RESUMEN
Stereotactic radiosurgery for craniopharyngioma is usually a high risk procedure due to the intimate relationship of the tumour to the optic chiasm and conservative dosing has been advocated to reduce complication rates. In 2002, in a publication from Karolinska Hospital, Sweden, 13 out of 21 patients received only a marginal dose of 6 Gy (not considered a radical dose) and 11 out of 13 tumours progressed. This recent report must argue against single dose stereotactic radiosurgery as the primary radiation therapy modality in most cases. However, where the disease is 'away' from the optic apparatus, such constraints do not apply. We here report the successful treatment of three consecutive patients whose craniopharyngioma was confined to the pituitary fossa, and a finite distance from the optic pathways and in whom optimal dosing was employed.
Asunto(s)
Craneofaringioma/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias Hipofisarias/cirugía , Radiocirugia/métodos , Adolescente , Adulto , Niño , Preescolar , Craneofaringioma/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Neoplasias Hipofisarias/diagnóstico , Resultado del TratamientoRESUMEN
Haemophilus influenzae is an uncommon pathogen in shunted patients and there is uncertainty about optimal management. We report here two cases which were managed differently, with different outcomes. The first case was treated with chloramphenicol and the shunt was not removed. Although there were subsequent episodes of respiratory infection, the outcome was satisfactory. The second case was treated with cefuroxime and the shunt was exteriorized. Re-shunting was followed by relapse and further shunt removal. This and other case reports suggest that in Haemophilus meningitis in shunted patients treatment need not involve shunt removal, but that this is so only if appropriate antimicrobials such as chloramphenicol are used.