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Objective Intraoperative ultrasound (IOUS) is an imaging method that can be used in various neurosurgical procedures. It assists in the removal of brain tumors, hematomas, in the insertion of ventricular catheters, and in spinal and peripheral nerve surgeries. The original studies using IOUS were performed with devices that produced lower-quality images, generating little interest in their use. The introduction of ultrasound devices that yielded higher-quality images associated with a relative low cost and ease of use rendered IOUS attractive. Thus, we started using it in multiple neurosurgical procedures, studying its practicality, efficacy and limitations. Materials and methods A retrospective case study on the use of IOUS in neurosurgery from August 2014 to December 2020 at a single institution, evaluating its practicality, efficacy and limitations. Results A total of 127 IOUS scans were performed in 112 patients aged 19 to 83 (mean: 53.8) years: 106 scans of the brain, 4 of the spinal cord, and 2 of the peripheral nerves. Brain tumors were the majority, with 86 cases (67.8%). The IOUS was unsatisfactory in 9 cases (7.1%), and there were no cases of infection related to the IOUS. Conclusion The IOUS is a dynamic, safe, and practical exam. It can be performed in a few minutes and repeated several times during the surgical procedure. It enables surgeons to observe the pulsation of tissues and vessels, the displacement of lumps in liquid collections, and to monitor the drainage of cysts and collections, in vivid, interactive and real-time images.

Objetivo A ultrassonografia intraoperatória (USIO) é um método de imagem que pode ser utilizado em vários procedimentos neurocirúrgicos. Auxilia na remoção de tumores cerebrais, hematomas, no implante de cateteres ventriculares, e em cirurgias espinhais e de nervos periféricos. Os estudos iniciais com a USIO eram realizados com aparelhos que disponibilizavam imagens de baixa qualidade, o que gerava pouco interesse no seu uso. Com o desenvolvimento de aparelhos de ultrassom que produziam imagens de melhor qualidade, eram de fácil manuseio e tinham relativo baixo custo, reacendeu-se o interesse na USIO. Por este motivo, iniciamos a utilização da USIO em múltiplos procedimentos neurocirúrgicos, e estudamos sua praticidade, eficácia e limitações. Materiais e métodos Estudo retrospectivo dos casos em que a USIO foi utilizada em neurocirurgia de agosto de 2014 a dezembro de 2020 em uma só instituição, com a avaliação de sua praticidade, eficácia e limitações. Resultados Foram realizadas 127 USIOs em 112 pacientes com idades entre 19 e 83 (média: 53,8) anos, 106 no encéfalo, 4 em medula espinhal, e 2 em nervo periférico. Os tumores cerebrais foram a maioria, com 86 casos (67,8%). A USIO foi insatisfatória em 9 casos (7,1%), e não houve casos de infecção relacionada à USIO. Conclusões A USIO é um exame dinâmico, seguro e prático. Pode ser feito em poucos minutos e repetido várias vezes durante o procedimento cirúrgico. É possível observar a pulsação dos tecidos e vasos, o deslocamento de grumos em coleções líquidas, e acompanhar a drenagem de cistos e coleções, em imagens vivas, interativas e em tempo real.

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Primary intracranial malignant fibrous histiocytoma (MFH), or myxofibrosarcoma, is an extremely rare condition, with only a few cases reported in the literature. We report a case of a dural-based myxofibrosarcoma in a previously healthy 42-year-old man that was initially presumed to be an atypical meningioma. The findings based on conventional and advanced magnetic resonance sequences, including diffusion-weighted imaging, perfusion weighted imaging and proton magnetic resonance spectroscopy, as well as histopathological aspects, are discussed.

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RESUMEN Introducción: Los tumores cerebrales son un grupo heterogéneo dada las diferentes líneas celulares que los originan. Los tumores cerebrales más frecuentes son los que se derivan de la glía, siendo los astrocitomas los más comunes. Objetivo: Sistematizar los hallazgos de los estudios que examinaron múltiples factores pronósticos de supervivencia en pacientes con tumores cerebrales tipo astrocitoma. Método: Se realizó una revisión sistemática de estudios observacionales, analíticos, prospectivos. La búsqueda bibliográfica se efectuó en las bases de datos electrónicas Medline, SciELO, LILACS, PubMed y Google Académico, con los siguientes términos descriptores: edad, sexo, factores pronósticos, cáncer cerebral, astrocitoma. Resultados: En la búsqueda se hallaron 136 452 artículos que estaban distribuidos en diferentes bases de datos. Al aplicar los criterios de elegibilidad quedaron para el análisis 13 artículos. En el caso de los factores pronósticos dependientes de la lesión, tumor o enfermedad, en la mayoría de las investigaciones se mostró una tendencia a evaluar el grado histológico y la histología de la lesión. En el caso de los pronósticos dependientes del paciente existió una mayor inclinación hacia la edad, el sexo y la sintomatología presentada, mientras que en los dependientes del tratamiento se mostraron indistintamente las modalidades de tratamiento sugeridas a los pacientes: cirugía, quimioterapia y radioterapia. Conclusiones: En esta investigación se presentaron los principales factores pronósticos en pacientes con tumores astrocíticos contenidos en las literaturas referentes al tema, que se agrupan en factores pronósticos dependientes del tumor, el paciente y el tratamiento. Estos deben ser tenidos en cuenta para evaluar al paciente con estas lesiones tumorales cerebrales.

ABSTRACT Introduction: Brain tumors are a heterogeneous group given the different cells that originate them. The most frequent brain tumors are those derived from the glia, with astrocytomas being the most common. Objective: To systematize the findings of studies that examined multiple prognostic factors for survival in patients with astrocytoma-type brain tumors. Method: a systematic review of observational, analytical, prospective studies was carried out. The bibliographic search was carried out in the electronic databases Medline, SciELO, LILACS, PubMed and Google Scholar, with the following descriptive terms: age, sex, prognostic factors, brain cancer, astrocytoma. Results: The search found 136,452 articles that were distributed in different databases. When applying the eligibility criteria, 13 articles remained for analysis. In the case of prognostic factors dependent on the lesion, tumor or disease, most researches showed a tendency to evaluate the histologic grade and the histology of the lesion. In the case of the patient-dependent prognoses, there was a greater inclination towards age, sex and the symptoms presented, while in those dependent on the treatment, the treatment modalities suggested to the patients were shown indistinctly: surgery, chemotherapy and radiotherapy. Conclusions: In this research, the main prognostic factors contained in the literature about patients with astrocytic tumors were presented, which are grouped into prognostic factors depending on the tumor, the patient and the treatment. These must be taken into account to evaluate the patient with these brain tumor lesions.

