[Chronic subgaleal hematoma in a child. Case report]. / Hematoma subgaleal crónico en un lactante. Presentación de un caso.

Neonatal subgaleal hematomas are under-diagnosed collections of blood beneath the galea, often caused by certain obstetric procedures such as use of forceps or vacuum. They generally have low volume and often resolve spontaneously. Occasionally, they can achieve a large volume and may endanger the live of the affected newborns. Rarely, they become chronic and exceptionally they may require surgical treatment. We report the case of a child under one year of age who was referred to our department because of a subgaleal hematoma secondary to vacuum-assisted delivery that required surgical treatment.

[Pituitary apoplexy. A review]. / Apoplejía pituitaria. Revisión del tema.

Pituitary apoplexy constitutes a syndrome that is characterized by the ischemic infarction or hemorrhage into a pituitary tumour. Clinically the patient develops sudden headache, meningismus, visual disturbances, even blindness, and occasionally decrease in level of consciousness. To diagnose it is basic to perform a cerebral MRI. Treatment consists in urgent sellar decompression by transsphenoidal surgery and substitute therapy with steroids.

[Scedosporium apiospermum brain abscess. Report of one case with literature review]. / Absceso cerebral por Scedosporium apiospermum. Presentación de un caso con revisión de la literatura.

Scedosporium apiospermum is a fungus found in the soil and in contaminated water and commonly cause cutaneous infections and is a rare cause of central nervous system infection. Invasive infection is usually associated with immunosuppresion. The authors present a 73-year-old woman with chronic renal disease who presented with headache for 2 weeks. Computerized tomography scans revealed a ring-enhancing lesion in left temporal lobe. An urgent craniotomy was performed and the lesion was totally removed. The patient died 5 days later. Scedosporium apiospermum was isolated in the culture of the extirpated lesion. The authors review the previously reported cases of brain abscess for Scedosporium apiospermum.

[Chronic subdural hematoma associated with arachnoid cyst. Report of 12 cases]. / Hematoma subdural crónico asociado a quiste aracnoideo. Presentación de 12 casos.

INTRODUCTION: We designed this study to investigate the clinical, neurological, and radiological outcome of patients with chronic subdural hematoma related to an intracranial arachnoid cysts. PATIENTS AND METHODS: Medical records of 12 cases of patients with arachnoids cyst complicated with chronic subdural hematoma were retrospectively reviewed. RESULTS: Between January 1984 and April 2008, 12 patients (0.9%) of 1.253 cases of chronic subdural hematoma surgically treated in our hospital had associated arachnoid cyst. Arachnoid cysts were located in the middle fossa (10 cases) and convexity (2 cases). The most frequent symptom was headache (6 cases), followed by seizures (3 cases). Eleven patients underwent burr hole and drainage; the oldest patient was treated conservatively. CONCLUSIONS: Patients with AC, especially when these are located in temporal fossa, appear to harbour a life-long risk of contracting subdural hematoma. Hematoma evacuation is adequate at first operation and if arachnoid cyst is symptomatic or preoperative symptoms persist, additional arachnoid cyst surgery should be considered.

[Filum terminale ependymomas. Analysis of a serie of 20 consecutive cases]. / Ependimomas del filum terminal. Análisis de 20 casos consecutivos.

OBJECTIVE: to analyze the clinical, radiological and surgical outcome of a series of filum terminale ependymomas. Patients and methods. This retrospective study involved 20 patients with 21 ependymomas of the filum terminale encountered during a 21 year period (1988- 2008). All patients were diagnosed using MRI and surgically treated. RESULTS: the male: female ratio was 1:1.5, and the mean age at diagnosis was 44.8 years (range 15-64). First symptom included radicular pain (12 cases) and lumbar pain in the other 8 cases, with average symptom duration of 8.7 years (range 0-6-32). All patients underwent open biopsy, seventeen tumours received gross-total resection and 4 received subtotal resection. Histologically, 20 tumours were myxopapillary ependymomas (grade I) and 1 case a grade II ependymoma. The mean follow-up period was 8 years (range 1-18 years). CONCLUSIONS: filum terminale ependimomas are slow growing tumours of the cauda equina with a high incidence in young adults. The most common presentation is with low back pain long time evolution. Although ependymomas of the filum terminale are thought to be benign, local recurrence is not uncommon.

