Glioblastoma multiforme de fosa posterior. Presentacion de un caso / Posterior fosa multiform glioblastoma

Objective: to report a case of glioblastoma multiforme (GBM) of the posterior fossa. Description: male, 53 years old, with a clinical presentation of dizziness and diplopia. MRI: posterior fossa tumor in the left cerebellar hemisphere, with an extension to the peduncle, brain stem and cerebellopontine angle. Intervention: a subtotal ressection was performed through a suboccipital craniotomy. Pathology informed GBM. After surgery the patient completed the treatment with radiotherapy (60Gy). The outcome was favorable. Conclusion: the preoperative diagnosis of a posterior fossa GBM is difficult because its a extremely rare localization, nevertheless it must be suspected (AU)

Carcinomatosis meningea. Comunicacion de dos casos / Meningeal carcinomatosis. Report 2 of cases

Objective: To describe 2 cases of leptomeningeal carcinomatosis. Description: Case 1 (24 years old female) complained of right ciatica and wakness in the last 15 days, with urinary retention. MRI showed a conus medullaris lesion that enhanced with gadolinium. Case 2 (47 years old female) with a previous history of a high grade B-cell limphoma, complaneid of astenia, anorexia and radicular pain. Lately she developed neurological deterioration, VII nerve palsy, urinary retention and seizures. A cisternal puncture was positive for neoplastic cells. Intervention: In case 1 surgery was performed and pathology infrmed high grade glioma. After 30 days she developed a meningeal syndrome with bilateral VI and VII cranial nerves paresis and neurological deterioration. Lumbar puncture was positive for neoplastic cells. She died after 15 days. Case 2 received intrathecal chemotherapy. Conclusion: Patients with extraneural malignat tumors and high grade tumors of the nervous system that refer signs and symptoms of a meningeal dissemination, meningeal carcinomatosis must be suspected (AU)

Abordajes quirurgicos a la bifurcacion basilar estudio anatomico de las diferentes vias de acceso presentacion en 3D / Surgical approaches to the basilar bifurcation: anatomical study in 3D

Objective: This study was conducted to show the different ways to approach the basilar bifurcation. Methods: Four formalin-fixed adults heads were examined using X 6 to X 40 magnification. The vessels were filled with colored silicon. Results: The different approaches to the basilar bifurcation are: 1) subtemporal approach; 2)transylvian approach; 3) pretemporal approach; 4)transcavernous approach; 5)anterior transpetrosal approach and 6) trans third ventricle approach. Conclusion: The Knowledge of the different approaches to the basilar bifurcation is important in the management of the lesions in this region (AU)

Comparacion de tecnicas de reconstruccion empleadas en cirugia de plexo braquial entre las lesiones supra e infraclaviculares / Comparison of brachial plexus surgical reconstruction techniques used between supra and infraclavicular lesions

Objective: to compare the thecnical procedures used for reconstruction in different groups of traumatic brachial plexus lesions (TBPL): supra and infraclavicular. Methods: all cases of brachial plexus lesions operated between September 2002 and March 2004 were included. Each case was analyzed separately and included in one of the two groups. Results: a total of 12 lesions were included in this presentation. Out of these, 8 were supraclavicular lesions, wich required neurorraphy in 4 nerves or trunks, neurotization in 11, and neurolisis in one. There were 4 infraclavicular lesions: 4 required neurolisis, and 2 neurorraphy. Conclusion: Eachs group of TBPL required a different surgical reconstruction technique (AU)

Analisis de la incidencia de la paralisis del nervio motor ocular comun en una poblacion neuroquirurgica. Correlacion clinica, anatomica e imagenologica / Incidence analysis of third nerve palsy in a neurosurgical poblation. Clinical, anatomical and image correlation