RESUMO Introdução: Os tumores cerebrais são um grupo heterogêneo devido às diferentes linhagens celulares que os originam. Os tumores cerebrais mais frequentes são os derivados da glia, sendo os astrocitomas os mais comuns. Objetivo: Sistematizar os achados de estudos que examinaram múltiplos fatores prognósticos de sobrevida em pacientes com tumores cerebrais do tipo astrocitoma. Método: Foi realizada uma revisão sistemática de estudos observacionais, analíticos e prospectivos. A busca bibliográfica foi realizada nas bases de dados eletrônicas Medline, SciELO, LILACS, PubMed e Google Acadêmico, com os seguintes termos descritivos: idade, sexo, fatores prognósticos, câncer cerebral, astrocitoma. Resultados: A busca encontrou 136.452 artigos que foram distribuídos em diferentes bases de dados. Ao aplicar os critérios de elegibilidade, restaram 13 artigos para análise. No caso de fatores prognósticos dependentes da lesão, tumor ou doença, a maioria das investigações mostrou uma tendência a avaliar o grau histológico e a histologia da lesão. No caso dos prognósticos paciente-dependentes, houve maior inclinação para a idade, sexo e os sintomas apresentados, enquanto nos dependentes do tratamento, as modalidades de tratamento sugeridas aos pacientes foram mostradas indistintamente: cirurgia, quimioterapia e radioterapia. Conclusões: Nesta pesquisa foram apresentados os principais fatores prognósticos em pacientes com tumores astrocíticos contidos na literatura sobre o assunto, os quais são agrupados em fatores prognósticos dependendo do tumor, do paciente e do tratamento. Estes devem ser levados em consideração para avaliar o paciente com essas lesões tumorais cerebrais.

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ABSTRACT Objective To report the case of a teenager (12 years old) diagnosed with a brain tumor in the right frontal-parietal region emphasizing the main characteristics observed in neuropsychological examinations. Methods In the pre-surgical evaluation, the patient presented behavioral alterations, including deficits in verbal comprehension, perceptual organization, working memory, processing speed, and slight alterations regarding constructive praxis. Results A reevaluation after two years surgery revealed significant improvement in verbal and perceptual comprehension and constructive praxis while remaining a slight change in processing speed. These results suggest that the tumor's surgical resection produced significant improvements in the patient's neurocognitive context, especially in executive functions. This study also indicates that Neuropsychological evaluation are useful for pre- and post- surgical evaluation of cognitive functioning and its evolution. Conclusion Brain tumor causes cognitive and behavioral changes and its resection can result in improvements in the patient's quality of life.

RESUMO Objetivo Relatar o caso de uma adolescente (12 anos de idade) diagnosticada com tumor cerebral na região frontoparietal direita, enfatizando as principais características observadas em exames neuropsicológicos. Métodos Na avaliação pré-cirúrgica, a paciente apresentou alterações comportamentais, incluindo déficits na compreensão verbal, organização perceptual, memória de trabalho, velocidade de processamento e pequenas alterações na praxia construtiva. Resultados Uma reavaliação dois anos após a cirurgia revelou melhora significativa na compreensão verbal e perceptiva e na práxis construtiva, permanecendo uma ligeira alteração na velocidade de processamento. Esses resultados sugerem que a ressecção cirúrgica do tumor produziu melhoras significativas no contexto neurocognitivo da paciente, sobretudo nas funções executivas. Este estudo também indica que a avaliação neuropsicológica é útil para avaliação pré e pós-cirúrgica do funcionamento cognitivo e sua evolução. Conclusão O tumor cerebral causa alterações cognitivas e comportamentais e a sua ressecção pode resultar em melhorias na qualidade de vida do paciente.

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Introducción: El nimotuzumab es un anticuerpo monoclonal empleado en el tratamiento de pacientes con tumor cerebral. Dada su novedad se justifica la realización de estudios de farmacovigilancia que avalen su seguridad. Objetivo: Caracterizar los eventos adversos relacionados con este medicamento en la práctica médica habitual. Métodos: Se realizó un estudio descriptivo y transversal de 41 pacientes con tumor cerebral primario tratados con nimotuzumab en el Departamento de Ensayos Clínicos del Hospital Provincial Docente Saturnino Lora Torres de Santiago de Cuba, desde mayo de 2017 hasta abril de 2019. Resultados: En la serie se identificaron 31 eventos adversos, de los cuales 17 eran conocidos y 14 desconocidos. Predominaron la cefalea (80,5 %), la debilidad en miembros inferiores (48,8 %) y la fosfatasa alcalina elevada (41,5 %). Cabe destacar que el total de los efectos no deseados se consideraron ligeros, según su intensidad; reversibles, según sus resultados y sin cambios, según la actitud respecto al medicamento. Conclusiones: Las características de los eventos adversos encontrados se asemejan a las descritas en otros estudios que también avalan la seguridad del fármaco.

Introduction: The nimotuzumab is a monoclonal antibody used in the treatment of patients with cerebral tumor. The realization of pharmaco surveillance studies that guaranteed its security is justified given its new features. Objective: To characterize the adverse events related to this medicine in the habitual medical practice. Methods: A descriptive and cross-sectional study of 41 patients with primary cerebral tumor treated with nimotuzumab in the Clinical Trial Department of Saturnino Lora Torres Teaching Provincial Hospital was carried out in Santiago de Cuba, from May, 2017 to April, 2019. Results: In the series 31 adverse events were identified, of which 17 were known and 14 were unknown. There was a prevalence of the headache (80.5 %), weakness in lower members (48.8 %) and the high alcaline phosphatase (41.5 %). It is necessary to highlight that all the non wanted effects were considered light according to the intensity; reversible, according to the results and without changes, according to the attitude regarding the medicine. Conclusions: The characteristics of the adverse events that were found resemble to those described in other studies that also guarantee the security of the drug.

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INTRODUCTION: Glioblastoma multiforme is the most common primary brain tumour, with the least favourable prognosis. Despite numerous studies and medical advances, it continues to be lethal, with an average life expectancy of 15 months after chemo-radiotherapy. DEVELOPMENT: Recent research has addressed several factors associated with the diagnosis and prognosis of glioblastoma; one significant factor is tumour localisation, particularly the subventricular zone, which represents one of the most active neurogenic niches of the adult human brain. Glioblastomas in this area are generally more aggressive, resulting in unfavourable prognosis and a shorter life expectancy. Currently, the research into microRNAs (miRNA) has intensified, revealing different expression patterns under physiological and pathophysiological conditions. It has been reported that the expression levels of certain miRNAs, mainly those related to neurogenic processes, are dysregulated in oncogenic events, thus favouring gliomagenesis and greater tumour aggressiveness. This review discusses some of the most important miRNAs involved in subventricular neurogenic processes and their association with glioblastoma aggressiveness. CONCLUSIONS: MiRNA regulation and function play an important role in the development and progression of glioblastoma; understanding the alterations of certain miRNAs involved in both differentiation and neural and glial maturation could help us to better understand the malignant characteristics of glioblastoma.

