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Vol. 5. Issue 1.
Pages 32-36 (January 1994)
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Vol. 5. Issue 1.
Pages 32-36 (January 1994)
Ependimomas anaplásicos intraventriculares
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G. Posadas Narro, J. Vaquero Crespo, J.M. del Pozo García, G. Bravo Zabalgoitia
Servicio de Neurocirugía. Clínica Puerta de Hierro. Universidad Autónoma de Madrid-España
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Resumen

Se analizaron 10 pacientes con ependimomas anaplásicos, hospitalizados entre enero de 1970 y diciembre de 1992.

La edad osciló entre 1 y 46 años con un promedio de 13,8 años. Siete eran hombres y 3 mujeres. El tiempo de duración de la enfermedad fue de 2 a 24 meses. En el cuadro clínico predominaron: hipertensión endocraneal, déficit de pares craneales y síndrome cerebeloso. Siete tumores se localizaron en el IV ventrículo (5 en el velo inferior y 2 en el velo superior), 2 en el ventrículo lateral, y 1 en el III ventrículo. Todos los pacientes presentaron hidrocefalia necesitando derivación ventricular, 5 de ellos antes de realizar la craneotomía. Se realizó resección tumoral completa en 5 casos y parcial en otros 5. Cinco pacientes recibieron radioterapia tras la cirugía y 4 de ellos radioterapia más quimioterapia. En el seguimiento de 1 a 10 años, 6 de ellos presentaban secuelas y 2 fallecieron, uno por bronconeumonía y el otro por el propio tumor. Tres de 5 pacientes presentaron células neoplásicas en L.C.R., y uno de estos además metástasis en médula cervical de la que fue operado. Un caso presentó meningoencefalitis por cándida albicans, resuelta con antibióticos.

Se concluye que los ependimomas anaplásicos intraventriculares se presentan preferentemente en menores de 15 años, localizándose fundamentalmente en el IV ventrículo. Estos tumores conllevan una gran morbilidad neurológica, y el tratamiento quirúrgico más radioterapia representa la mejor actitud terapéutica.

Palabras clave:
Neoplasia intraventricular
Ependimoma
Summary

We have analyzed 10 patients with intraventricular anaplastic ependymomas studied between January 1970 and December 1992.

The age ranged from 1 to 46 years with a mean age of 13,8 years. Seven patients were males and 3 were females. The duration of the disease ranged between 2 and 24 months. Raised intracranial pressure, cranial nerve deficit and cerebellar syndrome were the predominant clinical manifestations. Seven of the tumors were localized in the IV ventricle (5 in the inferior velum and 2 in the superior velum), 2 in the lateral ventricle and 1 in the III ventricle. All the patients showed hydrocephalus and it was necessary to implant a ventriculo-peritoneal CSF shunt in 5 of them before performing craneotomy.

Complete tumor resection was done in 5 cases and partial in another 5 cases. It was followed by radiotherapy in 5 cases, and by radiotherapy and chemotherapy in 4. At follow-up, ranging from 1 to 10 years, 6 of the patients had neurological deficits and three of the 5 patients had neoplasic cells in the cerebral fluid, and 1 developed spinal metastases.

The conclusions are that intraventricular anaplastic ependymomas predominantly occur in individuals under 15 years of age, are mainly located in the IV ventricle, and produce a severe neurologic morbidity. Surgical treatment followed by radiotherapy improves the final prognosis of these patients.

Key words:
Ventricular neoplasms
Ependymoma

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