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PURPOSE: Stereotactic brain biopsies are highly efficient for diagnosing intracerebral pathologies, particularly when surgical resection is infeasible. Fluorescence-based agents such as 5-aminolevulinic acid (5-ALA) and fluorescein sodium (NaFl) can enhance diagnostic accuracy and safety, improving the visualization of lesional tissues. This meta-analysis aimed to evaluate their effect on diagnostic yield and complication rates of brain biopsies. METHODS: This study adhered to Cochrane and PRISMA guidelines. We assessed studies for diagnostic yield and complication rates. Data was analyzed using a random-effects model in RStudio. Diagnostic accuracy measures such as sensitivity and predictive values were calculated based on fluorescence visibility in biopsy samples. RESULTS: Thirty-two non-randomized studies were included, comprising 947 patients, with a mean age ranging from 37 to 77 years, and a mean sample number ranging from 1 to 15 specimens. Diagnostic yields were high: 93% for NaFl and 96% for 5-ALA. Major complications occurred in 3% of procedures with both agents, while minor complications were reported in 7% and 5% with NaFl and 5-ALA respectively. The Negative-predictive-value (NPV) of 5-ALA and NaFl were 8-11% and 60-80% respectively. NaFl demonstrates higher sensitivity and specificity at 84% and 100% compared to 5-ALA's 66%. and 85% respectively. CONCLUSION: 5-ALA and NaFl provide high diagnostic yields with acceptable safety profiles in stereotactic biopsies. NaFl showed higher sensitivity and specificity. NaFl outperforms 5ALA in terms of NPV making it more efficient for small lesions near eloquent regions or major blood vessels. The significance of these findings can be further ascertained through randomized trials.

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Juvenile xanthogranuloma (JXG) is a rare type of non-Langerhans cell histiocytosis. Its systemic form affects 4% of patients. Lesions in the Central Nervous System (CNS) occur in 2% of systemic cases. Sellar JXG should be one of the differential diagnoses for sellar lesions in young. This is a 15-year-old patient with non-specific headache, progressive visual loss and magnetic resonance imaging showing sellar lesion with suprasellar extension. The patient underwent microsurgery by pterional craniotomy with partial resection of the tumor. Pathology evidenced JXG. It progressively evolved with impairment of neuroendocrine functions, new lesions in different CNS locations and death two years after diagnosis. Sellar JXG without cutaneous manifestations is rare. There are no specific findings of the disease. Diagnosis requires additional tests, being defined by pathological analysis. Total resection presents a greater potential control comparing to partial resection. Even so, some patients may have progressive disease with poor clinical outcome.

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Intracranial lipomas are rare benign tumors considered exceptional when localized in the cerebellopontine angle (CPA), with an incidence of 0.1% of the total number of expansive processes located in this area. We present a case of the sudden death of a 26-year-old young woman in which an unencapsulated neoformation of 0.8 cm was documented at the right cerebellopontine angle and was histologically characterized as intracranial lipoma. The cause of death was then identified as a cardiocirculatory failure secondary to supratentorial (uncal right) herniation caused by the lipoma of the pontocerebellar angle with high-grade diffuse cerebral edema.

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Background: Cryptococcosis is an invasive fungal infection primarily affecting lungs and potentially spreading to the central nervous. This fungal infection might be misdiagnosed as other infection diseases, such as tuberculosis; granulomatous diseases, like sarcoidosis; and even neoplastic diseases. Some previous reports described cases of cryptococcomas resembling brain tumors. In this paper, we present a very rare presentation of brain cryptococcoma mimicking a malignant glioma. To the best of our knowledge, this is the third case description in the literature. Case Description: A 64-year-old male patient presented at the hospital with a history of progressive frontal headache for 1 month, becoming moderate to severe, associated with visual changes, without nausea or vomiting. No fever was reported. He was a heavy smoker and denied other relevant previous medical data. Neuroimage disclosed a right temporal expansive lesion initially considered a malignant glioma. The patient underwent a right temporal craniotomy and biopsy revealed a cryptococcoma. Conclusion: Cryptococcomas characteristics in magnetic resonance are quite nonspecific. They should always be included in differential diagnosis of expansive brain lesions, both malignant and benign. Therefore, once cryptococcomas may resemble like other intracranial expansive lesions, biopsy should always be carried out to clarify diagnosis and avoid inadequate treatment and definition of prognosis only based on radiological patterns.

