Neurologically Asymptomatic Lumbar Traumatic Dislocation With Vascular Compression in a Patient With Ankylosing Spondylitis: Case Report.

BACKGROUND: Ankylosing spondylitis (AS) is associated with high rates of severe thoracolumbar fractures, in many cases with neurological deficits. It is currently a point of debate as to whether the optimal surgical treatment is posterior fixation and fusion or combined approaches. Vascular injuries in this kind of fracture are a challenging issue to solve in the management of these patients. METHODS: We are reporting the case of a 65-year-old man who presented an L4 traumatic fracture-dislocation. He had a long history of symptomatic AS. No neurological deficits were detected during the initial exploration. During the preoperative work-up, a lumbar spine computed tomography (CT) scan was taken with vascular reconstruction of the abdominal vessels. It confirmed the compression of the abdominal aorta, which had caused more than 90% stenosis. A posterior approach, an open reduction, and fixation with pedicle screws were performed, without hemodynamic or neurological changes. A postoperative angiography demonstrated a complete recovery of the vessel caliber, without contrast leaks. RESULTS: After a 2-year follow-up, the patient was pain free and the CT scan revealed bone fusion. CONCLUSIONS: The vascular structures involved in severe thoracolumbar fractures present a dangerous situation that should be considered in the choice of the surgical approach. The posterior approach alone may be a good option in the absence of vascular damage. However, due to risk of vessel rupture during the fracture reduction, vascular surgeons must take part in the surgery. LEVEL OF EVIDENCE: 5. CLINICAL RELEVANCE: The article provides help for surgeons who have to treat severe fractures in the context of ankylosing spondylitis.

Spontaneus involution of meningioma. Case report and literature review. / Involución espontánea de meningioma. Caso clínico y revisión de la literatura.

Meningiomas are tumors of the cerebral meninges, with slow growth and usually benign, whose treatment is essentially surgery. They have progesterone receptors, and to a lesser extent estrogen, which sometimes causes them to have growth or involution linked to hormonal treatment. Its spontaneous involution is extremely rare. We present the case of a male with a meningioma of the sphenoid planum. He had a history of diabetes mellitus, myasthenia gravis and prostate cancer. He was in treatment with analogs of GnRH (leuprorelin), antiandrogen (bicalutamide), ß3 agonists and α1 blockers. 15 months after the hormonal blockade, a reduction of the tumor of approximately 90% of its volume was detected. Previous reports show that treatment with gonadotropin analogues produces growth in some meningiomas. Other reports of spontaneous involution affect diabetic patients and patients in treatment with α1 blockers. Literature focus on meningiomas with spontaneous involution is reviewed.

Current use of Social Media in Neurosurgery in Spain. / Situación actual del uso de redes sociales en Neurocirugía en España.

OBJECTIVE: To analyze the current situation in Spain of the use of Social Media in Neurosurgery. MATERIALS AND METHODS: We made an observational transversal study between February and March 2017, with a systematic search of the Facebook, Twitter and Youtube accounts from public and private neurosurgical units, scientific societies, peer-reviewed publications and patients groups in relation with Neurosurgical pathologies. We rank them according their popularity. RESULTS: According of our search only 5 public neurosurgical services have social media accounts, being their popularity inferior to the private units accounts. In relation with the scientific societies and neurosurgical publications their presence in social media is marginal, even more in comparison to the accounts of other medical specialities. The popularity of associations of patients and supporting groups is high, especially among patients, finding there more information about their disease. CONCLUSIONS: The use in Spain of Social Media about Neurosurgery is low in comparison to other medical specialities. There is a huge field to improve the popularity of the accounts, making in them promotion of health and extend the diffusion of the scientific society and the peer-reviewed publication Neurocirugía.

Anterior sacral meningocele presenting as intracystic bleeding.

PURPOSE: To report a case of anterior sacral meningocele with intralesional bleeding secondary to sacrococcygeal trauma. Likewise, there is a discussion about the physiopathology and the surgical approach to these types of lesions. METHODS: A 43-year-old man diagnosed with Marfan syndrome suffered sacrococcygeal trauma. He was admitted to the emergency room due to symptoms of headache, nausea, and lower limb subjective weakness. CT and MRI showed a large retroperitoneal mass with hemorrhagic content close to the sacrum. Likewise, the MRI showed an image compatible with subarachnoid hemorrhage in the thoracic spinal area, cerebral convexity, and the basal cisterns. The patient went into surgery for an anterior abdominal approach in the midline to reduce the content of the lesion, and subsequently, in the same act, a posterior approach was done with an S1-S2 laminectomy and obliteration of the pedicle. Postoperative MRI 5 months later showed resolution of the ASM. RESULTS: Anterior sacral meningocele is characterized by herniation of the dura mater and the arachnoid mater outside the spinal canal through a defect of the sacrum. We add the risk of bleeding after trauma-never seen in the literature-as one of the possible inherent complications of this lesion. CONCLUSIONS: This report highlights a complication never seen in the literature of a relatively rare condition. In our case, the combined approach was effective for both clinical control and lesion regression.

