Traumatic epidural retroclival hematoma with odontoid fracture and cardiorespiratory arrest.

STUDY DESIGN: Case report. OBJECTIVES: To describe a case or traumatic retroclival hematoma with features not previously reported. SETTING: Single center. METHODS: Description of a case, in the context of relevant literature on the subject. RESULTS: Traumatic retroclival hematomas are a rare, typically pediatric, entity. Only four cases of epidural hematoma in adult patients have been reported. We describe an additional case, the first with a fatal course in the acute setting. It is also the first retroclival hematoma associated to an odontoid base fracture. CONCLUSION: Retroclival hematomas are a rare diagnosis, to be considered in pediatric patients with flexion-extension, high-energy injuries. Morphology is typically epidural. Brain stem and cranial nerve symptoms are typical. Treatment is usually conservative. Outcome is regarded as favorable, with partial recovery and neurologic sequelae. Adult cases are extremely rare. The case we describe adds new characteristics to the scarcity of cases.

[Meduloblastoma: infrequent onset in local recurrence]. / Meduloblastoma: una presentación infrecuente en la recurrencia local.

INTRODUCTION. Meduloblastoma is high potential to recur and spread tumour. CASE REPORT. One case posterior fosse meduloblas toma in six years old boy who received 3 surgeries, chemotherapy and radiotherapy, with local recurrence and extracranial extension into neck laterocervical musculature. CONCLUSION. Although meduloblastoma extraneural metastases are not isolated phenomenon, meduloblastoma extracraneal extension is uncommon phenomenon in local recurrence.

[Intracranial tuberculoma: a case report and review of the literature]. / Tuberculoma intracraneal: caso clínico y revisión de la bibliografía.

INTRODUCTION: Cerebral tuberculoma constitutes an important neurotuberculosis clinical form with high morbimortality and important diagnoses difficulty. CASE REPORT: Only giant cerebral tuberculoma case in 3 years-old man who present dizziness and surgically treated by diagnostic suspicion of cerebral tumor. CONCLUSION: Cerebral tuberculomas can often be confused with cerebral tumors when they are not included in differential diagnosis.

[Comparison [corrected] of Chiari I malformation treatment using suboccipital craniectomy and posterior arch of C1 resection with or without dural graft]. / Comparación del tratamiento de la malformación de Chiari tipo I mediante craniectomía suboccipital y resección del arco posterior de C1 con o sin duroplastia.

UNLABELLED: There are various surgical approaches to treat Chiari I malformation. In spite of the good clinical results that are reported with most of them, there is still controversy about the optimal treatment of this pathology. OBJECTIVE: To compare the clinical and radiological results of surgical treatment of the Chiari I malformation with suboccipital craniectomy, posterior arch of C1 resection with or without dural graft, analyzing clinical and radiological findings and describing the complications. MATERIAL AND METHODS: Retrospectively clinical cases series of patients who underwent Chiari I malformation surgery between 1998 and 2006 in the Hospital Germans Trias i Pujol in Badalona. The inclusion criteria consisted in: patients older than 18 years, who have had surgery in our hospital, detailed neurological examination before and after surgery (calculating the EDSS scale punctuation), craniospinal magnetic resonance imaging before and after surgery and minimal follow up period of 6 months. The election of the surgical approach was left to the discretion of the main surgeon. Patients were divided in two groups depending of the surgical technique: Group A (with dural graft) and Group B (without dural graft). To evaluate the morphological results in both groups, measurements of the position of the fastigium above a basal line in the midsagittal T1 weighted magnetic resonance images were obtained. In patients with syringomyelia, siringo-to-cord ratio was measured before and after surgery. To evaluate the clinical results, neurological examination was recorded in both groups before and after surgery. RESULTS: The mean age of Group A patients was 47 (-/+12.89) years, and of Group B was 38.3 (-/+7.77) years. Mean follow up period was 2.48 (-/+2.44) years in Group A and 4.2 (-/+4.46) in Group B. Creation of an artificial cisterna magna was observed en 35.7% of Group A patients and only in 3.5% of Group B patients (p=0.022). In 8 patients front Group A, 8 patients (28.6%) an upward migration of the cerebellum was seen, whereas any of the Group B patients presented it (p=0.022) Siringo-to-cord ratios were decreased in both groups without significant differences. All of the Group A patients improved their clinical exploration. In Group B, 60% of the patients improved and the 40% left maintained clinical stability. Any patient worsened. All patients that maintained clinical stability belonged to Group B, the differences between the two groups were statistically significant (p=0.04). Five patients presented immediate surgical complications (2 pseudomeningoceles, 2 meningitis and 1 hydrocephalus). All this patients where operated with dural graft (p=0.049). CONCLUSIONS: According to our study, suboccipital craniectomy with resection of the posterior arch of C1 and dural graft shows better clinical and radiological results than without dural graft. Nevertheless this technique can increase the incidence of surgical complications.

[Anterior approach complications in cervical spine pathology]. / Complicaciones del abordaje anterior en la patología de la columna cervical.

OBJECTIVE: To analyze cervical discectomy complications with anterior approach. MATERIAL AND METHODS: Retrospectively clinical cases series of 193 patients, between December 1989 to December 2004, in the Hospital Germans Trias i Pujol in Badalona. We analyzed complications arisen with cervical anterior approach and its relation with differents procedures. Demographic variables (age, sex), clinical variables (onset symptoms, cervical pathology cause, complication type, and duration time) and surgical variables (operated levels number, procedure, graft used) were analyzed. We made a statistical analysis with multivariant analysis, T-Student test and Chi-square test to analyze the relation between the complications and different studied variables. RESULTS: We found complications in 50 patients (25.91%). Most frequent has been dysphagia, present in 15 patients. Most of them appear with transitory form (13 patients) and in very few occasions permanent form (2 patients). T-Student test in statistical analysis showed no statistically significant differences (p=0.431) between the ages and complications, and were not statistically significant differences, used Chi-square test, in sex (p=0.515), in onset symptoms (p=0.923), in pathology origin (p=0.364), in a procedure(p=0.295), and graft used (p=0.382). We found statistically significant differences in operated levels number (p=0.018) with a ratio for the advantages (single /multiple) of 2.221. Multivariant analysis with linear regression model considering age, sex and operated levels number, showed that persistist the risk of complications in operated number levels, independently of the age or sex, being the multiple spaces a 117.3% more frequent than the single space (OR 2.173; IC95% 1.104-4.279). CONCLUSIONS: 1. Cervical anterior approach, is a simple technique, and safe surgically procedure with under number of complications. 2. Dysphagia is most frequent complication, but it is inherent to the procedure and it is solved without treatment in most ocasions. 3. Have been many the procedures used for the cervical spine fixation, with more than 40 years of experience, and still it is to define as he is the best one. It would be necessary more studies of prospective multicentric character to be able to compare clinical, radiological results, and the presence of complications.