Material and method: 140 ETVs were performed in 132 patients; 120 of them are shunt free (90.90%). Eight patients (5.71%) showed closure of the ventriculostomy: in 4, it was presumed to be related to postoperative radiotherapy; 2 patients had an insufficient opening of the Lilliequist membrane and 2 showed ostoma closure of unknown origin. In all of them a second ETV was performed, and the procedure was successful. Twelve patients (8.57%) required shunt placement; 4, with a history of septated postmeningitis hydrocephalus, now only need a single ventricular catheter. Of the remaining, 3 presented with meningeal seeding from malignant tumors; 1 with racemous neurocysticercosis; 1 with multiple malformations and history meningitis; 2 with a previously unknown aresorptive component; 1 with history of post-shunt meningitis. Most patients with ETV failure developed CSF fistula. In all these cases, patency of the ostoma was confirmed during re-exploration, and consequently, a shunt was indicated.
Discussion and Conclusions: We consider ETV to be the standard treatment for obstructive hydrocephalus. With low morbidity in our series (4.68%) and no mortality. Re-exploration and eventual re-fenestration are indicated in all cases of ETV failure, given the benefits of shunt independence.]]> Description: Case 1: patient of 48 years, who enters by sensory abnormalities, with CT that demonstrated tetraventricular hydrocephalus. The CSF was positive for neoplasic cells. Primary tumor was found in bladder. Case 2: patient of 55 years, who entered by progressive cuadriparesia. He presented sensory abnormalities by acute hydrocephalus. The autopsy informed meningeal affectation by gastric carcinoma.
Discussion: Although patognomonic signs do not exist, the more frequent clinical manifestations are affectation of cranial nerves, headache and alterations of the mental functions. The RNM with gadolinium is the best method, with a sensitivity of 70%. In the infrequent cases of acute hydrocephalus, the CT is the first study to perform.
Conclusions: Before the unspecific signs, the diagnosis of certainty of meningeal carcinomatosis is based on the help of radiological investigations and the findings of the LCR, on an oncologic context.]]> Method. Between 1999 and 2007, 28 consecutive patients with symptomatic supratentorial cysts underwent neuroendoscopic treatment in our department.
Results.The mean age was 3.1 years (range 1 month to 15 years), 18 were male and 10 female. In 5 patients a prenatal diagnosis was established. Eighteen patients presented increased intracranial pressure, 5 developmental delay, 3 seizures and 3 hemiparesis. According to its localization we have clasificated the cysts in: interhemispheric (8), intraventricular (7), cuadrigerminal (5), paraventricular (5) and suprasellar (3). We have excluded the temporal cysts of this series. All patients underwent neuroendoscopic treatment involving cystoventriculostomy in 24 and cystocisternostomy in 4. The complications were: 1 CFS leak, 3 patients required ventriculo-peritoneal shunt, 1 cystoperitoneal shunt and 1 subdural peritoneal shunt. There were no surgery-related morbidity or death.
Conclusion. Endoscopic treatment of symptomatic supratentorial cysts can be considered a useful alternative to traditional treatment.]]> Method: Retrospective Descriptive Study. A pubmed researh have been done and compared with the outcomes obtained in this study.
Results: Forty one clinical charts from patients with mass lesions which required stereotactic biopsies have been analized. The histopatological diagnostic was made in 90% of the cases. 66% had neoplasic lesions. The morbility was 4%, represented by intracerebral hematomas, that required emergency surgical treatment. The mortality was 2%.
Conclusion : In our experience the stereotactic biopsies CT guided whith the Zamorano Dujovny stereotactic system is a practical and relatively easy method, with low morbility and mortality, and whith a high accuracy in the diagnosis.]]> Method: We used a side-opening-Magnet, 0,23 Tesla, installed in a surgical area specially designed with all the advances of the modern operating rooms.
Results: A great variety of neuro-surgical procedures can be made with REMAIN controls. The obtained images are clear, without devices and with an excellent definition of the anatomical structures and the pathology, that allows the neurosurgeon to make more precise and safer interventions.
Conclusions: The images of REMAIN in a surgical scope, make possible that injuries can be identified and located with absolute precision. It is particularly useful in determining with exactitude the tumor-like limits, optimizing the surgical approaches, obtaining complete extirpations of brain injuries and controlling the possible intraoperative complications.]]> Material and methods: 17 patients with SAH were admitted between January and July 2007.15 patients with brain aneurysms and 2 patients with AVM´s. CTA was performed in 9 patients with brain aneurysms and1 patient with AVM. Surgery was performed in 5 patients on the basis of CTA alone. CTA was used as postoperative control in 4 patients.
