RESUMEN
Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.
Asunto(s)
Neoplasias Encefálicas/cirugía , Cirugía Asistida por Computador/métodos , Ácido Aminolevulínico , Microscopía Fluorescente/métodos , Cuidados Posoperatorios , Neoplasias Encefálicas/patología , Cuidados Preoperatorios , Estudios Retrospectivos , Neuronavegación/métodos , Cerebro/cirugía , Cerebro/patología , Cuidados Intraoperatorios , América Latina/epidemiologíaRESUMEN
Metastasis to the calvarium with direct pericranium or dural infiltration may be treated with radical surgical removal in selected cases. We describe microsurgical resection of calvarial metastases with fluorescence-guided technique using 5-aminolevulinic acid (5-ALA) in two female patients with breast cancer. Fluorescence findings were positive in both cases. Margins in the scalp and dural layer were 5-ALA negative at the end of surgical removal. Intraoperative pathology was performed in all cases to confirm if oncological limits were free of disease. One case was 5-ALA positive in the outer layer of the dura-mater and another in the pericranium. At the end of the removal in both cases, the surgicalmargins were 5-ALA fluorescence-free. Intraoperative pathology confirmed oncological limits of the resection. 5-aminolevulinic acid fluorescence-guided surgery for calvarial metastases with pericranium and/or dural extension seems to be a safe and reliable method to aid the surgical margins for complete removal, possibly delaying or avoiding adjuvant irradiation for progression control.
Asunto(s)
Neoplasias de la Base del Cráneo/cirugía , Fluorescencia , Ácido Aminolevulínico , Metástasis de la Neoplasia , Cráneo/anomalías , Cráneo/cirugía , Estudios Retrospectivos , Neoplasias de la Base del Cráneo/diagnóstico , Márgenes de EscisiónRESUMEN
The illustrious Colombian Professor Salomón Hakim provided the annals of neurology with one of the most brilliant and original bodies of research on record, developing the concept of normal pressure hydrocephalus, as well as proving that ventricular shunting is an effective treatment. Thus, Professor Hakim proved that some of the dementias, at that time considered senile, could be successfully treated. Here the authors present an historical review of his main contributions, which continue to influence the study of dementia to this day.
Asunto(s)
Hidrocéfalo Normotenso/historia , Neurología/historia , Colombia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Derivación Ventriculoperitoneal/historiaRESUMEN
ABSTRACT The illustrious Colombian Professor Salomón Hakim provided the annals of neurology with one of the most brilliant and original bodies of research on record, developing the concept of normal pressure hydrocephalus, as well as proving that ventricular shunting is an effective treatment. Thus, Professor Hakim proved that some of the dementias, at that time considered senile, could be successfully treated. Here the authors present an historical review of his main contributions, which continue to influence the study of dementia to this day.
RESUMO O ilustre professor colombiano Salomón Hakim deixou como legado nos anais da neurologia uma das mais brilhantes e originais séries de pesquisa da história, desenvolvendo o conceito de hidrocefalia de pressão normal, bem como introduzindo a derivação ventricular como tratamento efetivo. Assim, Hakim provou que algumas das demências até então consideradas senis tinham possibilidade de tratamento bem-sucedido. Aqui os autores apresentarão uma revisão histórica de suas maiores contribuições, que continuam a influenciar o estudo de demências até os nossos dias.
Asunto(s)
Historia del Siglo XX , Historia del Siglo XXI , Hidrocéfalo Normotenso/historia , Neurología/historia , Derivación Ventriculoperitoneal/historia , ColombiaRESUMEN
During a 4-month period, 2 recipients of renal homografts developed infections caused by Mycobacterium abscessus (M. chelonei). The infections were indolent and progressive, producing multiple subcutaneous abscesses and osteomyelitis, located primarily in the legs. Vogorous efforts did not identify intrahospital source(s) of infection. A skin test survey using mycobacterial antigens suggested that apparently healthly hospital personnel who cared for these patients were not themselves infected.