Objective: to describe the incidence and the different etiologies of oculomotor palsy in neurosurgical patients. Methods: Hospital records from the last 3 years were retrospectively reviewed. Five formalin-fixed adults heads were examined using X6 to X40 magnification. A correlation between clinical findings, anatomical studies and MRI images was performed. Results: medical records from 382 patients operated on at our department were reviewed. Of these, 16 patients underwent complete oculomotor palsy before brain surgery. Two patients had a mesencephalic tumor, 6 patients underwent uncal herniation due to a fast-growing intracranial mass, one patient had a superior cerebellar artery aneurysm, 3 patients had a posterior communicating artery aneurysm, one patient had a cavernous sinus meningioma. An analysis of the clinical, anatomical and MRI/ angiography data of 5 cases are presented in this study. Conclusion: oculomotor palsy is a relatively common finding in neurosurgical practice. The fact that it can be caused by different etiologies should be considered in order to arrive to the appropiate diagnosis and treatment. Anatomical knowledge of third nerve is very important when dealing with oculomotor palsy (AU)

Hematoma subdural subagudo y cronico: tratamiento quirurgico en 176 pacientes. Nuestra experiencia / Subacute and chronic subdural hematomas: surgical treatment in 176 patients. Our experience

Objective: to describe our surgical experience in suvacute and chronic subdural hematomas. Method: 176 patients with subacute or chronic subdural hematomas were operated between June 1998 and May 2003. Hospital records were used to ascertain data. We did a comparative analysis of the different types of surgical procedures performed. Results: the surgical procedure commonly performed was a burrhole craniostomy with subdural closed - system drainage (66 por ciento). This procedure was associated with a low rate of complications and reoperations, in comparison with the burr hole craniostomy or the craniostomy without subdural closed-system drainge. Global recurrence rate was 13 por ciento and 20,4 por ciento of the cases required reoperation. Clinical improvement rate was 72,3 por ciento. Conclusion: In our cases, burr hole craniostomy with closed-system drainge was the method of choice for the initial treatment in subacute and chronic subdural hematomas. Craniotomy should be reserved for those cases of recurrence or residual hematoma (AU)

Pseudotumor inflamatorio idiopatico orbitario bilateral con extension intracraneana. Comunicacion de un caso / Bilateral idiopathic orbital inflammatory pseudotumor with intracranial extension. Case report

Objective: To describe a case of bilateral idiopathic orbital inflammatory pseudotumor with intracranial extension. Description: a 46 years old female patient complaneid of right eye blurred vision and amaurosis since the past 9 months. Examination revealed: right eye 7/10 visual acuity and exophthalmos; left eye amaurosis and optic atrophy: CT scan and MRI showed a bilateral intraorbital and intracanal lesions with left intracranial extension. Intervention: Through a left frontal approach the left intracranial extension eas removed and the optic nerve was decomprssed. Intraoperative biopsy revealed a linfoproliferative lesion. Surgery ended and definitive pathology was informed as an inflammatory pseudomotor. The patient received corticoids with a good response. Conclusion: The presence of bilateral intraorbital lesions with intracranial extension, should force us too think about inflammatory pseudotumors (AU)

Neurinoma glosofaringeo: comunicacion de un caso / Glossopharyngeal neurinoma: case report

Objective: To describe a patient with a IX cranial nerve neurinoma of the cerebellopontine angle. Description: A 29 years old woman complained of headache and decreased hearing of the right ear during the last two years. MRI showed a lesion in the right cerebellopontine angle. Intervention: The patient was operated through a retrosigmoid approach. During surgery we realized that the lesion was related to the glossopharyngeal nerve. The tumor was totally resected, without postoperative morbidity. The pathologist informed schwanoma. Conclusion: The possibility of a glossopharyngeal schwannoma with auditive loss is possible

Anatomia microquirurgica del segmento P1 de la arteria cerebral posterior / Microsurgical anatomy of the P1 posterior cerebral artery segment

Objective: This study was conducted to clarify the anatomy of the posterior cerebral artery P1 segment. Methods: Four formalin-fixed adults heads were examined using X6 to X40 magnification. The vessels were filled with colored silicon. Results: The branches arising from the P1 are: 1) the posterior thalamoperforating arteries; 2) the short and long circumflex branches; 3) the medial posterior choroidalartery; and 4)the meningeal branch of Davidoff and Schechter. Conclusion: the correct knowledge of the anatomy of the P1 segment of the posterior cerebral artery is very important in the treatment of lesions located in the interpeduncular cistern (AU)