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ABSTRACT Intracranial lipomas are rare benign tumors considered exceptional when localized in the cerebellopontine angle (CPA), with an incidence of 0.1% of the total number of expansive processes located in this area. We present a case of the sudden death of a 26-year-old young woman in which an unencapsulated neoformation of 0.8 cm was documented at the right cerebellopontine angle and was histologically characterized as intracranial lipoma. The cause of death was then identified as a cardiocirculatory failure secondary to supratentorial (uncal right) herniation caused by the lipoma of the pontocerebellar angle with high-grade diffuse cerebral edema.

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Teratoma is a rare neoplasia with differentiation in two or three germ cell lines. Intracranial teratoma in birds has rarely been reported, especially affecting the brain. This is the first report of a brain teratoma in a mallard with neurological clinical signs. The neoplasm was characterized as a mature brain teratoma, extending from the cerebellum to the brainstem, and with one nodule in the cortex.(AU)

O teratoma é uma neoplasia rara, com diferenciação em duas ou três linhagens de células germinativas. Teratomas intracranianos, em aves, são raramente relatados, principalmente, com localização cerebral. Este é o primeiro relato de teratoma cerebral em um pato-real com sinais clínicos neurológicos. A neoplasia foi caracterizada como um teratoma cerebral maduro, estendendo do cerebelo ao tronco encefálico e com um nódulo no córtex.(AU)

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INTRODUCTION: Chordoma is a malignant tumor that usually involves the axial skeleton. Intradural chordomas are even rarer and 37 cases have been reported to the best of our knowledge. We present a case of a patient with an atypical metastatic diffuse intradural spinal involvement. CASE DESCRIPTION: We present a 33-year-old woman previously submitted to five brain surgeries to treat a posterior fossa intradural chordoma since December 2012. Currently, she presented almost with right and left hemiplegia (grade 2 bilaterally) and also left oculomotor, adbucent and facial nerve paresis. We performed neuroaxis magnetic resonance MR which disclosed stability of posterior fossa tumor which was previously irradiated. However, there were new intradural lesions at the level of C3, T11/T12 and L4/L5/S1 vertebrae. DISCUSSION: With the advent of contemponaeous surgery, radiotherapy options and even available chemotherapy to treat Chordomas (Imatinib), patients may experience enlarged survival and thus face complications such as drop metastases along neuroaxis. Our case illustrates a late (6 years) follow-up presentation of an initial posterior fossa intradural chordoma. It suggests that whole neuraxis involvement may be the final presentation of all patients harbouring chordomas and surviving after adequate initial treatment.

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BACKGROUND: Pituicytomas are considered World Health Organization Grade I malignancies. Until September 2017, a total of 81 cases of pituicytomas were diagnosed and described in literature. We present such a case in which histopathology shows an epithelioid pattern, a rare variant of pituicytoma. As far as we know, this is only the second such case described in the literature. CASE DESCRIPTION: A 61-year-old male patient presented with complaints of progressive decrease in visual acuity for about 7 months, worse on the left side. Laboratory and endocrinological investigation returned normal values. Magnetic resonance imaging revealed a mixed solid-cystic lesion, measuring about 3.1 × 2.2 × 2.9 cm. The lesion presented with intermediate signal intensity in T1 and T2 sequences and showed avid postcontrast enhancement. The patient underwent resection through a left pterional approach. Pathology revealed a glial neoplasm with an epithelioid pattern and moderate cellularity with rounded-elongated cell nuclei and with a broad eosinophilic cytoplasm. Absence of cellular pleomorphism, any mitotic figures, or areas of necrosis was noted. CONCLUSION: The epithelioid variant of pituicytomas differs from the commonly encountered forms of this tumor which typically present in a fascicular pattern. Microsurgical resection is the treatment of choice. However, in many cases, subtotal resection was performed because of a considerable risk for neurovascular injuries.