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BACKGROUND: Stereotactic brain biopsy (SBB) is used for establishing the histological diagnosis of intracranial lesions that are not amenable for a direct surgical approach. OBJECTIVE: The objective of the study was to describe our experience having an evaluation of the biopsy sample by a neuropathologist during SBB. MATERIALS AND METHODS: Retrospective analysis of 140 consecutive patients who underwent SBB between 2014 and 2018 in whom trans-operatory analysis of the sample was performed. RESULTS: There were 56% men. The mean age was 45 years. Histological diagnosis was performed in 131 of 140 patients (94% overall diagnostic yield). The presurgical radiological diagnosis was correct in 39%. Neoplastic lesions were reported in 108 cases, and 32 were non-neoplastic. We performed craniotomy and resection after biopsy in 14%. We found complications in 6% of patients. CONCLUSIONS: SBB continues to be a safe, useful, and inexpensive procedure. The diagnostic performance of SBB increases when intraoperative cytological evaluation by a neuropathologist is included in the study.

ANTECEDENTES: la biopsia cerebral por estereotaxia (SBB) se utiliza para establecer el diagnóstico histológico de lesiones intracraneales que no son susceptibles de un abordaje quirúrgico directo. OBJETIVO: describir nuestra experiencia de tener una evaluación de la muestra de biopsia por un neuropatólogo durante el procedimiento. MATERIAL Y MÉTODOS: análisis retrospectivo de 140 pacientes consecutivos sometidos a SBB entre 2014-2018 en los que se realizó análisis transoperatorio de la muestra. RESULTADOS: El 56% fueron hombres. La edad promedio fue de 45 años. El diagnóstico histológico se realizó en 131 de 140 pacientes (rendimiento diagnóstico global del 94%). El diagnóstico radiológico prequirúrgico fue correcto solo en el 39%. Se identificaron lesiones neoplásicas en 108 casos, y en 32 se documentaron lesiones no neoplásicas. En el 14% de los casos se realizó posterior a la biospia craneotomía y resección de la lesión. Encontramos complicaciones en el 6% de los pacientes. CONCLUSIONES: SBB sigue siendo un procedimiento seguro, útil y económico. El rendimiento diagnóstico de SBB aumenta cuando se incluye la evaluación citológica intraoperatoria por un neuropatólogo.

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Introducción: El glioblastoma multiforme es el tumor cerebral primario más frecuente y agresivo en adultos, representa cerca de 25 por ciento de los tumores intracraneales. Las principales manifestaciones clínicas están dadas por cefalea, convulsiones, cambios de conducta y un síndrome focal más definido (frontal, temporal, parietooccipital o del cuerpo calloso). En algunos pacientes, el comienzo es brusco por hemorragia o crecimiento rápido de un quiste intratumoral. El diagnóstico se realiza por resonancia magnética y se confirma con biopsia cerebral. El tratamiento es multidisciplinario e incluye resección quirúrgica, quimioterapia y radioterapia. No obstante, el pronóstico es desfavorable en la mayor parte de los pacientes. Objetivo: Describir el caso de un paciente con glioblastoma multiforme que se presentó en forma seudovascular. Caso clínico: Se presenta el caso de un paciente masculino de 60 años de edad con antecedentes de hipertensión arterial y enfermedad cerebrovascular. Tres días antes de su ingreso comenzó a manifestar dificultad para hablar y alteración en la marcha por pérdida de la fuerza muscular en el hemicuerpo derecho. Por lo anteriormente expuesto fue llevado al Hospital Clínico Quirúrgico Julio Trigo López donde fue ingresado y se diagnosticó un tumor cerebral. El paciente evolucionó tórpidamente y falleció. El estudio anatomopatológico arrojó la presencia de un glioblastoma multiforme. Conclusiones: El caso presentado de glioblastoma multiforme forma de defecto motor ofrece información sobre esta afección que en nuestro centro no es habitual(AU)

Introduction: Glioblastoma multiforme is the most frequent and aggressive primary brain tumor in adults, representing about 25percent of intracranial tumors. The main clinical manifestations are given by headache, seizures, behavior changes and a more defined focal syndrome (frontal, temporal, parieto-occipital or corpus callosum). In some patients, the onset is abrupt due to bleeding or rapid growth of an intratumoral cyst. The diagnosis is made by magnetic resonance imaging and confirmed with brain biopsy. Treatment is multidisciplinary and it includes surgical resection, chemotherapy, and radiation therapy. However, the prognosis is poor in most patients. Objective: To describe the case of a patient with glioblastoma multiforme that presented in a pseudovascular form. Clinical report: The case of a 60-year-old male patient with a history of arterial hypertension and cerebrovascular disease is report. Three days before his admission, he began to show difficulty speaking and gait disturbance due to loss of muscle strength in the right half of his body. For the foregoing, he was taken to Julio Trigo López Surgical Clinical Hospital where he was admitted and diagnosed with a brain tumor. The patient evolved torpidly and died. The pathological study revealed the presence of a glioblastoma multiforme. Conclusions: The reported case of glioblastoma multiforme in the form of a motor defect provides information on this condition that is not common in our center(AU)

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Primary intracranial malignant fibrous histiocytoma (MFH), or myxofibrosarcoma, is an extremely rare condition, with only a few cases reported in the literature. We report a case of a dural-based myxofibrosarcoma in a previously healthy 42-year-old man that was initially presumed to be an atypical meningioma. The findings based on conventional and advanced magnetic resonance sequences, including diffusion-weighted imaging, perfusion weighted imaging and proton magnetic resonance spectroscopy, as well as histopathological aspects, are discussed.

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RESUMEN: La clasificación de los Tumores Primarios del Sistema Nervioso Central (SNC) tiene su origen en la descripción morfológica, cuyo análisis histopatológico ha permitido identificar la línea celular involucrada en estos tumores y obtener el reconocimiento de ciertas características de estas lesiones y su evolución clínica. El estudio molecular ha venido a complementar el diagnóstico inicial permitiendo reconocer entidades que no son distinguibles de otra manera y que han variado los conceptos y definiciones de varias entidades patológicas que modifican el horizonte visible de estas enfermedades. El papel de las imágenes de Resonancia Magnética (RM) en el manejo de los tumores intraaxiales se puede dividir ampliamente en el diagnóstico y la clasificación de los tumores, la planificación del tratamiento y el tratamiento posterior. El presente artículo resume la evidencia epidemiológica relacionada en la clasificación de los tumores primarios del SNC con marcadores moleculares y biomarcadores de imágenes de RM, apuntando a la importancia del uso de la investigación clínica con el manejo terapéutico.