[Trigeminal neuralgia secondary to petrous endostosis]. / Neuralgia del trigémino secundaria a endostosis del hueso temporal.

Arterial neurovascular compression is hypothesised to be the main cause of primary trigeminal neuralgia. Although it is the most common cause, other pathologies, such as tumours in the cerebellopontine angle, can cause trigeminal pain. We report a case of a 44-year-old female patient with right trigeminal neuralgia without satisfactory response to medical treatment. Cerebral MRI showed no structural injuries. During microvascular decompression of the trigeminal nerve, endostosis of the internal aspect of the petrous bone was found to compress the trigeminal nerve. The pain disappeared completely in the early postsurgical period, after the complete drilling of the endostosis and microvascular decompression. The patient remains asymptomatic one year later. Endostosis of the petrous bone is a rare cause of trigeminal neuralgia. A proper review of preoperative studies would enable the definitive surgical approach to be optimised.

[Reversible porencephalic cyst related to shunt dysfunction]. / Cavidad porencefálica reversible secundaria a disfunción valvular.

INTRODUCTION: The surgical treatment of hydrocephalus is one of the most commonly procedures of modern pediatric neurosurgical practice, and cerebrospinal fluid shunts are the main means of treatment of hydrocephalus, being independent of site of obstruction and ventricular shunt complications are frequent, especially in children. The most common complications are shunt obstructions, mechanical disconnections, overdrainage and infection. CASE REPORT: A 7.5-year-old girl with ventriculoperitoneal shunt presented with intermittent headache. A head computed tomography scan revealed a cyst located in right temporal lobe. After ventriculoperitoneal shunt revision, a gradual resolution of the cyst was demonstrated on computed tomography. CONCLUSIONS: Cerebrospinal fluid porencephaly is a rare postoperative complication of a ventricular shunt that results from dysfunction of the distal catheter, especially in children with taut ventricles.

TITLE: Cavidad porencefalica reversible secundaria a disfuncion valvular.Introduccion. El tratamiento quirurgico de la hidrocefalia es uno de los procedimientos quirurgicos mas habituales en la neurocirugia pediatrica, y las derivaciones ventriculoperitoneales constituyen una herramienta fundamental en el tratamiento de la hidrocefalia tanto infantil como del adulto. Las complicaciones de las valvulas son relativamente frecuentes, sobre todo en la poblacion pediatrica, y, entre estas, las mas habituales incluyen: las obstrucciones, las desconexiones, el hiperdrenaje y las infecciones. Caso clinico. Niña de 7,5 años, portadora de una valvula ventriculoperitoneal, que presentaba cefalea intermitente. Un estudio con tomografia computarizada demostro una lesion quistica temporal derecha. Tras la revision valvular, la tomografia computarizada evidencio la reduccion del quiste. Conclusiones. La formacion de una cavidad porencefalica es una complicacion poco frecuente. Se relaciona con problemas en el cateter distal en pacientes con ventriculos dilatados y de las que existen escasas referencias en la bibliografia.

[Intraventricular arachnoid cyst]. / Quiste aracnoideo intraventricular.

INTRODUCTION. Intracranial arachnoids cysts are considered benign developmental anomalies that occur within the arachnoid membrane and generally contain clear and colourless fluid resembling cerebrospinal fluid. The prevalence of these cysts is higher in the first two decades of life, and the incidence is widely quoted as approximately 1% of all space-occupying intracranial lesions. Arachnoids cysts in the elderly person are a rare occurrence. We report the unusual presentation of a woman with an intraventricular arachnoid cyst treated with endoscopic technique. CASE REPORT. A 75-year-old woman presented with progressive hemiparesis of two years duration. Cranial MR imaging showed a right parieto-occipital intraventricular cyst with local mass effect and moderate dilatation of lateral ventricles. A right-sided burr hole was made and the arachnoids cyst was reached and cysto-ventricle shunting was realized. This was followed by a septum pellucidum fenestration. There were no complications during the surgery and the patient presented no symptoms at time of discharge. CONCLUSIONS. The neuroendoscopic approach to intraventricular arachnoid cysts was effective with few complications.

TITLE: Quiste aracnoideo intraventricular.Introduccion. Los quistes aracnoideos intracraneales son lesiones congenitas de caracter benigno formadas por una membrana aracnoidea que contiene en su interior un liquido de caracteristicas similares al liquido cefalorraquideo. La prevalencia de estos quistes es alta en las primeras dos decadas de la vida, y es poco frecuente en ancianos; representan alrededor del 1% de todas las lesiones intracraneales ocupantes de espacio. Presentamos el caso de una paciente con un quiste aracnoideo intraventricular tratado endoscopicamente. Caso clinico. Mujer de 75 años que presenta una hemiparesia progresiva de dos años de evolucion. La resonancia magnetica craneal mostro una lesion quistica intraventricular en la region parietooccipital derecha, con efecto masa local y moderada dilatacion de los ventriculos laterales. A traves de un agujero de trepano frontal derecho, se realizo una fenestracion cistoventricular y apertura del septo pelucido. No se presentaron complicaciones relacionadas con la cirugia y la paciente fue dada de alta asintomatica. Conclusiones. La fenestracion neuroendoscopica es un tratamiento efectivo para los quistes aracnoideos intraventriculares, con un escaso indice de complicaciones.

