Description. Case Nº 1: male, 43 years old with generalized seizure. Ct scan shows a right frontal cystic tumor. Case Nº 2: female, 44 years old, with behavioral disorder and right brachiocrural palsy. Ct scan shows a left frontal cystic tumor
Intervention. In both cases surgery was performed with total resection of the tumor and the diagnosis was cystic meningioma. Very good results were obtained after surgery.
Conclusion. Before surgery the diagnosis of cystic meningioma is seldom made. For this kind of cases, the treatment is, even now, a surgical procedure and in some cases radiotherapy.]]>
Method. 192 CT assisted stereotactic brain biopsies in 186 patients were retrospectively reviewed from june 1998 to june of 2008.
Results. 186 patients, 101males (54.3%) and 85 females (45.7%), were analyzed. Mean age was 54.5 years. 144 (75%) of the biopsies were performed in hemispheric lesions, 43 (22.4%) in "deep seated" localization. The most frequent anatomopathologic diagnosis were glioblastoma (36,5%) and anaplasic astrocytoma (17%). 90,62% of the biopsies were positive, 7,3% were negative and 2,08% non diagnostic. Morbility rate was 3,64% and mortality 2,08%.
Conclusion.Stereotactic brain biopsy is a safe and effective procedure providing tissue for definitive anatomopathological diagnosis; it offers low morbidity and mortality rate. Our findings are similar to the literature.]]>
Material and method. We analyzed the information of four patients with pituitary tumor apoplexy.
Resulys. One patient had acromegaly and the apoplexy happened during a treatment with lanreotido. The other three cases were patients with non functional pituitary tumors. All the cases were operated by endonasal transsphenoidal approach.
Conclusion. Classic manifestations of pituitary tumor apoplexy include severe headache, visual field defects, and ophthalmoplegia. In the absence of contraindications, transsphenoidal decompression is recommended in most patients. pituitary tumor apoplexy include severe headache, visual field defects, and ophthalmoplegia. In the absence of contraindications, transsphenoidal decompression is recommended in most patients.]]>
Description. A 65-yeard-old male pacient presented a 4-months history of dorsal back pain, progressive 4/5 paraparesis and sensory abnormality of the lower extremities. MR studies of the thoracic spine show a well-defined intramedullary mass at the D6 level, isointense on T1, hiperintense on T2 and homogeneous, strong enhancement with gadolinium, compatible with vascular lesion, asociated with extensive cord edema from D8-C2.
Intervention. A D6-D7 laminectomy was performed and the tumor was completly removed en bloc by using standard microneurosurgical technique.
Conclusion. It is very important to know about the existence of intramedullary capillary haemangiomas. Despite of being extremely rare, they are benign vascular neoplasms with a good outcome after their complete resection. Therefore, it´s necessary to distinguish them of other malignant tumors, to avoid overtreatment of these benign lesions.]]>
Description: the clinical reports of 11 patients implanted by our group were reviewed, obtaining data for the analysis of indications, technique employed, complications, average values of stimulation and results.
Interventions: all the patients were treated by at least one of the members of the group, in different health centers, with similar techniques.
Conclusion: in spite of the low number of cases, we thought that the rigorous selection of patients, the technique employed and the strict follow up contributed directly in the good results obtained.]]>
Description. Series: 40 patients. Period: 1998 - 2008. Surgical techniques: microvascular decompression, radiofrequency thermorhizotomy and balloon compression. Analyzed parameters: age, sex, nerve root involved, pain relief, recurrence, complications, need to restart medication and reintervention.
Discussion. Microvascular decompression offers better long term results, radiofrequency is adequate for special cases (higher recurrence rate), and balloon compression is better for V1 neuralgia. Our sample is too small for statistics, yet our findings are coincident with the literature.
Conclusion. Better patient selection criteria for each technique are needed. Microvascular decompression should be the treatment of choice when possible. How to treat recurrence remains unanswered.]]>
Surgical techniques: LATS and the Spencer variant were the most commonly used techniques.
Results: Patients in both groups are in Engel Class I and II.
Conclusion: The good results in this series can be attributed to the complete resection of these entities.]]>
Methodology. Analytic retrospective cohort study including every patient presenting refractive epilepsy to pharmacologic therapy, operated with hemispherectomy techniques from 1988 to 2008 (n=49). Of 507 patients, operated for refractive epilepsy in the last 20 years, in 49 cases we used any kind of hemispherectomy techniques (9,7%). The male/female relationship was 1.13-1, with 53% males and 47% females. The mean age was 8±5 years old, minimum 4 months and maximum 19 years old. The epilepsy time evolution was 3±2 years. The age of initial presentation was 3±1 years old. The more frequent pathologies were: Rasmussen encephalopathy (30,6%) and secuelar lesions (34,7%).