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The pilomyxoid astrocytoma (PMA) is a rare glioma recently described as a separate entity, which is generally located on the hypothalamic area. The PMA was previously described as pilocytic astrocytoma (PA) due to similarities shared between them. Recent studies provided a deeper understanding of PMA, setting it as a separate entity, though PMA is still considered by many authors a variant of PA. The PMA is considered to be more aggressive than PA; however, further studies are necessary for a better comprehension of its behavior and, hence, for neurosurgeons and neurologists to get to a consensus about its management. This study presents a 16-year-old female patient who looked for medical assistance complaining of headaches of over 6 months and vomiting for 2 weeks prior to the visit to the doctor. She presented no other symptoms. The physical examination displayed only bilateral papilledema. The magnetic resonance imaging (MRI) scans showed an intraventricular and thalamic lesion composed of solid and cystic material associated with peritumoral edema. The patient underwent ventriculoperitoneal shunt and subtotal resection of the lesion. The histological and immunohistochemical studies showed typical features of PMA. The patient started adjuvant therapy with chemotherapy and radiosurgery. She has been asymptomatic for 9 months and has shown no signs of progression of the disease on the follow-up scans.

O astrocitoma pilomixoide (APM) é um raro glioma, recentemente descrito como uma entidade separada, que geralmente se localiza na região hipotalâmica. Anteriormente, o APM era descrito como astrocitoma pilocítico (AP) devido a características semelhantes que ambos apresentam. Estudos recentes permitiram um melhor entendimento do APM, configurando-o como uma entidade separada, embora o APM ainda seja considerado por muitos autores uma variante do AP. O APM é considerado mais agressivo que o AP; no entanto, mais estudos são necessários para um melhor entendimento do comportamento do tumor e, consequentemente, para que neurocirurgiões e neurologistas cheguem a um consenso sobre sua terapêutica. Este estudo apresenta uma paciente de 16 anos que procurou atendimento médico com queixas de dores de cabeça por mais de 6 meses e vômitos nas 2 semanas antecedentes à visita ao médico. Outros sintomas não eram apresentados. O exame físico revelou apenas papiledema bilateral. As imagens de ressonância magnética mostraram uma lesão intraventricular e hipotalâmica de componentes sólido e cístico associados a edema peritumoral. A paciente foi submetida a derivação ventriculoperitoneal e a ressecção subtotal da lesão. Os estudos histológico e imunohistoquímico demonstraram características típicas de APM. A paciente iniciou terapia adjuvante com quimioterapia e radiocirurgia. A paciente está em acompanhamento por 9 meses e, até o momento, manteve-se assintomática e não houve sinais de progressão da doença nos exames de imagem.

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Introducción: Los quistes epidermoides cerebrales son tumores de origen embrionario presentes desde la formación del tubo neural. Caso clínico: Hombre de 78 años con focalización en hemicuerpoizquierdo TAC cerebral reportó masa frontotemporal que se extirpó quirúrgicamente y el estudio histopatológico confirma diagnóstico de quiste epidermoide. Discusión: Los quistes epidermoides son tumores poco frecuentes y representan menos del 2% de los tumores intracraneales, el angulo cerebelopontino es la ubicación más frecuente y la resección completa junto con toda la cápsula es el único tratamiento efectivo.

Introduction: Epidermoid cysts are tumors of embryonic origin present since the formation of the neural tube. Case report: A 78-year-old male with a left hemisphere, brain CT scan reported frontotemporal mass that was surgically removed and the histopathological study confirmed a diagnosis of epidermoid cyst. Discussion: Epidermoid cysts are rare tumors and account for less than 2% of intracranial tumors, cerebellar angle is the most frequent site, and complete resection with the entire capsule is the only effective treatment.

