is acquiring the PET.
Conclusion. In those patients in clinical neurophysiology and epilepsy with suspected temporal lobe, but in the MRI images show no structural lesions, PET can play an important role defining the diagnosis.
Key words: epilepsy, temporal lobe, PET.

]]> Bibliografía

  1. Henry T, Roman D. Presurgical epilepsy localization with interictal cerebral dysfunction. Epilepsy Behav 2011; 20 (2): 194-208.
  2. Hogan R, Carne R, Kilpatrick C, Cook M, Patel A, King L, O'Brien T. Hippocampal deformation mapping in MR! negative PET positive temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2008; 79(6): 636-40.
  3. MRI negative PET positive temporal lobe epilepsy: a distinct surgically remediable syndrome. Brain 2004; 127: 2.276-85.
]]> ABSTRACT

Objective. To perform a retrospective analysis of 3 cases of Neurocutaneous Melanosis treated in our Department and to correlate the findings with literature.
Description. Neurocutaneous melanosis (NCM) is a rare congenital disorder characterized by the presence of multiple melanocytic nevi (3 or more), or a giant one, associated with benign or malignant proleration of melanocytes in the central nervous system (CNS), with leptomeningeal infiltration. Diagnosis is based on clinicalfindings, MRI and pathology of lesions. With very bad prognosis, the disease is usually present with hydrocephalus, obstructive or not, or is associated with other CNS malformations such as Dandy- Walker complex. We are presenting three cases treated between 2005 and 2011, whose clinical expresion, prognosis andfollow up matches with literature.
Intervention:. MRI, with and without contrast, were performed in all patients, as also surgical biopsy of meningeal lesions; VP shunt were placed for treating their hydrocephalus.
Conclusion. The MNC is a poor prognosis disease with high mortality. The diagnosis is based on three pillars: complete clinical examination, MRI and histopathology of lesions. Specialists interaction (neurosurgeon - dermatologist - oncologist) is essentialfor the correct advice and support to parents.
Key words: neurocutaneous melanosis - hydrocephalus - Dandy-Walker complex

]]> Bibliografía

  1. Mc Clelland S, Chamas LR, Santa Cruz KS, Garner HP, Lam CH. Progressive brainstem compression in an infant with neurocutaneous melanosis and Dandy—Walker complex following ventriculoperitoneal shunt placement for hydrocephalus. J Neurosurg 6 Suppl Pediatrics 2007; 107: 500-3.
  2. Józwiak S, Borkowska J. Neurocutaneous Melanosis. En: Riggieri M, Pascual Castroviejo I, Di Rocco C, ed. Neurocutaneous Disorders. 1 st ed. Germany: Springer-Verlag/ Wien; 2008. p. 73-81.
  3. Lozada Mengana Y, Casamajor Castillo MA, Frómeta Luna F, Dáger Salomón M, Babié Reyes BE. Melanosis neurocutánea. Medisan 2004; 8: 37-41.
  4. Hayashi M, Maeda M, Maji T, Matsubara T, Tsukahara H,Takeda K. Diffuse Leptomeningeal Hyperintensity on Fluid-Attenuated Inversion Recovery MR Images in Neurocutaneous Melanosis. AJNR Am J Neuroradiol 2004; 25: 138-41.
  5. Demir M K, Aker FV, Akinci O. Ózgültekin A. Primary Leptomeningeal Melanomatosis. Radiology 2008; 247: 905-9.
  6. Chu WC, Lee V, Chan Y, Shing M MK., Chik KW, Li CK, et al. Neurocutaneous Melanomatosis with a Rapidly Deteriorating Course. AJNR Am J Neuroradiol 2003; 24: 287-90.
]]> ABSTRACT

Objective. To present two cases of migration retrograde catheter
Description. Two children with a history of hydrocephalus treated with DVP, which were presented to the outpatient clinic with symptoms of valvular dysfunction and palpable tumor at occipital level and another at the neck.
Intervention. We performed scanning and repositioning of the distal catheter in the peritoneum.
Conclusion. The diagnosis was achieved by probing the integrity of the drainage system and confirmed by radiographs of the shunt system.
Key words: Migration retrograde catheter. Complications of CSF shunts, Ventriculoperitoneal shunt (DVP). Hydrocephalus.