Results: Surgical findings were compared with preoperative CTA and were considered accurate in all cases. However in postoperative CTA the presence of metallic devices (clips and stent), makes difficult the correct visualization of the nearby arteries.
Conclusion: The 3D CTA is a useful diagnostic method for detection of brain vascular malformations in patients suffering SAH.]]> Material and Method. Revision of 89 clinical records of patients with aneurysmal SAH treated in our Service during years 2004 to 2006. We considered in their admission: sex, age, Hunt/Hess clinical grade, Fisher scale and the presence or not of hydrocephalus in CT, Glasgow coma scale, and other co morbid factors as arterial hypertension and diabetes.
Results. Age, hypertension and diabetes, demonstrated not to be strong factors associated with post aneurysmal SAH acute hydrocephalus in our series. Hydrocephalus prevalence in males was similar to that in females, but it is interesting to mention that the 100% of cases treated surgically were females. We have found a firm relationship between Hunt/Hess and Fisher high scores at admission and the presence of ventricular blood invasion as well as great volume of it in the basal cisterns with the occurrence of acute hydrocephalus.
Conclusion. Our results confirm the latest pathophysiological concepts that acute hydrocephalus post SAH is an obstructive entity, remarking the following as the principals predictive factors: a) Severe neurological deterioration at admission (Hunt - Hess 4/5), b) Important amount of blood in subarachnoideal space and ventricular system (Fisher III/IV).]]> Material and method. The study is a retrospective review of the clinical charts of patients with intracranial metastasis seen between 1988 and 2006. Inclusion and exclusion criteria were established for the different cases.
Results. In this period, 1740 cns tumors were operated on, of which 12 cases were intracranial metastasis (0.7%.). Mean age of the children was 11 years. Six patients were male and 6 female. Location of the primary tumor was: suprarenal in 4 cases, in the bone in 2, and in the bladder, kidney, testicle, hypopharynx, facial bone, and thigh in 1 case each. Four patients had multiple metastasis: 10 located in the cerebral hemispheres, 2 in the skull bone, and 2 at the epidural level. All patients presented with symptoms due to the brain metastases. Total resection was achieved in 9 cases, subtotal resection in 1, and partial resection in 2. Mortality rate was 50%, with a mean follow-up of 23 months.
Conclusion. The incidence rate of brain metastasis in children is much lower than the published incidence rates in adults. The location of the primary tumor and histology found were also different. We consider surgery, when possible, a good therapeutic option within the multimodal treatment of metastases.]]> Description: Female patient of 34 years old, who consults for invalidating anal pain and rectal tenesmus. The MRI shows an image compatible with cystic dilatation of ventriculus terminalis.
Intervention: The treatment consists in simple wide laminectomy; midline microsurgical myelotomy and marsupialization with subaracnoidal space. Following myelotomy and fenestration a significant reduction in size of the cyst was seen in MRI.
Conclusion: The patient clinical response was good in relation with her initial situation (invalidating anal pain); only persists the parestesis in the right dermatomas L5-S1. This last symptom requires medical co-adyuvance (CBZ). Radiological evolution of the lesion was excellent. To 5 years only post-surgical changes are evident.]]> Description: Both, a 44-year-old female (case 1) with a 9 months history of myeloradiculopathy and a 50-year-old female (case 2) with a 2 year history of cervicobrachial pain had a C5-C6 posterolateral discal hernia diagnosed by magnetic resonance. As medical treatment failed, both patients were taken to surgery.
Intervention: In both cases we performed a cervical arthroplasty using a 14 mm Bryan cervical disc prosthesis. There were no intraoperative complications. Case 1 had a postoperative sagittal misalignment: end plate angle was -10° (preoperative +3°). This was caused by an inappropriate use of the manual stabilizer. Case 2 had a postoperative coronal misalignment: coronal angle was 18° (preoperative 0°). This was caused by the asymmetric anterior ostheophyte and end plate drilling. At the latest follow-up, 6 and 3 months respectively, case 1 still had muscular pain and case 2 was asymptomatic.