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BACKGROUND: As far as public health is concerned, brain tumors burden is significant despite their low incidence, because they comprise high direct costs (specific diagnostic resources, high complexity treatments, and rehabilitation) and high-unforeseen costs (labor leave, family, and social issues). Although the Argentine's Health System is supposed to provide healthcare to all the population, it would not guarantee equity of access for brain tumors treatment. In order to analyze this hypothesis we decided to carry out a survey to obtain data on access, availability and resources for tumor management in Argentina. METHODS: An online questionnaire with eight dimensions and 29 queries was conducted addressing all professionals involved in tumor management. Two variables were generated: (1) type of medical center according to their financial support, and (2) the geographic region (GeoR). Analysis of association between these variables and the accessibility to different resources was performed with Chi-square and Fisher's exact test. Multivariate analyses through multiple logistic regression models were also tested. RESULTS: One hundred and fourteen surveys were collected from 56 state-managed centers and 55 private/trade-union managed centers. Responders came from 15 provinces grouped into integrated GeoR. Results and analysis of each dimension were reported. CONCLUSION: The data obtained provides information about the accessibility to brain tumors treatment, exposing the unequal distribution of human and technologic resources in Argentina. This problem exceeds the limits of public health to become a bioethical problem. We think these results could be essentially associated to our health system fragmented structure, and the large geographical extension of our country. Finally, we believe that collaboration of professional associations working together with public and private sector authorities responsible for financial resources and logistic should bring a principle of solution.

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BACKGROUND: Gross total resection for malignant brain neoplasms is challenging owing to the heterogeneity of these lesions and infiltration in eloquent areas. Gross total resection is a very important part of treatment of these patients and is a crucial prognostic factor. Fluorescence-guided surgery is an important tool that improves the rate of total resection. METHODS: We built a device to use in surgical microscopes with an excitation and a barrier filter to perform fluorescence-guided surgery. All patients received a standard dose of 500 mg of sodium fluorescein before skin incision. Surgical view under white light was compared with use of the light filters. RESULTS: In all cases with use of the filters, the tumors showed a high fluorescence contrasting with the normal surrounding brain, making it easier to identify the limits of the lesion and to achieve gross total resection. CONCLUSIONS: The use of fluorescence for malignant brain tumor resection increases the rate of gross total resection. It is an important tool that makes it possible to identify the lesion in areas where it looks like normal tissue under white light. This device is a low-cost option that has shown good results in our experience.

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Teratomas are the most common type of Germ Cell Tumors (GCTs). GCTs are classified as extragonadal, if there is no evidence of a primary tumor in neither the testicles, nor in the ovaries. Intracranial Mature Teratomas are tumors with a very low incidence, and clear male predominance. We present the case of a 21 year-old female patient, with a history of two seizures 15 days prior to admission, without any abnormalities upon physical examination. The Magnetic Resonance Imaging (MRI) performed at the admission evidenced an expansive, heterogeneous lesion in the frontal lobe, hypointense on T1-weighted images, hyperintense on T2-weighted images, and restriction on the diffusion imaging and ADC-mapping. The patient underwent microsurgical resection, and it was possible to achieve a near-total resection. During surgery, a welldefined capsule was identified, which was removed after adequate debulking. Tissues resembling hair were taken from inside the lesion. The patient recovered well, without any neurological deficits, and no further intervention was necessary. The authors aim to describe this rare pathology and their option for a surgical approach.

Os teratomas são o tipo mais comum de Tumores de Células Germinativas (TCG). TGC são classificados como extragonadais, quando não há evidências de um tumor primário em nos testículos, ou nos ovários. Os Teratomas Maduros Intracranianas são tumores com uma incidência muito baixa, e com uma predileção pelo sexo masculino. Nós apresentamos o caso de uma paciente, feminina, 21 anos de idade, com história de dois episódios de convulsões tônico-clônicas generalizadas, 15 dias antes da admissão, sem nenhum déficit focal ao exame físico. A Ressonância Magnética realizada na chegada mostrou uma lesão sólida, expansiva, grande e heterogênea, hipointensa em T1, e hiperintensa em T2, com restrição a difusão e ADC-mapping. Foi realizado uma cirurgia, e foi possível obter uma ressecção quase total. Havia uma cápsula bem definida, a qual foi removida após adequada redução do volume tumoral. Dentro da lesão foi encontrado tecido semelhante a cabelo. A paciente se recuperou bem, e foi dado alta sem novos déficits neurológicos, não foi realizado mais nenhuma intervenção, e ela está sendo acompanhada regularmente. Os autores visam descrever essa patologia rara e sua opção por uma abordagem cirúrgica.

