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Background Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified—that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care.

Los Meningiomas Rabdoides son una variante poco común de los meningiomas grado III según la clasificación WHO de 2016 con alto índice mitótico, invasión a tejido cerebral sano, alta tasa de recurrencia y baja expectativa de sobrevida, en esta oportunidad presentamos el caso clínico de una paciente de 23 meses de edad diagnosticada con esta patología, abarcando brevemente aspectos clínicos característicos de la patología, histopatología del diagnóstico y una revisión corta de la literatura actual sobre el tratamiento y la sobrevida de estos pacientes. Rhabdoid meningioma are quite rare type of intracranial tumors. according to WHO classification 2016 characterized by high mitotic index, invasion to healthy brain tissue, high recurrence rate and low survival expectancy, on this occasion we present the case of a 23 months child diagnosed with this pathology, covering clinical aspects characteristic of the pathology, histopathology of the diagnosis and a short revision of the current literature on the treatment and the survival of these patients

Pituicytoma is a rare tumor that arises from the glial cells of the neurohypophysis. For a long time, it was believed that pituicytomas only appeared in adults. Currently, at least three cases of this entity occurring in children have been reported in the literature. The aim of the present report is to describe the case of a 5-year-old girl who presented to the emergency department with visual disturbances, and the diagnosis was a recurrent pituicytoma. Therefore, the clinical presentation, the radiological features of the tumor, and the corresponding surgical management are described. Additionally, a brief review of the management of this unusual entity was performed.

Hydrocephalus is present in 1 of every 1,000 newborns treated with ventriculoperitoneal shunts (VPSs) in the majority of cases. This procedure carries a high risk of complications. One of them is the mechanical disconnection of the system that leads to dysfunction of the shunt and implies neurologic changes that the neurosurgeon has to address as soon as possible. We present two cases of congenital hydrocephalus previously treated with ventriculoperitoneal shunts. The first patient was hit on the right side of his neck. The day after the event, the patient was hypoactive and unable to communicate properly with the examiner and his parents. The radiological cervical X-ray showed disconnection of the catheter at the cervical level. The second case was of a 37-year-old man with hydrocephalus managed with VPS for the first time at the age of 14 years, who was brought to emergency due to rapid onset of symptoms apparently associated with trauma related to a blow with a soccer ball; the patient's X-ray showed fracture of the catheter's path at the thoracic level. For both cases, surgical repair was needed. Results were good, and the patients showed rapid neurologic improvement.

Objective The aim of the present review was to describe the evolution of the damage control concept in neurotrauma, including the surgical technique and medical postoperative care, from the lessons learned from civilian and military neurosurgeons who have applied the concept regularly in practice at military hospitals and civilian institutions in areas with limited resources. Methods The present narrative review was based on the experience of a group of neurosurgeons who participated in the development of the concept from their practice working in military theaters and low-resources settings with an important burden of blunt and penetrating cranial neurotrauma. Results Damage control surgery in neurotrauma has been described as a sequential therapeutic strategy that supports physiological restoration before anatomical repair in patients with critical injuries. The application of the concept has evolved since the early definitions in 1998. Current strategies have been supported by military neurosurgery experience, and the concept has been applied in civilian settings with limited resources. Conclusion Damage control in neurotrauma is a therapeutic option for severe traumatic brain injury management in austere environments. To apply the concept while using an appropriate approach, lessons must be learned from experienced neurosurgeons who use this technique regularly.

Cerebrospinal fluid leaks of the cranial vault, constitute one of the most common complications after neurosurgical procedures. In this paper we introduce to you an observational study, in which a series of patients with this complication where managed by using elastic compression hat during 18 hours per day, for two weeks to four months. Every one of them presented complete resolution of the leak, without any recurrence until actual controls. After that we perform a review of the literature, demonstrating this is a new therapeutic management, being us the first group on reporting it. According to the observed results, it was concluded that despite more studies are required, the use of elastic compression hats for this kind of patients could be effective and safe.