Conclusion: In both cases misalignment problems could have been avoided with a proper surgical technique and were not inherent to the insertion technique.]]> Description: the authors selectioned 3 cases among 53 adults who underwent surgical treatment with ETM diagnosis.
Case 1: Female patient, 32 years old. Antecedents of complex partial crisis since 6 years old, some of the crisis related to febrile episodes. Aura related like unpleasent gastroesophageal sensation, break of contact, right hand dystonia, cephalic turn to right and oroalimentary and manual automatism. RMI and EEG-Video: injury compatible with left ETM.
Case 2: Male patient, 24 years old. Antecedents of complex partial crisis since 13 years old. Break of contact, verbal automatisms (repeats unintelligible sounds) and sensation of postictal sickness. RMI: increase of signal (FLAIR) in both hippocampus, impressing rigth atrophy. EEG-Video with profund electrodes implanted: start of the crisis on a rigth mesial temporal level.
Case 3: Female patient, 21 years old. Antecedents of complex partial crisis since 12 years old. Complex partial crisis with bimanual and oroalimentary automatisms with an episode of generalization. RMI and EEG-Video: injury compatible with rigth ETM.
Intervention: Case 1 and 2 were resolved by the realization of an anteromesial resection of Spencer. In case 3 a selective amygdalo hippocampectomy was practiced.
Conclusion: ETM is the paradigm of the refractory epilepsy in an adult population. Precocious diagnosys and treatment allow to obtain a high index of cure with small amount of significant sequels.]]> Description. 55, female. Two yrs. history of generalized convultions. Left frontomedial lesion biopsied outwards. PA: low grade astrocytoma. Medically trated until feb. 2007. Sudden headache and right sided hemiparesis with crural predominance. Hoffmann and slight right hyper reflexia. MRI: expansion of primary lesion with intra lesional hemorrhage. Surgical resection. PA: mixed anaplastic glioma. The inmediate posoperative status was of a right CB plejia with severe apathy and abulia with right spatial hemineglect and hypofluent and anomic languaje, with preserved repetition and comprehension. Total recovery of paresis and languaje except when stressed.
Discussion. The SMA is limited by cingulate cortex inferiorly, PMC posteriorly, and vértex superiorly. The anterior border is not well defined. SMA activates before the PMC, during planification and iniciation of movement. Is connected with the PMC, spinal cord neurons, basal ganglia and contralateral SMA. By intraoperative stimulation it could be established the somatotopic organization of SMA, with the the hindlimb posterior the forelimb intermediate and face anterior. Before the facial representation is the language area in the dominant hemisphere. Epileptogenic crisis originated in this area produce abduction and supination of the contralateral forelimb with deviation of the head to the same side. The syndrome of lesion of SMA includes: Global akinesis, proximal predominance of motor déficit, with secuelar difficulty for the fine movements of hands an a quick recuperation (days to weeks).
Conclussion. The síndrome of the supplementary motor area is well recognized after medial frontal lobe surgery. Its features include reduction of spontaneous movements in the contralateral limbs and speech deficit. The impairment of volitional movements is the main finding. Recovery is complete in a short period of time.]]> Description: In the last two years we performed 15 carotid endarterectomies with transcranial doppler intraoperative monitoring. In all cases we didn’t use a shunt during the procedure based on the monitoring results.
Results: All patients recovered without any neurological deficit.
Conclusions: Intraoperatve monitoring with transcranial doppler seems to be a good method to determinate the use or not of a shunt during the procedure.]]> Material and methods: First case: Male patient, 25 years old. The RMN of brain showed a lesion in selar, supra and paraselar location .Second case: female patient, 40 years old. The RMN of brain showed right temporal lesion with adjacent bone commitment.
Results: Both patients were treated surgically, anatomopathologyic diagnosis was giant cells tumor (GCT).
Conclusion: The GCT are generally benign, locally aggressive, the surgical excision has proved to be the most effective treatment. The presentation of this work is due to the scant bibliography reported until the moment on GCT of the skull base.]]> Description. A 54-year-old patient with a right progressive exoftalmos due to a tumor inside the orbit. He was operated 18 years ago with an histopatology diagnosis of neurofibroma. He recovered well from the surgery, but 3 years ago the right exoftalmos reappeared. The MRI shows multiple subgaleal tumors located in the right fronto temporal area, inside and outside the orbit.
Intervention. A right fronto orbitary craniotomy was performed with the resection of soft non encapsulated subgaleal lesions.
