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Key Clinical Message: Persistent hypotension is a rare complication of celiac plexus neurolysis. It is important to know what are the main and rare complications and how to treat these in patients who undergo CPN. Abstract: Celiac plexus neurolysis is an effective treatment for visceral abdominal pain in oncological patients. Although it rarely has complications, some side effects may occur. A patient with visceral abdominal pain who developed long-lasting orthostatic hypotension and was treated with the use of corticosteroids after a neurolytic celiac plexus block for intractable pain. We describe a rare complication and its treatment and we emphasize the importance of having a guide for the management and treatment of rare complications. We also suggest that every patient be informed about complications, from the most common to the rarest.
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Background: Myxofibrosarcoma (MFS) is a type of sarcoma that mainly affects elderly people; it represents only 5% of all sarcomas and shows no line of differentiation. Intracranial MFS is a rare condition. At present, limited data exist regarding brain metastasis from MFS. This article reports a case of MFS and reviews the literature regarding MFS metastasis. Case Description: We report a case of brain metastasis from chest wall MFS. The patient was diagnosed with an anterior thoracic MFS and underwent surgery and radiotherapy. One year later, he noticed a tumor on his left shoulder, and more than 1 year thereafter, bilateral lung metastasis was observed. Twelve months after lung metastasis, he presented to the emergency department and underwent contrast-enhanced magnetic resonance imaging, which demonstrated a left frontal tumor suggestive of brain metastasis. Since the main hypothesis was a sarcoma metastasis at the location close to the left motor area, and the patient had a good Karnofsky performance scale, the patient underwent neuronavigation-guided surgery. After surgery, the patient developed Grade III hemiparesis and aphasia. Brain tumor histopathology confirmed a malignant neoplasm with osteosarcomatous differentiation and metastasis from MFS. Conclusion: We report a rare case of MFS metastasis. To the best of our knowledge, this is the eighth case of intracerebral metastasis from MFS.
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Spasticity is amotor disorder that leads to a resistance to passive jointmovement. Cerebral palsy is the most important cause of spasticity and can be caused by several factors, including multiple gestations, alcoholism, infections, hemorrhages, drowning, and traumatic brain injuries, among others. There aremany scales that help tomeasure andmonitor the degree of impairment of these patients. The initial treatment should focus on the causal factor, such as tumors, inflammation, degenerative diseases, hydrocephalus, etc. Subsequently, the treatment of spastic musculature includes oral or intrathecal myorelaxants, spinal cord electrostimulation, neurotomies, Lissauer tract lesion, dentatotomy and selective dorsal rhizotomy. The latter is a safetechnique, possibleto beperformed inmost centers with neurosurgical support, and it is effective in the treatment of severe spasticity. In this article, the authors describe the surgical technique and conduct a review the literature.
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Enfermedad de la Neurona Motora/cirugía , Rizotomía/rehabilitación , Espasticidad Muscular/cirugía , Espasticidad Muscular/etiología , Parálisis Cerebral/complicaciones , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Rizotomía/métodos , Laminoplastia/métodos , Relajantes Musculares Centrales/uso terapéuticoRESUMEN
Dorsal root entry zone (DREZ) lesioning is still used as a choice of treatment for some painful conditions as well as spasticity in selected patients. The most commonly used techniques to perform DREZotomy are the microsurgical one and DREZ radiofrequency (RF) coagulation. The technical difficulties using punctures to perform RF lesions include complications such as occurrence of lesions in the dorsal columns or in the corticospinal tract. This paper describes a new technical improvement in RF lesions at DREZ using intraoperative ultrasound (US) to optimize the lesions and to minimize the risk of complications. Using intraoperative US after laminotomy allows the surgeon to differentiate between the gray matter of the spinal cord and white matter, showing the correct entry zone, the angle to introduce the RF electrode, and the depth. Using intraoperative US to guide DREZ lesions provides real-time optimization of DREZotomy.
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Monitorización Neurofisiológica Intraoperatoria/métodos , Laminectomía/métodos , Espasticidad Muscular/diagnóstico por imagen , Espasticidad Muscular/cirugía , Raíces Nerviosas Espinales/diagnóstico por imagen , Raíces Nerviosas Espinales/cirugía , Ultrasonografía Intervencional/métodos , Adulto , Humanos , Masculino , Médula Espinal/diagnóstico por imagen , Médula Espinal/cirugíaRESUMEN
Some authors have reported the association between CMC and brain aneurysms. In this paper it is reported a fusiform brain aneurysm associated to CMC and the vessel wall MRI findings.
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Candidiasis Mucocutánea Crónica/diagnóstico , Encefalitis/microbiología , Aneurisma Intracraneal/microbiología , Adolescente , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/microbiología , Arteria Carótida Interna , Angiografía Cerebral/métodos , Angiografía por Tomografía Computarizada/métodos , Encefalitis/diagnóstico , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico , Angiografía por Resonancia Magnética/métodos , Imagen Multimodal/métodosRESUMEN
Giant aneurysms (>25 mm) represent approximately 5-10% of all intracranial aneurysms. In this paper it's reported a giant calcified aneurysm presenting with hydrocephalus. It's highlighted the pre-operative images and intra-operative endoscopic findings.