SUMMARY: The classification of primary tumors of the Central Nervous System (CNS) has its origin in the morphological description whose histopathological analysis has allowed to identify the cell line involved in these tumors and obtain the recognition of certain characteristics of these lesions and their clinical evolution. The molecular study has come to complement the initial diagnosis allowing to recognize entities that are not distinguishable in another way and that have varied the concepts and definitions of various pathological entities modifying the visible horizon of these diseases. The role of Magnetic Resonance (MR) images in the management of intraaxial tumors can be broadly divided into the diagnosis and classification of tumors, treatment planning and subsequent treatment. The present article summarizes the epidemiologic evidence related to the classification of primary tumors of the CNS with molecular markers and MR imaging biomarkers.

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Introducción: Las amebas de vida libre (AVL) Naegleria fowleri, Acanthamoeba spp., Balamuthia mandrillaris, son protozoos ampliamente distribuidos en la naturaleza. Son microorganismos oportunistas, que afectan preferentemente al sistema nervioso central causando cuadros de meningoencefalitis amebiana primaria o de encefalitis granulomatosa amebiana (EGA), ambas patologías de alta mortalidad. Descripsión del Caso: Paciente femenina de 10 años, que ingresa a nuestro hospital por presentar hemiparesia braquiocrural izquierda, vómitos y cefalea de 72 horas de evolución. Se realiza tomografía computada y Resonancia Magnética en la que se identifica una lesión expansiva, sólido-quística ubicada en la región fronto derecha. Se realiza exéresis completa de la misma y se implementa tratamiento farmacológico lográndose la restitución ad-integrum de la función motora y la resolución de la EGA a 30 meses de seguimiento. Discusión: La encefalitis granulomatosa amebiana es una patología causada por amebas de vida libre. Su presentacíon clínica puede ser indistinguible de otras causas de leptomeningitis o encefalitis, como las de origen bacteriano, viral o por micobacterias lo que impide conocer su real incidencia. Su tratamiento antiparasitario es muy complejo y su evolución es habitualmente fatal. Conclusión: Reportamos un caso de Encefalitis Amebiana Granulomatosa en una paciente pediátrica inmunocompetente, con excelente evolución.

Introduction: Free-living amoebas (FLA) Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris, are protist widely distributed in nature. Are opportunistic microorganisms, preferentially affect the central nervous system causing primary amoebic meningoencephalitis or amoebic granulomatous encephalitis (AGE), both with high mortality. Case report: A 10 year-old female patient was admitted with a three-day history of left hemiparesis accompanied with headaches and vomiting. Computed tomography and magnetic resonance were performed, in which an expansive solid cystic mass was observed in the right fronto-parietal region. Complete resection was performed and pharmacological treatment was started, achieving complete restitution of motor function and resolution of AGE after 30 months of follow-up. Discussion: AGE is a desease caused by free-living amoebas. Its clinical presentation is similar to other leptomeningitis or encephalitis of different etiology such as bacterial, viral or by mycobacterial, which cannot know its real incidence. Its pharmacological treatment is complex and its evolution is usually fatal. Conclusion: We report a case of Amoebic Granulomatous Encephalitis in an immunocompetent pediatric patient with good outcome.

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Introducción: La dupla Cyberknife y bisturí de rayos gamma (Infini) que se describe es la primera en Latinoamérica. Ambas máquinas han mostrado ser los mejores equipos para radiocirugía intracraneal. Se describe la experiencia inicial de Cyberknife en Centroamérica y su incorporación a un programa existente de bisturí de rayos gamma por vía de análisis comparativos dosimétricos. Material y método: En el año 2019 se realizaron planes comparativos y se trataron 180 pacientes con radiocirugía intracraneal con ambos sistemas tanto en patología tumoral, como vascular y funcional. Resultados: En el análisis dosimétrico comparativo en el gradiente de dosis de Infini mostró ser superior a Cyberknife en todos los casos. Para una esfera utilizando el colimador de 4 mm en Infini y de 5 mm en Cyberknife utilizando un plan isocéntrico con el -Trigeminal Path- el gradiente de dosis para Infini fue de 1.5 y para Cyberknife de 1.66. Para los casos de patología el gradiente de dosis media para Infini fue de 3 mm y para Cyberknife de 3.8 mm. Dando un puntaje de gradiente de dosis (Gradient Score Index) si Infini fuese de 100, Cyberknife obtuvo 87.3. Cyberknife mostró mejor conformalidad y cobertura (97% versus 96%) para todos los targets. Entre enero 2019 y enero 2020 se realizaron 180 radiocirugías, 60 con Cyberknife y 120 con Infini, 60 pacientes recibieron 146 sesiones con Cyberknife, radiocirugía fraccionada 39 (65%) y 21 (35%) en sesión única. Las dosis medias en tumores en dosis única fue 15 Gy (12.5 a 25 Gy) y en radiocirugía fraccionada 21 Gy (18 y 35). Ningún paciente ha experimentado toxicidad mayor a grado dos. Conclusiones: El bisturí de rayos gamma rotatorio reveló superioridad en gradiente de dosis con relación al Cyberknife. En su primer año Cyberknife ha mostrado ser una herramienta segura en el tratamiento de patología intracraneal. Más seguimiento clínico y radiológico es necesario para verificar su efectividad comparativa

Introduction: The match between Cyberknife and Infini here described in this article is the first in Latinamerica. Both machines have proven to be the best for intracranial radiosurgery, we describe our initial experience with Cyberknife in Central America and how it was incorporated in an existing gamma ray program by ways of dosimetry comparisons. Methods: During 2019 comparative plans were made and a total of 180 patients received intracranial radiosurgery with both technologies, patients were treated for tumors, vascular anomalies, and functional pathology. Results: Basic dosimetry analysis regarding dose gradient the Infini proved superior to Cyberknife in all plans. For a sphere using the 4 mm collimator in Infini and the 5 mm in Cyberknife along with an isocentric plan using the -Trigeminal Path- dose gradient was 1.5 for Infini and 1.66 for Cyberknife. For the pathology cases Infini was 3 mm and for Cyberknife 3.8 mm on mean. Giving a Gradient Score Index (GSI) if Infini would be 100, Cyberknife would be 87.3. Cyberknife showed better conformality and coverage for all pathology targets (97% versus 96%). From January 2019 to January 2020, 180 intracranial radiosurgeries were done, 60 with Cyberknife and 120 with Infini, 60 patients received 146 sessions with Cyberknife, fractionated scheme 39 (65%) and 21 (35%) single dose. The median dose for tumors was 15 Gy (12.5 a 25 Gy) for single session and 21 Gy (18 y 35) for fractionated scheme. No patient experienced a higher toxicity tan grade two. Conclusions: In its first year Cyberknife has shown to be safe in treating intracranial pathology. Infini had a better dose gradient than Cyberknife. Longer clinical and radiological follow-up is needed to verify its comparative effectiveness.