Conclusion. Segmental neurofibromatosis is a rare afection wich is very difficult to deal with, because of the high incidence of recurrence of the neurofibromas. Despite this, in cases like this one a surgical treatment is highly recommended to prevent not only visual defects but also cosmetic alterations.]]> Method: 7 cases of Central Neurocytoma, were diagnosticated and received treatment in Hospital Cordoba & Clinica Reina Fabiola between 2000 - 2006, with a follow up of, at last, 12 months.
Results: we find male predominance, average age 26 years. They, have frequently, intracranial hypertension because of hydrocephaly. Atypical tumor and subtotal resection had early recurrence.
Conclusions: When we have intraventricular tumors in male young people, we should think about these lesions. The treatment would be aggressive in the first resection and always perform Mib 1 index because the recurrence depends on previous factors. Radiant therapy can be used in atypical cases and Mib 1> 3%.]]> Material and method. Age, sex, way of presentation, location, radiologic features, surgical technique and complications of 15 epidermal and 1 dermal tumors diagnosed between may 1997 and october 2006, were retrospectively assessed.
Results. Mean age: 43 yrs. Most frequent clinical manifestation: headache. Most tumors were at CPA. All resections were done with microsurgical technique. There were 3 cases of chemical meningitis that resolve without sequel.
Discussion. Dermal and epidermal cysts are originated by inclusion of ectodermic material at the moment of occlussion of the neural tube. They represent the 0,3 - 1,5% of intracranial tumors beeng dermal 5-9 times less frequent. The most frequent location of epidermal cysts is at the CPA while dermal are more frequent in the midline. Clinical fatures depend on location. MRI is the gold standard for diagnosis, specially the DWI sequence. CT is important for the detection of bone invasion.
Treatement is so extensive as possible surgical resection, difficult, sometimes because of strong adhesions to eloquent structures.
Conclusion. Dermal and epidermal cysts are high fat content lesions, that produce edherence to neural structures. Surgical excision is the election tratement.]]> Methods: a retrospective study was conducted by analysing the charts of the patients including surgical records, imaging studies and histopatological records.
Results: a total of 304 meningiomas were operated on between 1994-2007 in our department. There were 16 patients with olfactory groove meningiomas including 9 women and 7 men. A mean age of 52,8 yr (age range 21-72 yr). The most frequent symptom was a higher function impairment ( 5 pt). Olfactory simptoms were infrequent in our series. The average maximum tumoral diameter was 5,8 cm. The approaches used were the subfrontal, bifrontal craniotomy with orbital osteotomy, pterional and frontolateral. CSF fistula was the most frequent complication. Perioperative mortality was recorded in two cases. No relation with surgery was demostrated. The mean follow-up period was 78 months.
Conclusion: the olfactory groove meningiomas reaches a big size due to delay in diagnosis. The best treatment is the surgical excision with a surgical approach wich provides quick access to the tumor with the lesser morbimortality possible.]]> Description. Case 1. 61, female. Left extraaxial temporo- occipital formation enhancing with gadolynium, tentorial implantation. Simpson II resection. PA: atypical metaplasic meningioma, EMA, VIM and PGR positive. Ki- 67: 13%. Without parenchimal infiltration. Local 3D radiotherapy. Visual deterioration, walk disturbance. Relapse with compromise of rectus and transverse sinuses. Simpson II resection. In 12 months, progression of the disease along the convexity. Paliative treatement with hidroxiurea. Case 2: 69, female. Rt. occipito- parietal meningioma 1995 subtotal resection in other center. Radiotherapy of remnant tumor. 2001 reoperated. Simpson II resection. PA: meningtheliomatous meningioma Ki- 67: 5%. Dec. 2006 Total resection of relapsing anaplastic meningioma. June 2007, extensive FPT dural dissemination. Medical treatement.
Discussion. Anaplasic meningiomas present an exponential growing pattern that differenciates them from better grade lesions, possibly mediated by genetic factors (10q, 14q, 9p deletions). However, the only independent predictor seems to be the cellular kinetic index Ki- 67. 5 yr. 95% and 10 yr. 79% survival rates are reported for anaplasic meningiomas with shorter relapse delays.
Conclusion. High aggressive reccurrent dissemination of anaplastic meningiomas is uncommon. Simpson’s I or II total resection is the initial tratement complemented as second line treatement by radiotherapy. Chemotherapy is of scant utility.]]>