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In addition to findings from conventional magnetic resonance imaging, modern magnetic resonance imaging techniques have provided important information about tumor metabolism, in vivo metabolite formation, water molecule diffusion, microvascular density, and blood-brain barrier permeability, all of which have improved the in vivo diagnostic accuracy of this method in the evaluation of primary central nervous system lymphoma. These nonconventional magnetic resonance techniques are useful in the clinical practice because they enhance conventional magnetic resonance imaging by reinforcing the possibility of a diagnosis and by allowing the early detection of disease recurrence. This report is a review of the most relevant contributions of nonconventional magnetic resonance techniques to the imaging diagnosis of primary central nervous system lymphoma, the differential diagnosis of this disease, and the prognosis of patients. This paper aims to describe a wide range of presentations of primary central nervous system lymphoma, their appearance in imaging, and the differential diagnoses of this disease.

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Abstract In addition to findings from conventional magnetic resonance imaging, modern magnetic resonance imaging techniques have provided important information about tumor metabolism, in vivo metabolite formation, water molecule diffusion, microvascular density, and blood-brain barrier permeability, all of which have improved the in vivo diagnostic accuracy of this method in the evaluation of primary central nervous system lymphoma. These nonconventional magnetic resonance techniques are useful in the clinical practice because they enhance conventional magnetic resonance imaging by reinforcing the possibility of a diagnosis and by allowing the early detection of disease recurrence. This report is a review of the most relevant contributions of nonconventional magnetic resonance techniques to the imaging diagnosis of primary central nervous system lymphoma, the differential diagnosis of this disease, and the prognosis of patients. This paper aims to describe a wide range of presentations of primary central nervous system lymphoma, their appearance in imaging, and the differential diagnoses of this disease.

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Intradural clival chordomas are very rare, and only 29 cases have been reported to our knowledge. They arise purely intradurally without bone or dural involvement and may differ from classic clival chordomas in physiopathology and management. We present a 28-year-old woman who presented with intradural clival chordoma and tumoral bleeding. After initial gross macroscopic surgical resection, she presented with tumor recurrence after 2 years, again with intratumoral bleeding. Although usually considered to have a more favorable prognosis in comparison to typical chordomas, intradural chordomas appear to behave as typical chordomas. Intratumoral bleeding may be a sign of an aggressive lesion and risk of recurrence. We highlight the differential diagnosis of intrinsic posterior fossa bleeding, especially in young patients. Intradural chordomas may be underdiagnosed and incorrectly treated as other types of parenchymal hemorrhage.

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BACKGROUND: Choroid plexus papilloma is a rare intracranial neoplasm derived from choroid plexus epithelium accounting for less than 1 % of all brain tumors. These tumors are highly vascularized, and tumor resection is difficult, especially in small children, due to severe intraoperative bleeding. Preoperative embolization is helpful to reduce intraoperative bleeding, but it may not be possible in small children or if the tumor has no suitable feeding vessels for embolization. METHODS: We present the case of a 2-year-old girl with a giant choroid plexus papilloma. An attempt of tumor resection was previously performed in another clinic, but the surgery was aborted due to massive intraoperative bleeding and only a biopsy was done. Angiography showed no suitable vessels for embolization. A new attempt of tumor removal was carried out, but again, severe intraoperative bleeding occurred and only a partial resection was possible. Intratumoral embolization with onyx through direct percutaneous puncture was performed. RESULTS: Radical tumor removal was possible after two additional surgeries. Intraoperative blood loss was 345 ml (first surgery = only partial removal), 250 ml (second procedure = 1/3 of tumor volume resected), and 250 ml (third surgery = total removal). The patient presented no additional deficits. CONCLUSIONS: Intratumoral percutaneous embolization with onyx was very helpful in reducing intraoperative bleeding in this case. Safe radical tumor resection was possible. This technique may be useful for those surgeons dealing with highly vascularized tumors, especially in small children. No report of intratumoral embolization with onyx in cases of intracerebral tumors could be found in the literature.