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RESUMEN Introducción: los ependimomas constituyen aproximadamente del 3-5 % de los tumores intracraneales y del 5-10 % de los tumores cerebrales, en la edad pediátrica. Objetivo: caracterizar los pacientes con ependimomas intracraneales intervenidos quirúrgicamente, en el Hospital Pediátrico ¨Juan Manuel Márquez. ¨ Materiales y método: estudio descriptivo, retrospectivo, a pacientes en edad pediátrica con diagnóstico histológico de ependimoma de localización intracraneal. En el período de enero 2012 a diciembre 2017. El universo quedó conformado por todos los pacientes en edad pediátrica operados con diagnóstico histológico de ependimoma intracraneal en el lugar y período antes mencionado (N=22). Resultados: la edad media fue 2,75 años con límites entre 1 y 17 y una desviación estándar de 3,65. Los pacientes del sexo masculino representaron el 63,64 %, la relación con el sexo femenino en los primeros 4 años fue de 1:1. En cuanto al cuadro clínico, se observó predominio de la hidrocefalia en el 72,73 % de los pacientes. Los ependimomas intracraneales de localización infratentorial, (63,64 %) predominaron. El 45,45 % de las lesiones estudiadas se correspondían con el subtipo histológico de ependimoma anaplásico. Conclusiones: la combinación de cirugía, radioterapia y quimioterapia se empleó en la mayoría de los casos. Predominó el abordaje directo de la lesión a través de craneotomía y exéresis adecuada a la localización del ependimoma, sin embargo, en la mayoría solo se logró resección entre el 50 y 90 %. En la mayoría de los pacientes la evolución luego del diagnóstico, evidenció una tendencia hacia la estabilidad (AU).

ABSTRACT Introduction: ependymoma are almost 3-5 % of the intracranial tumors and 5-10 % of the brain tumors in pediatric age. Objective: to characterize the patients with intracranial ependymoma who underwent surgery in the Pediatric Hospital ¨Juan Manuel Márquez.¨ Materials and method: retrospective, descriptive study of patients in pediatric age with histological diagnosis of ependymoma of intracranial location in the period January 2012-December 2017. The universe was formed by all patients of pediatric age who underwent surgery with histological diagnosis of intracranial ependymoma in the before-mentioned place and period (N=22). Results: the average age was 2.75 years with limits between 1 and 17 years old. Male patients represented 63.64 %; the relation with female sex during the first 4 years was 1:1. Regarding the clinical characteristics, hydrocephaly predominated in 72.73 % of patients. Intracranial ependymoma of infratentorial location (63.64 %) predominated. 45.45 % of the studied lesions corresponded to the histological subtype of anaplastic ependymoma. Conclusions: the combination of surgery, radiotherapy and chemotherapy was used in most of the cases. The direct approach of the lesion through craniotomy and a removal adequate to ependymoma location predominated. However, in most of them just the resection of 50-90 % was achieved. The evolution of most of patients after the diagnosis evidenced a tendency to the stability (AU).

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Resumen: La tomografía por emisión de positrones/tomografía computada (PET/CT) por sus siglas en inglés, es una modalidad de imagen única que proporciona evidencia in vivo de actividades tanto bioquímicas como fisiológicas en diferentes órganos y estructuras del cuerpo. El meduloblastoma es el tumor maligno más frecuente del sistema nervioso central (SNC) en pacientes pediátricos, por este motivo el PET/CT juega un papel importante en el manejo de estos pacientes ya que proporciona información sobre el grado y extensión del tumor, así como a determinar el sitio adecuado para la toma de biopsia, valorar la respuesta al tratamiento y determinar el pronóstico del paciente. Existen diferentes radiofármacos para la evaluación de los tumores de sistema nervioso central, pero se ha estudiado que el 18F-FDG (flúor-2-fluoro-2-desoxi-D-glucosa) y el 68Ga-DOTA-NOC (68Ga-DOTA0-1NaI3-octreotide) nos ayudan a evaluar y dar seguimiento a pacientes con diagnóstico de meduloblastoma. El meduloblastoma tiene una sobreexpresión de transportadores de glucosa, principalmente tipo 1 y sobreexpresión de receptores de somatostatina predominantemente tipo 2, lo cual permite que exista una gran afinidad por estos radiofármacos.

Abstract: PET/CT (positron emission tomography/computed tomography, for its acronym in English) is a unique imaging method that provides in vivo evidence of both biochemical and physiological activities of the brain, spinal cord and tumors that involve these structures. Medulloblastoma is the most common malignant tumor of the central nervous system (CNS) in pediatric patients, so PET/CT plays an important role as it provides information on the grade and extent of the tumor, as well as to determine the appropriate site for the biopsy, assessing the response to the treatment and the patient's prognosis. There are different radiopharmaceuticals for the evaluation of central nervous system tumors, but 18F FDG (Fluor-2-fluoro-2-desoxy-D-glucose) and 68Ga-DOTA-NOC (68Ga-DOTA0-1NaI3-octreotide) have been studied to help us evaluate and follow up patients diagnosed with medulloblastoma. Medulloblastoma has an overexpression of glucose transporters, mainly type 1, and an overexpression of predominantly type 2 somatostatin receptors, which allows a high affinity for these radiopharmaceuticals.