]]> Bibliografía

  1. Alvarez Garijo JA, Pecourt JC, de la Resurrección M. Migration of ventriculo-peritoneal shunt into the lateral ventricle of an adult. Surg Neurol 1979; 11:399-400.
  2. Conan MA, Allen Jr MB. Retrograde migration of the venous catheter as a complication of ventriculoatrial shunts in adults. J Neurosurg 1971; 35: 348-50.
  3. Domínguez CJ, Tyagi A, Hall G, TimothyJ, Chumas PD. Sub-galeal coiling of the proximal and distal components of a ventriculoperitoneal shunt. An unusual complication and proposed mechanism. Childs Nery Syst 2000; 16: 493-5.
  4. Ferraresi S, Griffin C, Torcello L, Cassinari V. Duplicated peritoneal catheter as a cause of shunt malfunction. Case report. Neurosurg 1991; 14: 149-50.
  5. Heim RC, Kaufman BA, Park TS. Complete migration of peritoneal shunt tubing to the scalp. Childs Nervy Syst 1994; 10: 399-400.
  6. Martínez-Lage JF, Poza M, Esteban JA. Mechanical Complications of the reservoirs and shunting devicesin ventricular shunt systems. Br J Neurosurg 1992; 6: 321-6.
  7. Martínez-Lage JF, Poza M, Izura V. Retrograde migration of the abdominal catheters as a complication of ventriculoperitoneal shunts: the fishhook sign. Childs New Syst 1993; 9: 425-7.
  8. Mazza C, Briccolo A: Upward dislocation of peritoneal catheter into the ventricular cavity. A rare complication of the ventriculoperitoneal shunt. Report of a case.Neuropediatrie 1975; 6: 313-6.
  9. Mori K, Yamashita J, Handa H. "Missing tube" of peritoneal shunt: migration of the whole system into the ventricle. Surg Neurol 1975; 4: 57-9.
  10. Pang, D., Wilberger, J.F.: Upward migration of peritoneal tubing. Surg Neurol 1980; 14: 363-4.
  11. Scott M, Wycis HT, Murtagh F, Reyes V. Observations on ventricular and lumbar subarachnoid peritoneal shunts in hydrocephalic patients. J Neurosurg 1955; 12: 165-75.
  12. Villarejo F, Alvarez-Sastre C, Giménez D, González C. Migration of an entire shunt into the ventricle. Neurochirurgia 1979; 22: 196-8.
]]> ABSTRACT

Objective. To establish that the implantation of smallerfixed rate intrathecal infusíon pumps is the best choicefor the early treatment of severe spastic quadriparesis and dystonia and to determine its optimal placement
Materials and Method. Seven patients were implanted withfixed rate pumps. In two patients the indication was chronic pain and were excluded from the present study. Three patients were operated with 5.6 centimeters of diameter Tricumed pumps and two patients with Codman Arquimedes pumps.
Results. Two patients implanted with tricumed pumps and two with codman pump evolvedfavorably up to date, with a refill of 190, 200, 232 and 245 micrograms respectively. The device had to be explanted from the last patient due to post-op infection and dysfunction.
Conclusion. Early implantation of a baclofenpumpfacilitates and simplifies neuro-orthopedic treatments and gastrostomy implants. With an adequate subfascial technique and smaller infusion pumps satisfactory results can be achieved.

]]> Bibliografía

  1. Zahavi A, Geertzen JH, Middel B, Staal M, Rietman JS., Long term effect (more than five years) of intrathecal baclofen on impairment, disability, and quality oflife in patients with severe spasticity of spinal origin, J Neurol Neurosurg Psychiatry. 2004; 75(11): 1553-7.
  2. Ramstad K, Jahnsen R, Lofterod B, Skjeldal OH., Continuous intrathecal baclofen therapy in children with cerebral palsy – when does improvement emerge?, Acta Paediatr. 2010; 99(11): 1661-5.
  3. Piatt JH Jr., Pump implantation for intrathecal baclofen infusión after laparotomy for necrotizing enterocolitis, Pediatr Neurosurg 2003; 39(3): 166-8.
]]> ABSTRACT