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Astrocitomas constituem o tipo mais comum de tumor cerebral neuroepitelial primário apresentando grande heteogeneidade. De acordo com a Organização Mundial de Saúde, os astrocitomas podem ser histologicamente divididos em graus I- IV. Astrocitomas pilocíticos (grau I) são tumores circunscritos, de crescimento lento e bom prognóstico. Astrocitomas difusos (grau II) apresentam hipercelularidade, crescimento relativamente lento e propensão para invadir o tecido cerebral normaladjacente. Astrocitomas anaplásicos (grau III) apresentam aumento da celularidade, atipia nuclear e figuras mitóticas. Glioblastomas (GBMs - grau IV) representam o mais frequente e maligno tumor cerebral humano com crescimento extremamente agressivo, anaplasia, células altamente proliferativas, com frequente neoangiogênese e necrose. O comportamento altamente invasivo dos GBMs, caracterizado pela infiltração difusa para o parênquima cerebral normal adjacente, inviabiliza a remoção cirúrgica total do tumor. Além disso, as células dos GBMs são relativamente resistentes às terapias disponíveis. Analogamente a outros tipos de câncer, os GBMs demonstram comportamentos semelhantes às de células trofoblásticas, sugerindo vias de sinalização compartilhadas no controle dos processos tumorigênicos e de implantação da placenta. Em ambos os casos, o estabelecimento de um fenótipo invasivo compreende processos celulares que incluem aumento da proliferação, expressão ou repressão de moléculas de adesão celular específicas, produção de enzimas que digerem a matriz extracelular, expressão de produtos de proto-oncogenes, ativação da telomerase, evasão ou edição da resposta imune do hospedeiro e angiogênese. Com base nas características comuns entre células tumorais e trofoblastos, o presente trabalho teve como objetivo a busca in silico de genes expressos em placenta e tecidos tumorais e que podem contribuir para o estabelecimento e manutenção do fenótipo maligno, utilizando os bancos de dados de MPSS e...

Astrocytomas are the most common type of primary neuroepithelial brain tumour and show great heterogeneity. According to World Health Organization criteria, astrocytomas can be histologically separated into grades I through IV. Pilocytic astrocytomas (grade I) are circumscribed, slow growing tumours with a good prognosis and mainly occur in children or young adults. Low-grade astrocytomas (grade II) show hypercellularity, relatively slow growth, and a propensity to invade surrounding normal brain tissue. Anaplastic astrocytomas (grade III) have increased cellularity, nuclear atypia, and mitotic figures. Glioblastomas (GBMs - grade IV), are the most common malignant and aggressive of all brain malignancies, exhibiting anaplastic, highly proliferative cells, with frequent neoangiogenesis and necrosis. GBM cells can escape complete resectability and are relatively resistant to the available therapies (radiation and chemotherapy). Similar to other cancer types, GBMs demonstrates behaviours that are analogous to trophoblastic cells, suggesting shared pathways to control tumourigenic processes and placental implantation. In both cases, the establishment of an invasive phenotype comprises cellular processes that include increased proliferation, the expression or repression of specific cell adhesion molecules, the production of enzymes that digest the extracellular matrix, the expression of proto-oncogene products, telomerase activation, evasion or edition of the host immune response, and angiogenesis. Based on the shared characteristics of tumour cells and trophoblasts, we searched in silico for genes that are in both placenta and tumour tissues using MPSS and SAGE databases and that could contribute to the establishment and maintenance of a malignant phenotype. Among 12 selected genes, CD99 exhibited the highest relative mRNA expression in GBM compared to non-neoplastic brain tissues. In a larger cohort of astrocytic tumours, we further demonstrated increased CD99...

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Artigo extraído de dissertação de mestrado, cujo objetivo foi caracterizar a interação dos enfermeiros com os diagnósticos de enfermagem em neurocirurgia oncológica, considerando comportamentos, manifestações, atitudes e práticas. Participaram da pesquisa dezesseis enfermeiros que atuam com igual ou mais de cinco anos em neurocirurgia oncológica no Instituto Nacional de Câncer. Utilizou-se como referencial teórico o Interacionismo Simbólico e como abordagem metodológica a Teoria Fundamentada nos Dados. Os achados apontaram que, o enfermeiro está desvelando possibilidades de cuidar do cliente de neurocirurgia oncológica, não somente na perspectiva do sofrimento, mas, sobretudo, na perspectiva do cuidado existencial, abarcando as suas necessidades e singularidades, respeitando as suas limitações.