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El desarrollo tecnológico y científico en salud de los últimos años ha permitido mejoras en el diagnóstico y mayor eficacia en el tratamiento de pacientes con tumores cerebrales, generado un aumento no solo en la supervivencia, sino también una mayor demanda de los servicios de neuropsicología y rehabilitación, debido a las alteraciones cognitivas asociadas y dificultades en cuanto a la funcionalidad e independencia, disminuyendo significativamente la calidad de vida de estos pacientes. La presente investigación documenta el caso de un paciente masculino de 43 años, remitido al servicio de neuropsicología tras la resección de oligoastrocitoma frontal derecho, en la evaluación neuropsicológica se evidenció alteraciones en funciones ejecutivas, fluidez de lenguaje discursivo y dificultad en habilidades instrumentales. La investigación se realizó bajo el diseño cuasi experimental de caso único, donde se aplicó en repetidas ocasiones a lo largo del tratamiento el Inventario de Adaptabilidad Mayo-Portland (MPAI-4) para determinar las dificultades funcionales del paciente. El objetivo de la rehabilitación neuropsicológica se centró en implementar estrategias de autoinstrucciones y automonitoreo, que pudieran ser aplicadas en contextos cotidianos y en intereses específicos del paciente. Los resultados indican que el proceso de rehabilitación neuropsicológica demostró tener un efecto positivo en la funcionalidad del paciente y las estrategias aprendidas pueden ser trasladadas a su vida cotidiana

The technological and scientific development on health in recent years has allowed improvements in diagnosis and treatment on brain tumor patients, have increase not only their survivor rate but also their need of neuropsychology and rehabilitation services due to cognitive alterations associated and the subsequent struggling with independence and functionality that reduces significantly their life quality. The present research documents the case of a male patient, 43 years old, referred to the service after resection of right frontal oligoastrocytoma, in the neuropsychologic evaluation evidenced executive functions, discursive language fluency alterations and difficulties in instrumental skills. The research was carried out under the quasi experimental design of a single case where there will be applied repeatedly during the course of treatment the Mayo-Portland Adaptability Inventory (MPAI-4) to identify functional difficulties on the patient. The objective of the neuropsychological rehabilitation focuses on implementing self-instruction and self-observance strategies in order to apply them on an ordinary context and the patient's specific areas of interest. The results indicate that the neuropsychological rehabilitation treatment has shown a positive effect on the patient's functionality and an improvement on his ability to apply the learned strategies to his day to day life.

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Resumen: Introducción: la craneotomía vigil para el tratamiento de tumores cerebrales en áreas elocuentes es una técnica que se realiza en forma cada vez más frecuente. Sin embargo, muy poca literatura se ha publicado en referencia a cómo percibe el paciente esta experiencia que podría parecer estresante. El objetivo de este trabajo es describir la experiencia emocional de los pacientes sometidos a despertar intraoperatorio para el tratamiento de los gliomas. Materiales y Métodos: Se realizó una revisión retrospectiva de 16 pacientes operados entre enero de 2015 y octubre de 2017, a los cuales se les efectuó una craneotomía con despertar intraoperatorio. Se identificaron 6 pacientes que cumplieron con los criterios de inclusión. Posteriormente a la cirugía se realizó, en una primera instancia, encuestas estandarizadas en donde se evaluó: datos sociodemográficos, nivel de ansiedad durante el despertar intraoperatorio, miedo a la anestesia y nivel de información de la enfermedad. En una segunda instancia, se le realizó una entrevista subjetiva por parte de un Licenciado en Psicología. Resultados: De los datos sociodemográficos obtuvimos que el 67% son hombres, y que la media de edad era de 30,66 años. En cuanto a la ansiedad observamos que el 60% de los pacientes tenían un nivel de ansiedad bajo, el 40% un nivel de ansiedad medio, y destacamos que ningún paciente tuvo un nivel de ansiedad alto. Con respecto al miedo a la anestesia y acto quirúrgico el 67% no tuvo miedo, mientras que el 37% restante afirman tenerlo, y los motivos más frecuentes para ello fueron: a morir, y a quedar con secuelas. En cuanto al nivel de información que fue proporcionada por el médico, en un 17% fue excelente, 33% muy completa, el 33% indicaron que la información fue suficiente y el 17% restante indica que la misma fue escasa. Conclusión: Destacamos que la cirugía con despertar intraoperatorio es bien tolerada. De las lecciones prácticas aprendidas enfatizamos la importancia de la entrevista preoperatoria en donde se explican con detalle el objetivo del procedimiento y cuáles son los pasos a seguir, para de esta manera maximizar la cooperación.

Abstract: Introduction: awake craniotomy for brain tumors surgery is a technique that is performed for tumors located on eloquent areas. However, a few articles has been published in reference to how the patient perceives this experience. Our objective is to describe the emotional experience of patients undergoing intraoperative awakening for the treatment of gliomas. Materials and Methods: Retrospective review of 16 patients operated between January 2015 and October 2017, who underwent awake craniotomy. Six patients who met the inclusion criteria were identified. After the surgery, standardized surveys were carried out, in the first instance, where the following were evaluated: sociodemographic data, level of anxiety during intraoperative awakening, fear of anesthesia and level of information about the disease. In a second instance, a subjective interview was conducted by a Psychologist. Results: There were 4 mans and 2 womens with average age was 30.66 years. Regarding anxiety, we observed that 60% of patients had a low anxiety level, 40% had a medium level of anxiety, and we emphasized that no patient had a high level of anxiety. Regarding the fear of anesthesia and surgery, 67% were not afraid, while the remaining 37% claim to have fear of death or sequelae. Regarding the level of information that was provided by the doctor, 17% was excellent, 33% very complete, 33% indicated that the information was sufficient and the remaining 17% indicated that it was scarce. Conclusion: We emphasize that surgery with intraoperative awakening is well tolerated. From the practical lessons learned we emphasize the importance of the preoperative interview where the objective of the procedure is explained in detail and which are the steps to follow, in order to maximize cooperation.

Resumo: Introdução: A craniotomia de vigília para o tratamento de tumores cerebrais em áreas eloqüentes é uma técnica cada vez mais realizada. No entanto, muito pouca literatura foi publicada em referência a como o paciente percebe essa experiência que pode parecer estressante. O objetivo deste trabalho é descrever a experiência emocional de pacientes submetidos ao despertar intraoperatório para o tratamento de gliomas. Materiais e Métodos: Revisão retrospectiva de 16 pacientes operados entre janeiro de 2015 e outubro de 2017, submetidos à craniotomia com despertar intraoperatório. Foram identificados seis pacientes que preencheram os critérios de inclusão. Após a cirurgia, em primeira instância, foram realizados inquéritos padronizados, nos quais foram avaliados: dados sociodemográficos, nível de ansiedade durante o despertar intraoperatório, medo da anestesia e nível de informação sobre a doença. Em um segundo momento, uma entrevista subjetiva foi conduzida por um Bacharel em Psicologia. Resultados: A partir dos dados sociodemográficos, obtivemos que 67% são homens e a idade média foi de 30,66 anos. Em relação à ansiedade, observamos que 60% dos pacientes apresentavam baixo nível de ansiedade, 40% apresentavam nível médio de ansiedade e enfatizamos que nenhum paciente apresentava alto nível de ansiedade. Com relação ao medo da anestesia e da cirurgia, 67% não temeram, enquanto os 37% restantes afirmaram tê-lo, e os motivos mais frequentes foram: morrer e ficar com seqüelas. Em relação ao nível de informação que foi fornecido pelo médico, 17% foi excelente, 33% muito completo, 33% indicaram que a informação era suficiente e os 17% restantes indicaram que esta era escassa. Conclusão: Enfatizamos que a cirurgia com despertar intraoperatório é bem tolerada. A partir das lições práticas aprendidas, enfatizamos a importância da entrevista pré-operatória, onde o objetivo do procedimento é explicado em detalhes e quais são os passos a seguir, a fim de maximizar a cooperação.