[Cervical lymphatic metastasis of an intracranial meningioma]. / Metastasis linfatica cervical de un meningioma intracraneal.

INTRODUCTION: Meningioma is the most common primary intracranial tumor, accounting for around a third of all primary brain tumor. In most cases, they are benign neoplasms that start in the cells of the arachnoid mater. Meningiomas are typically slow growing; however they can metastasize in 0.1% of all patients. CASE REPORT: A 45-years-old woman was admitted with a four weeks history of a painless enlarging mass in the right side of his neck and present in a MRI recurrence of the frontal meningioma surgically removed four times over the last 18 years. The patient underwent a complete removal of lesions and the microscopic observation showed an anaplastic meningioma in both (grade III of the World Health Organization). CONCLUSIONS: Metastatic meningioma is a rare cause of neck mass, but should be considered in any patient with a history of meningioma, especially if the tumor has histological features of malignant behavior. The present case demonstrates the aggressive biologic potential of an intracranial meningioma, with potential for distant spread and lymphatic invasion.

[Paediatric neurocysticercosis: two case reports]. / Neurocisticercosis pediatrica: a proposito de dos casos.

INTRODUCTION: Neurocysticercosis, caused by the larvae of Taenia solium, is the most common parasitic infection of the central nervous system in humans. Considered an endemic parasitosis in developing countries including Latin America, Asia and Africa while in Europa, the cases of neurocysticercosis are anecdotal. CASE REPORTS: We report two cases of neurocysticercosis in children of non-Spanish origin who presented with seizures, with the initial diagnosis of brain tumors both were treated with surgery; later, to be the diagnosis of neurocisticercosis antiparasitic therapy was administered. CONCLUSIONS: Neurocysticercosis can be a potential cause of epilepsy even in non-endemic countries. Some cases may be difficult to diagnose and they can be confused with other intracranial lesions. Clinicians should be aware of this condition given increasing incidence in Spain and neurocysticercosis should be always be considered in the differential diagnosis particularly in patients from Latin America and Africa.

[Chronic subdural hematoma in young patients]. / Hematoma subdural crónico en pacientes jóvenes.

OBJECTIVE: The objective of this study was to analyse demographic, clinical and radiological findings and surgical results in a series of chronic subdural haematomas (CSDH) in young adult patients. PATIENTS AND METHODS: This retrospective study included 42 patients under 40 years of age who were diagnosed and surgically treated for a CSDH during a 30-year period (1982-2011). RESULTS: Of the 42 cases analysed, 32 were males and 10 were females, and the mean age at diagnosis was 29.3±8.9 years (range: 4 to 39 years). The mean interval from trauma to appearance of clinical symptoms was 33.4±9.7 days (range: 19 to 95 days). The main symptoms were headache (59.5%) and seizures (21.4%), and the most frequent predisposing factors were ventriculoperitoneal shunting in 5 (11.9%) patients and haematological disorders in another 5 (11.9%) cases. CSDH was right-sided in 21 cases (50%), left-sided in 19 cases (45.3%) and bilateral in the remaining 2 patients (4.7%). Postoperative complications occurred in 2 patients (1 recurrence and 1 acute subdural haematoma). CONCLUSIONS: CSDH is a rare pathology during the first decades of life. It mainly affects males and headache is usually the first symptom. Prognosis is good in young patients, since postoperative complications and recurrences are less frequent at this age than in older populations.

[Intracranial tuberculoma mimicking malignant tumour]. / Tuberculoma cerebral que simula un tumor maligno.

INTRODUCTION: Tuberculous involvement of the central nervous system is uncommon in western countries. Brain tuberculoma is a granulomatous inflammatory process than in rare occasions can simulate a malignant neoplasm. CASE REPORT: A 81-year-old man regarding symptoms of several weeks of evolution of numbness affecting upper limb and right face. The neuroimaging studies showed a left parietal lesion suggestive of a primary malignant tumor. A stereotactic biopsy was performed and the pathological examination showed a brain tuberculoma. The patient was treated with anti-tuberculous drugs. CONCLUSIONS: Parenchymal central nervous system tuberculosis are rare in our medio and may present as a space-occupying lesion with complex neuroimaging morphology suggesting a malignant neoplasm. Definitive diagnosis was performed with neuropathological studies or with the demonstration of acid-fast bacilli in the tuberculoma.