Article extracted from a Master's dissertation whose objective was to characterize the interaction of nurses with nursing diagnoses in neurosurgical oncology, considering behaviors, expressions, attitudes and practices. The participants were sixteen nurses who work with equal or more than five years in neurosurgical oncology at the National Cancer Institute. The Symbolic Interactionism was used as the theoretical framework, and the Grounded Theory, as a methodological approach. The findings indicate that the nurse is unveiling possibilities of caring for the client of neurosurgical oncology, not only in the perspective of suffering, but especially from the perspective of existential care, covering their needs and singularities, and respecting their limitations.

Artículo extraído de una tesis de maestría, cuyo objetivo fue caracterizar la interacción de las enfermeras con los diagnósticos de enfermería en oncología neuroquirúrgica, teniendo en cuenta los comportamientos, expresiones, actitudes y prácticas. Los participantes fueron dieciséis enfermeras que trabajan cinco años o más en neurocirugía oncológica, en el Instituto Nacional del Cáncer. El Interaccionismo Simbólico fue utilizado como el marco teórico, y la Teoría Fundamentada en los Datos, como un enfoque metodológico. Los resultados indican que la enfermera está presentando posibilidades de cuidado para el cliente de neurocirugía oncológica, no sólo en la perspectiva del sufrimiento, pero sobre todo desde la perspectiva de la atención existencial, cubriendo sus necesidades y singularidades, y respetando sus limitaciones.

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Introducción. A pesar de los notables progresos en cáncer infantil, más del 60% de los niños afectados en el mundo tienen escaso acceso a tratamientos eficaces. El propósito de este estudio fue evaluar los resultados de tratamiento en una situación de recursos limitados. Métodos. Fue un estudio descriptivo-histórico con componente analítico en 242 menores de 16 años atendidos entre 1990 y 2007 en la Clínica Infantil Colsubsidio de Bogotá, Colombia. Durante tres periodos se introdujeron protocolos internacionales, atención en "hospital de día" para tratamientos de quimioterapia y soporte ambulatorio, con enfermeras entrenadas en oncología, una pediatra oncóloga y un hematólogo con dedicación de 8 horas, el apoyo en hospitalización de médicos pediatras 24 horas y la agilización de trámites administrativos. Se compararon la supervivencia y las fallas de tratamiento. Resultados. Se observó aumento (40.5 a 63%) en la supervivencia (P =0.021) y disminución (22.4 a 8.9%) en la remisión a otros centros (P =0.025); tendencia a la reducción en mortalidad por complicaciones agudas (16.3 a 9.9%) y en frecuencia de rechazo o abandono del tratamiento (5.2 a 3%). La supervivencia libre de eventos para leucemia linfoblástica fue de 65% a 10 años. Conclusiones. El programa mostró resultados alentadores en un contexto de recursos limitados.

Background. Despite remarkable progress achieved for pediatric cancer, >60% of children affected worldwide have little or no access to effective therapy. This study assessed the results of a pediatric cancer program in a limited resources setting. Methods. A historical descriptive study with analytic component was conducted between 1990 and 2007 in 242 children <16 years of age at Clínica Infantil Colsubsidio in Bogotá, Colombia. Measures included international protocol-based therapy, day-hospital system for chemotherapy and blood-cell support provided by trained nurses, pediatric oncologist and hematologist staffed 8-h with 24-h on-site physician coverage, as well as rapid administrative support. Treatment failure rates and survival were compared during the study. Results. An increase (40.5% to 63.3%) in survival (p =0.021) and a reduction in the referral for treatment (22.4% to 8.9%) to other centers (p =0.025) were observed during the study. There were also tendencies towards reduction in mortality due to acute complications (16.3-9.9%) and in frequency of those who refused or abandoned therapy (5.2 to 3%).The 10-year event-free-survival for acute lym-phoblastic leukemia was 65%. Conclusions. The strategy provided encouraging survival outcomes in a limited resources setting.