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O Glioblastoma (GBM) é o tumor cerebral mais comum e maligno, caracterizado por sua alta agressividade e respostas ineficazes aos tratamentos disponíveis. O diagnóstico impõe uma elevada taxa de mortalidade aos pacientes acometidos, que apresentam um tempo de sobrevida médio menor do que dois anos. A nível molecular, GBMs apresentam alterações em componentes chave das vias de sinalização de receptores tirosina quinase (RTKs), Ras/ERK e PI3K/AKT/mTORC1. A família das "ribosomal protein S6 kinases" (RSKs), ativada pela via Ras/ERK, foi proposta como um regulador da via de mTORC1, convergindo na regulação da síntese de proteínas. Em humanos, foram descritas quatro isoformas de RSKs (RSK1 - 4), que apresentam alta homologia e regulam diferentes funções celulares, sendo a desregulação das RSKs responsável por diferentes processos oncogênicos em diversos tipos tumorais. Contudo, a função das RSKs na regulação da síntese proteica global e de mRNAs específicos em GBMs ainda não foi descrita. Com a finalidade de se estabelecer um modelo robusto para o estudo dos efeitos das RSKs, especialmente do papel específico das isoformas no processo de tradução, foram geradas células nocaute para RSK1, RSK2 e duplo nocautes para RSK1 e RSK2 na linhagem celular de GBM LN-18, através da técnica CRISPR/Cas9. Os estudos com os clones nocautes validou o alvo P(S1798)-TSC2 para avaliação dos efeitos das RSKs. Além disso, detectamos que o alvo de RSKs, P(S422)-eIF4B, pode ser preferencialmente regulado pelas RSKs e não por mTORC1. Importantemente, realizamos a translatômica das células nocaute e analisamos os mRNAs diferencialmente traduzidos na presença ou ausência do inibidor de mTOR, Torin1, para estabelecer um modelo para o estudo da tradução de mRNAs dependentes de RSKs. A análise por meio de microarranjos mostrou que as isoformas RSK1 e RSK2 regulam diferentes conjuntos de mRNAs. A família de mRNAs contendo sequências 5'TOP são um dos principais alvos de mTORC1. De maneira surpreendente, observamos que a maioria dos 5'TOP mRNAs tem a tradução dependente de RSK1, em um mecanismo visualizado somente quando mTORC1 está inativado. Essa observação indica fortemente que RSK1, mas não RSK2 estaria mediando um mecanismo redundante e de resistência contra a inativação de mTORC1. Além disso, propomos um mecanismo inédito de controle da tradução de 5'TOP mRNAs. Desse modo, descrevemos um importante modelo para o entendimento das funções biológicas da família das RSKs em GBMs, que contribuirá com o desenho de alvos terapêuticos mais eficientes (AU)

Glioblastoma (GBM) is the most frequent and malignant brain tumor, characterized by its aggressiveness and poor response to the available treatments. Once diagnosed, GBM patients are inflicted with high mortality rates, and a mean survival lower than two years. From a molecular point of view, GBMs display alterations in key components of receptor tyrosine kinases (RTK), Ras/ERK and/or PI3K/AKT/mTORC1 pathways. The p90 ribosomal S6 kinase family (RSK) is directly regulated by the Ras/ERK pathway, and is thought to regulate mTORC1 pathway, converging on regulation of protein synthesis. Human cells display four RSK isoforms (RSK 1 - 4) that share high levels of sequence homology and regulate several cellular functions. The deregulation of RSKs seems to be responsible for different oncogenic outcomes in several types of tumors. Nevertheless, the function of RSKs in regulation of global protein synthesis and in translation of specific subsets of mRNA in GBM was not described so far. In order to establish a robust model for studying the effects of RSKs focusing on isoform-specific roles in the control of translation, we generated knockout cells using CRISPR/Cas9 system technology for RSK1, RSK2 and double-knockout cells for RSK1 and RSK2 in LN-18 cell line. The studies with knockout cells validated the target P(S1798)-TSC2 to evaluate the effects of RSKs. Also, we found that the RSK target P(S422)-eIF4B might be preferably regulated by RSKs, rather than mTORC1 in LN-18 cells. Importantly, we performed the translatomics on knockout cells and analyzed differentially translated mRNAs in the presence or absence of the mTOR inhibitor, Torin1, in order to determine a model for studying the translation of RSK-dependent mRNAs. Microarray data analysis revealed that RSK1 and RSK2 regulate different sets of mRNAs. The family of mRNAs containing a 5'TOP motif is the main target of mTORC1. Surprisingly, we observed that the majority of 5'TOP mRNAs have its translation dependent on RSK1, in a mechanism that emerges only when mTORC1 is inactivated. This observation strongly suggests that RSK1, but not RSK2, is mediating a mechanism of resistance against mTORC1 inactivation. Moreover, we propose an unprecedented mechanism for translation control of 5'TOP mRNAs. With this study, we were able to describe an important model for understanding the biological functions of RSK in GBMs that will contribute with development of more efficient therapeutic targets (AU)

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Introducción: los tumores que se diseminan en el cerebro, provenientes de una neoplasia primaria localizada en otros órganos del cuerpo son conocidos como tumores cerebrales metastásicos. Se estima que el 25 por ciento de los tumores malignos en otros lugares del organismo provocan metástasis en la cabeza. Objetivo: sistematizar los aspectos clínicos, epidemiológicos y quirúrgicos de los tumores cerebrales metastásicos, así como las herramientas diagnósticas y terapéuticas necesarias para ofrecerles al enfermo y familiares las mejores alternativas ante la enfermedad. Método: se realizó una revisión narrativa a partir del estudio documental de revisiones sistemáticas, metaanálisis, guías de práctica clínica, artículos originales y tesis doctorales que se encontraron en las bases de datos electrónicas. Resultados: la incidencia de la metástasis cerebral varía en dependencia de la localización del tumor primario. En los adultos, la incidencia más alta se observó entre la quinta y séptima década de vida, sin diferencias en el sexo. Los tumores cerebrales tienen diferentes formas de presentación clínica, entre ellas se encontraron el síndrome de hipertensión intracraneal, signos focales, crisis epilépticas y síndrome endocrino. Los tres componentes primordiales del manejo de pacientes con metástasis cerebral fueron las drogas no quimioterapéuticas y quimioterapéuticas, la intervención quirúrgica para la exéresis tumoral y la radioterapia. Conclusiones: los tumores metastásicos cerebrales constituyen un problema de salud con incidencia creciente, con un cuadro sindrómico complejo y polimorfo, poseen amplio arsenal terapéutico que abarca las drogas no quimioterapéuticas, la quimioterapia, la quirúrgica y la radioterapia las cuales deben ser ajustadas a las características de cada paciente para lograr una sobrevida lo más larga posible, con mayor calidad de vida(AU)

