OBJECTIVE The objectives of this study were to determine the overall survival (OS) and event-free survival (EFS) rates of patients with medulloblastoma treated in a national pediatric hospital in Peru, as well as to identify demographic, clinical, imaging, postoperative, and histopathological characteristics and prognostic factors associated with OS and EFS. METHODS The authors conducted a retrospective study analyzing information from the medical records of children with a diagnosis of medulloblastoma who underwent surgical treatment at the Instituto Nacional de Salud del Niño—San Borja, a public hospital in Lima, Peru, from 2015 to 2020. Clinical-epidemiological variables, degree of disease extension, risk stratification, extent of resection, postoperative complications, status of oncological treatment received, histological subtype, and neurological sequelae were taken into account. The Kaplan-Meier method and Cox regression analysis were used to estimate OS, EFS, and prognostic factors. RESULTS Of the 57 children evaluated with complete medical records, only 22 children (38.6%) underwent complete oncological treatment. OS was 37% (95% CI 0.25–0.55) at 48 months. EFS was 44% (95% CI 0.31–0.61) at 23 months. High-risk stratification—meaning patients with ≥ 1.5 cm2 of residual postoperative tumor, those younger than 3 years, those with disseminated disease (HR 9.69, 95% CI 1.40–67.0, p = 0.02), and those who underwent subtotal resection (HR 3.78, 95% CI 1.09–13.2, p = 0.04)—was negatively associated with OS. Failure to receive complete oncological treatment was negatively associated with OS (HR 20.0, 95% CI 4.84–82.6, p < 0.001) and EFS (HR 7.82, 95% CI 2.47–24.7, p < 0.001). CONCLUSIONS OS and EFS of patients with medulloblastoma in the author’s milieu are below those reported in developed countries. Incomplete treatment and treatment abandonment in the authors’ cohort were also high compared with high-income country statistics. Failure to complete oncological treatment was the most important factor associated with poor prognosis, both in terms of OS and EFS. High-risk patients and subtotal resection were negatively associated with OS. Interventions are needed to promote the completion of adjuvant oncological therapy for medulloblastoma in the disadvantaged Peruvian population.

Antecedentes: Los aneurismas del segmento comunicante posterior representan aproximadamente 25% de todos los aneurismas intracraneales, y el 50% de los aneurismas de la arteria carótida interna. El objetivo fue evaluar la eficacia del tratamiento quirúrgico y endovascular en el manejo de aneurismas de esta localización. Métodos: Estudio comparativo retrospectivo. Se revisó las historias clínicas de pacientes con aneurisma del segmento comunicante posterior que ingresaron al departamento de Neurocirugía del Hospital Nacional Guillermo Almenara durante el periodo 2010–2017. Se comparó estancia hospitalaria, complicaciones, mortalidad y estado funcional a los 12 meses, en relación al tratamiento recibido, microquirúrgico o endovascular. Resultados: Se evaluaron 256 pacientes, 111 (43.36%) recibieron tratamiento quirúrgico, y 145 (56.64%) endovascular. En el caso de aneurismas rotos, el estado de independencia funcional fue alcanzado por 68 (66.7%) y 69 (70.4%) pacientes que recibieron tratamiento quirúrgico y endovascular, respectivamente (OR: 0.84, IC 95%: 0.46–1.53; P = 0.505). Se presentaron complicaciones neurológicas en 37 (36,3%) y 34 (34.7%) pacientes sometidos a tratamiento microquirúrgico y endovascular, respectivamente (OR: 1.07, IC 95%: 0.60–1.91; P = 0.912). La estancia hospitalaria promedio fue 19.55 ± 13.85 y 14.06 ± 14.97 días, para pacientes con tratamiento quirúrgico y endovascular, respectivamente (P < 0.008). La mortalidad fue 11.8% y 11.2%, con ligera predominancia en el grupo tratado quirúrgicamente (OR: 1.05, IC 95%: 0.44–2.52; P = 0.904). Conclusión: No existe diferencia significativa respecto al resultado funcional a los 12 meses, complicaciones y mortalidad entre ambos tipos de tratamiento en el caso de aneurismas rotos. Los pacientes sometidos a terapia endovascular tuvieron de forma significativa menor estancia hospitalaria.

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Introduction: The extraparenchymal neurocysticercosis and the racemose form are very predisposed to complications. Subarachnoid sellar cysts are rare, are associated with intracranial hypertension and disorders visual fields. Clinical case: A 63-year-old male patient with racemose neurocysticercosis, hydrocephalus and cerebrospinal fluid fistula. He underwent transnasal endoscopy, removal of cysts from the sphenoid sinus, sellar, suprasellar, and prepontine regions, and fistula closure. He also presented erosion in the temporal bone and dural fistula, which were closed through microsurgery and endoscopy. The patient had a favorable initial evolution, with spastic quadriparesis, which improved with rehabilitation. Subsequently he presented episodes of ventriculoperitoneal shunt system dysfunction. Conclusion: Neuroendoscopy is a diagnostic and therapeutic method of various forms of neurocysticercosis. Extraparenchymal neurocysticercosis is able to produce bone and dural erosion, so must be considered in the differential diagnosis of cerebrospinal fluid. Keywords Neurocysticercosis, Fistula, Neuroendoscopy, Sphenoid sinus, Cysts (source: MeSH NLM)

Introduction: The extraparenchymal neurocysticercosis and the racemose form are very predisposed to complications. Subarachnoid sellar cysts are rare, are associated with intracranial hypertension and disorders visual fields. Clinical case: A 63-year-old male patient with racemose neurocysticercosis, hydrocephalus and cerebrospinal fluid fistula. He underwent transnasal endoscopy, removal of cysts from the sphenoid sinus, sellar, suprasellar, and prepontine regions, and fistula closure. He also presented erosion in the temporal bone and dural fistula, which were closed through microsurgery and endoscopy. The patient had a favorable initial evolution, with spastic quadriparesis, which improved with rehabilitation. Subsequently he presented episodes of ventriculoperitoneal shunt system dysfunction. Conclusion: Neuroendoscopy is a diagnostic and therapeutic method of various forms of neurocysticercosis. Extraparenchymal neurocysticercosis is able to produce bone and dural erosion, so must be considered in the differential diagnosis of cerebrospinal fluid. Keywords Neurocysticercosis, Fistula, Neuroendoscopy, Sphenoid sinus, Cysts (source: MeSH NLM)