Results. The results were evaluated with the Engel score. Using this classification, our patients were distributed in this manner: 40 patients (81,6%) were in class I of Engel; 4 patients (8,2%) in class II of Engel and 5 patients (10,2%) en Engel III and IV. 88% (43 cases) without complications, 4% (2 cases) present hematomas and the same occur with hydrocephalus and postoperative meningitis. One patient died a few days posterior to surgery because of hematologic complications.
Conclusion. The hemispherectomy for the management of refractive epilepsy is a safe procedure with high positive results and small morbimortality in selective pathologies.]]>
Method. Between june 1995 and june 2008 , surgery was performed in 12 patients with tuberous sclerosis and refractory epilepsy. Median age: 6 years (r=6 months-19 years). 6 males and 6 females. Epilepsy began during the first year of life. They have been studied with RMI and video-EEG. Two patients were studied with intracranial electrodes. Electrocorticography was performed in 7, somatosensory evoked potentials in 2 and cortical stimulation in 1. Epileptogenic region was frontal in 4 , temporal in 3, parietal in 2, occipital in 1 and bilateral in 2. Surgical procedures were resection of the epileptogenic regions and associated tuber(s) in 6, temporal lobectomy in 1, callosotomy in 1, parietal lobectomy in 1, frontal polectomy and vagus nerve stimulation in 1. A second surgery was performed in 1 case.
Results. The outcome of seizures was classified with Engel's outcome classification : 7 patients were in class I , 2 in class II and III . Callosotomy and vagus nerve stimulation were performed in 2 patients who had multifocal abnormality , seizure freedom was achieved in more than 60%.]]>
Material and method. The study is a retrospective review of the clinical charts of patients with cranial gunshot injuries seen between 1987 and 2007.
Results. In this period 40 patients were admitted and 38 were operated on always with general anesthesia. Mean age of the children was 7 years. Twenty eight patients were male and twelve female. Twelve children sustained transhemipheric injurieds, ten extradural injuries, 9 tangencial injuries, 5 bihemipheric injuries and 3 transventricular injuries. Mortality rate was 20% with a mean follow up of 36 months.
Conclusion. We conclude that almost all cranial gunshot patients should initially receive aggressive surgical therapy with a previous CT scan.]]>
Case report: A 9 month old infant was brought to consultation because of cranial bruit in the left retroauricular area and opisthotonus crisis. CAT scan of the brain showed modest enlargement of ventricles and widening of the subarachnoid space. Cerebral angiography depicted an adult type dural arteriovenous fistula and thrombosis of the left transverse sinus. Angiographic cure was achieved by transarterial embolization of the fistula. The clinical condition of the patient improved significantly.
Discussion: Dural arteriovenous fistulae (DAVS) constitute an heterogeneous group of disorders with an overall mortality of 38%. They have been classified by Lasjaunias in three categories: 1- Dural sinus malformations with DAVS, 2- Infantile type DAVS, and 3- Adult type DAVS. Clinical manifestations depend on the extent of the disorder and the magnitude of venous hypertension. Neonates may present with congestive heart failure (CHF). Infants and older children often show cranial bruits associated with macrocrania, seizures and developmental delay of variable severity.
Conclusion: DAVS are unusual in the pediatric population. Early diagnosis and treatment are of major importance, in order to control venous hypertension and avoid the development of irreversible brain damage. Endovascular therapy has an important role in the acute treatment of CHF, and seems to be the best choice for treatment, either curative or palliative.]]>
Description. Clinical histories were analyzed, the methodology, diagnoses and therapies of the patients dealt in our service with fistula of cerebrospinal fluid in included/understood period between June of the 2000 and March of the 2008. From 2007 the method of diagnosis employed, was the use of Cisternography with intrathecal gadolinium because it offers the best results for us.
Conclusion. The present methodology, using the intrathecal, precocious Gadolinium injection in the presence of a fistula, it offers the precise images not only for diagnoses, but also for the precise site of location and the necessity or not, of surgery.
Key words: Fistula of CSF; Gadolinium; Cisternography; Intrathecal.]]>
Method. Thirty two dry skulls were examined under X6 magnification. The septae and nasal conchae were removed in order to expose the anterior wall of the sphenoid sinus. A caliper was used for measurements.
Results. We found two ostia in each skull, except in one case (the left ostium was absent). In just four skulls the inferior edges of both ostia were found in the same height. In just one skull the superior edges of both ostia were found in the same height. The distance from the internal edge of the right ostium to midline is, on average, 2.04 mm (from 0.3 to 5.3 mm). The distance from the internal edge of the left ostium to midline is, on average, 2.18 mm (from 0.2 to 5.1 mm).
Conclusion. A great variability exists of the position of the ostia of the sphenoid sinus. This knowledge is useful when a transsphenoidal surgery is carried out.]]>