Objective. To propose a protocol for the management of patients with pseudotumor cerebri, including medical, ophthalmic, and surgical evaluation, describing the complications associated with the latter and its evolution.
Materials and methods. We analyzed our database between 2006 and 2011, determining how many patients who had consulted for pseudotumor cerebri required surgical treatment. We analized how many lumbar punctures (LP) they needed, which was the alternative medical treatment that was applied and whatfactors led to a surgical procedure. Based on these results, we structured a protocol for the management of these patients at our institution.
Results. Between 2006 and 2011, 115 patients were diagnosed with pseudotumor cerebri, of whom 11 (10%) required surgical treatment. Regarding medical treatment, acetazolamide and corticosteroids were administered, and up to 10 lumbar punctures were performed, before clefining a surgical procedure.
Conclusion. Pseudotumor cerebri is an entity with a variable and unpredictable response to treatment. It's essential to follow a protocolfor management it. Also it is very important to note that cases unresponsive to medical treatment should be surgically treated to avoid amaurosis, the most severe complication of this disease.
Key words: pseudotumor cerebri, protocol, medical treatment, surgery

]]>
  • Betancourt, Y. Pseudotumor cerebral pediátrico. Rev Neurología 2006: supl 3: S67-S73.
  • Corbett JJ, Thompson HS. The rational management of idiopathic intracranial hypertension. Arch Neurol 1989; 46: 1049-51.
  • Burgett RA. Lumboperitoneal shunting for pseudotumor cerebri. Neurology 1998; 50: 835-6.
  • Friedman D. Pseudotumor cerebri. Neurol Clin N Am 22; 2004: 99-131.
  • Spennato P. i'scudotumor cerebri. Ncrv Sys 2011, 27(2): 215-35.
    • ]]>         ABSTRACT

    Objective. To describe and analyze two cases of CNS aspergillosis.
    Description. Case 1: a 76 years oldfemale, with a medical story of DM type 2 and high blood pressure, complained of headaches and left side hearing loss sine 6 months before. The MRI showed a lejt temporal bone lesion that enhanced wíth contrast, including the petrous bone cerebellar surface. Case 2: a 23 years old female with an acute hepatic failure of unknown orígin, ten days after she was transplanted went into coma, requiring endotraqueal intubation. A CT scan showed a bihernispheric subcorticai hipodensity and a lumbar puncture showed hiperproteinoraquia with pleocitosis.
    Intervention. In case 1, a biopsy performed through a retrosigmoid approach was informed as aspergillosis. She received voriconazole. In case 2, at the 12 ° postoperative day a brain biopsy showed aspergillosis. The patient died on day 13 ° after surgery of multiorganicfailure and cardio-respiratory arrest. The necropsy showed a disseminated aspergillosis infection that affected lungs, liver, heart, skin, brain, colon and kidneys.
    Conclusion. The results obtained with the treatment in both patients were in accordance with the outcome severity of aspergillosis as was described in the reports reviewed.
    Key words. anphotericin B- brain mycosis- CNS aspergillosis- rinosinusal mycosis

    ]]>     Bibliografía

    1. Walsh TJ, Hier D. Aspergillosis of the central nervous system: clinicopathological analysis of 17 patients. Ann Neurol 1985; 18: 574-82.
    2. Torre-Cisneros J, Lopez OL. CNS aspergillosis in organ transplantation: a clínicopathological study. J Neurol Neurosurg & Psychiatry 1993; 56: 188-93.
    3. Kleinschmidt-DeMasters BK. Central nervous system aspergíllosis: a 20 year retrospectíve series. Hum Pathol 2002; 33:116-24.
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    ]]>         ABSTRACT

    Objective. To analyze two pediatric cases of ventriculo-gallblader shunt
    Material and method. Two patients, one beingfive days oíd and the other 14 months oíd, presented a hydrocephalus. Dueto dWerent reasons. both were unable to receive a classical ventritculo-peritoneal shunt. neither a ventriculo-atrial shunt. Both recelued a ventriculo-gallblader shunt, being a pediatric surgeon part of the surgical team.
    Results. Three years after the procedure, no signs of hydrocephaly were observed.
    Conclusion. Ventriculo-gallblader shunt is a valid option for hydrocephalus treatment when other options are contraindicated. Key words: hydrocephalus. ventriculo-gallbladder shunt

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