Introduction: tumors that spread in the brain, from a primary neoplasm located in other organs of the body are known as metastatic brain tumors. It is estimated that 25per cent of malignant tumors in other parts of the body cause head metastases. Objective: to systematize the clinical, epidemiological and surgical aspects of metastatic brain tumors, as well as the diagnostic and therapeutic tools necessary to offer the patient and family the best alternatives to the disease. Method: a narrative review was carried out based on the documentary study of systematic reviews, meta-analysis, clinical practice guides, original articles and doctoral theses that were found in the electronic databases. Results: the incidence of brain metastasis varies depending on the location of the primary tumor. In adults, the highest incidence was observed between the fifth and seventh decade of life, without differences in sex. Brain tumors have different forms of clinical presentation, including intracranial hypertension syndrome, focal signs, epileptic seizures and endocrine syndrome. The three primary ISSN 1028-9933 526 components of the management of patients with cerebral metastases were non-chemotherapeutic and chemotherapeutic drugs, surgical intervention for tumor excision and radiotherapy. Conclusions: metastatic brain tumors constitute a health problem with increasing incidence, with a complex syndromic and polymorphic picture, they have a wide therapeutic arsenal that includes non-chemotherapeutic drugs, chemotherapy, surgery and radiotherapy which must be adjusted to the characteristics of each patient to achieve a survival as long as possible, with a better quality of life(AU)

Introdução: tumores que se espalham no cérebro, a partir de uma neoplasia primária localizada em outros órgãos do corpo, são conhecidos como tumores cerebrais metastáticos. Estima-se que 25per cent dos tumores malignos em outras partes do corpo causem metástases na cabeça. Objetivo: sistematizar os aspectos clínicos, epidemiológicos e cirúrgicos dos tumores cerebrais metastáticos, bem como as ferramentas diagnósticas e terapêuticas necessárias para oferecer ao paciente e à família as melhores alternativas para a doença. Método: foi realizada uma revisão narrativa baseada no estudo documental de revisões sistemáticas, metanálises, guias de prática clínica, artigos originais e teses de doutorado encontradas nas bases de dados eletrônicas. Resultados: a incidência de metástases cerebrais varia de acordo com a localização do tumor primário. Nos adultos, a maior incidência foi observada entre a quinta e a sétima década de vida, sem diferenças entre os sexos. Os tumores cerebrais têm diferentes formas de apresentação clínica, incluindo síndrome de hipertensão intracraniana, sinais focais, convulsões epilépticas e síndrome endócrina. Os três componentes principais do tratamento de pacientes com metástases cerebrais foram medicamentos não quimioterápicos e quimioterápicos, intervenção cirúrgica para excisão de tumores e radioterapia. Conclusões: os tumores cerebrais metastáticos constituem um problema de saúde com incidência crescente, com quadro sindrômico e polimórfico complexo, possuem amplo arsenal terapêutico que abrange medicamentos não quimioterápicos, quimioterapia, cirurgia e radioterapia, que devem ser ajustados às características de cada paciente para alcançar a sobrevivência o maior tempo possível, com uma melhor qualidade de vida(AU)

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Abstract Grade III anaplastic ganglioglioma is an aggressive, rare, and radiosensitive central nervous system (CNS) tumour. It is more common in males, with a ratio of 1.3 to 1. Its peak incidence is in the third decade of life. Only 10 cases were recorded in children in Colombia from 2000 to 2014, with a fatal outcome in spite of radiation therapy. This is a case of an adolescent, who began having headaches, with warning signs related to an arteriovenous malformation hindering the diagnosis of this rare tumour. This presented in its aggressive, multi-focus form. Knowledge of clinical manifestations of space-occupying intracranial lesions facilitates the assessment and treatment of affected children.

Resumen El ganglioglioma anaplásico grado III es un tumor del sistema nervioso central (SNC) agresivo, infrecuente y radiosensible. Afecta más a hombres en una relación 1,3 a 1. Su pico de incidencia se encuentra en la tercera década de la vida. Existen solo 10 casos registrados en niños en Colombia desde el 2000 al 2014, con desenlace fatal a pesar de la radioterapia. Se presenta un caso de un adolescente que debutó con cefalea con signos de alarma asociado a una malformación arteriovenosa que dificultó el diagnóstico de este raro tumor, cuya presentación fue la más agresiva: la forma multicéntrica. El conocer las manifestaciones clínicas de lesiones intracraneales ocupantes de espacio facilita la evaluación y tratamiento a los niños afectados.

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ABSTRACT This paper presents an improved classification system for brain tumours using wavelet transform and neural network. The anisotropic diffusion filter was used for image denoising, and the performance of the oriented rician noise reducing anisotropic diffusion (ORNRAD) filter was validated. The segmentation of the denoised image was carried out by fuzzy c-means clustering. The features were extracted using symlet and coiflet wavelet transforms, and the Levenberg-Marquardt algorithm based neural network was used to classify the magnetic resonance (MR) images. This classification technique of MR images was tested and analysed with existing methods, and its performance was found to be satisfactory with a classification accuracy of 93.24%. The developed system could assist physicians in classifying MR images for better decision-making.

RESUMEN Este artículo presenta un sistema de clasificación mejorado para los tumores de cerebro usando la transformada de ondeletas (transformada wavelet) y la red neuronal. El filtro de difusión anisotrópica fue utilizado para la eliminación del ruido de la imagen, y se validó el funcionamiento del filtro de difusión anisotrópica orientado a reducir el ruido riciano (ORNRAD, siglas en inglés). La segmentación de la imagen 'desruidizada ' (denoised) fue realizada mediante el agrupamiento difuso c-means fuzzy. Las características fueron extraídas usando las transformadas de ondeletas symlet y coiflet, y la red neuronal basada en el algoritmo de Levenberg-Marquardt fue utilizada para clasificar las imágenes de resonancia magnética (RM) imágenes. Esta técnica de clasificación de imágenes de RM fue probada y analizada con métodos existentes, y se halló que su rendimiento era satisfactorio con una precisión de clasificación de 93.24%. El sistema desarrollado podría ayudar a los médicos a clasificar imágenes de RM para una mejor toma de decisiones.

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