D. Scavarda

Intramedullary spinal cord tumors: Pediatric aspects and adjunct therapies

Abstract Intramedullary spinal cord tumors (IMSCTs) have specific clinical and pathological features in children. A long clinical course of erratic pains, scoliosis, or both is common. Unlike in adults, astrocytomas occur more frequently in children than ependymomas. A wide spectrum of histological types was observed in our series of 64 children 16-years-old or younger surgically treated for an IMSCT: 40 astrocytomas, 10 ependymomas, 3 gangliogliomas, 7 dysembryoplastic tumors, and 4 miscellaneous tumors. If surgical technique for removal of these tumors is the same as in adults patients and total removal can be achieved in 70 to 90% of the cases depending of the pathology, the approach to the spinal canal must be totally different. The laminotomy and closure must be meticulous, and postoperative immobilization with a brace is necessary. Applying these principles helps avoid postoperative spinal deformities. Long-term outcomes for benign tumors are encouraging. Follow-up without recurrences has been lengthy. The place of adjunct therapies must be defined for chemotherapy (CT), particularly for low-grade gliomas. Radiotherapy is contraindicated in children. New chemotherapeutic agents and new clinical trials are needed to improve the prognosis of malignant tumors.

Subdural grid and depth electrode monitoring in pediatric patients

Invasive electroencephalographic monitoring with implantable subdural electrodes and intraparenchymal depth electrodes has become a basic tenet of epilepsy surgery. Improved localization of epileptic foci justifies the secondary procedure and monitoring period in many patients. Informed use of invasive monitoring in conjunction with imaging and functional studies makes epilepsy surgery a smaller, safer, and more effective endeavor. Herein we review the history, indications, implementation, and foreseeable future of grid, strip, and depth electrode use.

CERVICAL TUMORAL CALCIUM PYROPHOSPHATE DIHYDRATE DEPOSITION DISEASE 28 YEARS AFTER SUBOCCIPITAL CRANIOTOMY: CASE REPORT

OBJECTIVETo describe a rare case of tumoral cervical chondrocalcinosis that appeared 28 years after the patient had undergone suboccipital craniotomy. CLINICAL PRESENTATIONA 42-year-old woman suffered from cervicalgia associated with a firm mass at the occipitocervical region. Plain x-ray and computed tomographic and magnetic resonance images revealed a calcified lesion in a scar from a previous suboccipital craniotomy. INTERVENTIONThe patient underwent tumorectomy and histopathology, which revealed an exuberant tumoral chondrocalcinosis. Laboratory test results revealed no secondary cause for the chondrocalcinosis. CONCLUSIONIdentification of chondrocalcinosis beyond the cervical region is very rare. Localization of chondrocalcinosis in a scar from a previous suboccipital craniotomy has not been previously reported. Surgery appears to be the treatment of choice for this form of chondrocalcinosis.

Pediatric Intraspinal Lesions

The pathologies described in this chapter represent a great disparity of lesions. The common denominator is the possible similar clinical presentation. The functional prognosis depends on the severity of the clinical manifestations and the final result from precise histological diagnosis.