RESUMEN

Papillary tumor of the pineal region is a rare neuroepithelial tumor characterized by papillary architecture and epithelial cytology, immunopositivity for cytokeratin and ependymal differentiation. It is considered grade II-III by the World Health Organization and was first described by Jouvet in 2003. We present a 34-year-old male with headaches, blurred vision and normal examination. Radiological study showed a nodulocystic lesion in the pineal region compatible with pineocytoma. Surgery was performed using an infratentorial supracerebellar approach, finding a cystic tumor in the quadrigeminal cistern which was completely resected. Histopathology reported a papillary tumor of the pineal region. The patient made good progress without adjuvant therapy, and after 57 months of follow-up he remained asymptomatic and free of recurrence. A review of the literature was performed to collect all the cases published with gross total resection and no complementary treatment. In conclusion, there is still much to be learned about the pathogenesis, prognosis and management of this tumor

El tumor papilar de la región pineal es un infrecuente tumor neuroepitelial con arquitectura y citología epitelial, citoqueratina positiva y signos de diferenciación ependimaria. Descrito por Jouvet en 2003 es considerado grado II-III de la Organización Mundial de la Salud. Presentamos el caso de un varón de 34 años con cefalea, visión borrosa y exploración normal. El estudio radiológico muestra una lesión noduloquística en región pineal compatible con pineocitoma. Es intervenido mediante abordaje supracerebeloso infratentorial apreciándose lesión de aspecto quístico en cisterna cuadrigémina que es resecada por completo. El resultado histopatológico es tumor papilar de la región pineal. El paciente presenta buena evolución sin tratamiento adyuvante y tras 57 meses de seguimiento permanece asintomático y sin recidiva. Realizamos una revisión sistemática sobre la evolución de los casos publicados tratados mediante resección completa y sin tratamiento complementario, concluyendo que continuamos necesitando aprender sobre la patogénesis, pronóstico y manejo de este tumor

Asunto(s)

RESUMEN

Papillary tumor of the pineal region is a rare neuroepithelial tumor characterized by papillary architecture and epithelial cytology, immunopositivity for cytokeratin and ependymal differentiation. It is considered grade II-III by the World Health Organization and was first described by Jouvet in 2003. We present a 34-year-old male with headaches, blurred vision and normal examination. Radiological study showed a nodulocystic lesion in the pineal region compatible with pineocytoma. Surgery was performed using an infratentorial supracerebellar approach, finding a cystic tumor in the quadrigeminal cistern which was completely resected. Histopathology reported a papillary tumor of the pineal region. The patient made good progress without adjuvant therapy, and after 57 months of follow-up he remained asymptomatic and free of recurrence. A review of the literature was performed to collect all the cases published with gross total resection and no complementary treatment. In conclusion, there is still much to be learned about the pathogenesis, prognosis and management of this tumor.

Asunto(s)

RESUMEN

Introducción: El craneofaringioma representa alrededor del 3% de todos los tumores primarios del sistema nervioso central. Por lo general, se localiza en la región supraselar, sin embargo, puede tener una localización atípica. Caso clínico: Presentamos el caso de un varón de 29 años de edad que fue intervenido de un osteoma de mandíbula a los 19 años de edad, y a quien posteriormente se le diagnosticó síndrome de Gardner. Ingresó en nuestro hospital con una paresia facial derecha de un día de evolución acompañada de diplopía. La exploración neurológica confirmó la existencia de una paresia leve del VI y VII pares craneales derechos. La resonancia magnética cerebral mostró una lesión sólido-quística, redondeada, de contorno bien definido, de unos 2cm de diámetro que ocupaba el cuarto ventrículo. El paciente fue intervenido mediante una craneotomía fosa posterior, abordaje telovelar y extirpación completa del tumor implantado a nivel del techo del cuarto ventrículo. El estudio anatomopatológico definitivo informó de un craneofaringioma adamantinomatoso. Conclusión: El craneofaringioma es un tumor que puede aparecer en otra localización diferente de la región selar-supraselar, y por mecanismos etiopatogénicos hasta ahora desconocidos su localización atípica puede guardar relación con alguna forma de poliposis adenomatosa familiar como el síndrome de Gardner

Introduction: Craniopharyngioma accounts for around 3% of all primary tumours of the central nervous system. It is usually located in the suprasellar region, although it may also have an ectopic location. Case report: The case is presented on 29 year-old male who underwent surgery for a jaw osteoma when he was 19 years old and was subsequently diagnosed with Gardner's syndrome. He was admitted in our Hospital with right facial paresis and diplopia of one day onset. The examination showed mild right VII and VI cranial nerves paresis. Magnetic resonance imaging of the brain demonstrated a rounded solid and cystic lesion with well-defined contours of about 2cm in diameter filling the fourth ventricle. The patient underwent a posterior fossa craniotomy using a telovelar approach with complete removal of the tumour implanted at roof level of the fourth ventricle. The final histology of the tumour was reported as adamantinomatous craniopharyngioma. Conclusion: Craniopharyngioma may appear in another location other than the suprasellar region. Its atypical location may be related to Gardner syndrome by still unknown pathogenic mechanisms

Asunto(s)

RESUMEN

This report describes a reliable and simple technique for securing external ventricular drains (EVDs) to the scalp and avoiding pullout complications. The operative technique consists of fixing the drain between 2 hydrocolloid dressings and securing it with staples. A 10-year retrospective analysis of EVD pullout complications was performed in a series of 435 consecutive patients who were treated at a single institution. The EVD pullout complication rate was 0.4%. No complications related to the fixation technique were found. The median operative time required to fix the drain was 60 seconds. The technique presented here is a simple and reliable procedure to fix the EVD to the scalp, preventing pullout complications and thus reducing the morbidity of EVD reimplantation.

Asunto(s)

RESUMEN

INTRODUCTION: Craniopharyngioma accounts for around 3% of all primary tumours of the central nervous system. It is usually located in the suprasellar region, although it may also have an ectopic location. CASE REPORT: The case is presented on 29 year-old male who underwent surgery for a jaw osteoma when he was 19 years old and was subsequently diagnosed with Gardner's syndrome. He was admitted in our Hospital with right facial paresis and diplopia of one day onset. The examination showed mild right VII and VI cranial nerves paresis. Magnetic resonance imaging of the brain demonstrated a rounded solid and cystic lesion with well-defined contours of about 2cm in diameter filling the fourth ventricle. The patient underwent a posterior fossa craniotomy using a telovelar approach with complete removal of the tumour implanted at roof level of the fourth ventricle. The final histology of the tumour was reported as adamantinomatous craniopharyngioma. CONCLUSION: Craniopharyngioma may appear in another location other than the suprasellar region. Its atypical location may be related to Gardner syndrome by still unknown pathogenic mechanisms.

Asunto(s)