[Epidural haematoma due to an headrest in an adult]. / Hematoma epidural secundario al empleo de cabezal autoestático en un adulto.

A head fixation device with pins is commonly used for immobilization of the patients during neurosurgical procedures. Despite its appropriate management, it may be the cause of some serious complications such as skull perforation and intracranial injuries.We report the case of a 19-years-old young admitted for a endoscopic third ventriculostomy who developed an epidural haematoma due to the penetration of the skull by a pin.

[Eagle syndrome. An unusual cause of neck pain]. / Síndrome de Eagle. Una causa poco frecuente de cervicalgia.

Eagle syndrome is characterized by unilateral pain in oropharynx, the side of the face, and cervical region in patients after tonsillectomy. It is caused by an elongated styloid process. The authors present a case of a woman who suffered from pain in the cervical region during many years. The TC-3D scan showed bilateral elongation of the styloid process.

[Spontaneous resolution of an asymptomatic intracranial arachnoid cyst]. / Resolución espontánea de quiste aracnoideo intracraneal asintomático.

Arachnoid cysts are commonly considered to be benign, congenial, extraparenchymatous anomalies. Small cyst are common incidental findings in children and adults. The aetiology and natural history of arachnoid cysts are not fully understood. In most cases, the presence of the cysts is detected on CT-scans or MRI performed for other reasons. In the literature, there have been few documented cases of arachnoid cysts with spontaneous regression. We reports the case of a silvian arachnoid cyst, which disappeared spontaneously during the 13-year-follow-up period. We review the cases previously reported and the mechanisms underlying the resolution of the arachnoid cysts are discussed.

Meningiomas of the lateral ventricles. A review of 10 cases.

BACKGROUND: Intraventricular meningiomas are rare tumours that represent about 2% of all intracranial meningiomas, and represent one of the most challenging problems in neurosurgery. They are located deep within the brain and often are sizable and highly vascular. We report on a series of 10 meningiomas of the lateral ventricles treated at our institution during the last 28 years. PATIENTS: Ten patients (6 women, 4 men; mean age 41.6 yrs) were admitted to our medical center between 1978-2005 with meningioma of the lateral ventricles. Headache was the first symptom in 8 cases and ocular signs were present in 5 patients. RESULTS: Seven tumours were located in the right ventricle (70%) ranging in size from 2-8 cm, with 7 tumours larger than 3 cm in diameter. Nine patients underwent surgery with total excision in 8 cases and subtotal in the other; the remaining patient only received radiosurgery. CONCLUSIONS: Total resection is the gold standard for treatment which was possible in all but one of the cases undergoing surgery.

[Spontaneous resolution of a lumbar disc herniation]. / Resolución espontánea de hernia de disco lumbar.

Lumbar disc herniation is a common cause of lower leg radiculopathy and the most effective methods of treatment remain in question. Both surgical and nonsurgical treatments may provide a successful outcome in appropriately selected patients. The spontaneous resolution of herniated lumbar discs is a well-established phenomenon. The authors present a case of spontaneous regression of a herniated lumbar nucleus pulpous in a patient with radiculopathy.

[Spinal meningiomas]. / Meningiomas espinales.

OBJECTIVE: To present the incidence, clinical presentation, radiological features, localization, surgical techniques, and long term results of surgically treated spinal meningiomas. PATIENTS AND METHODS: We review retrospectively 57 spinal meningiomas in 55 patients operated between January 1980 and June 2004. Age, sex, duration and type of symptoms, radiological and surgical results, histological features and long term outcome are analyzed. RESULTS: Fifty five patients, consisting 46 females and 9 males, with an age range from 12 to 84 years (mean 65.2+/-9.2) were identified. The first symptom was motor deficit (N=34, 61.8%) and the mean duration symptoms were: 6.2 months. Distribution along the spinal axis was 51 thoracic, 5 cervical and 1 lumbar. The most common type was meningothelial (N=31, 54.3%). CONCLUSIONS: Meningiomas account in our experience, the 46% of spinal cord tumours and account the 7.5% of all meningiomas. They are more frequent in females most frequently occur in the thoracic region and have low recurrence rate. Typically, they are located in the intradural extramedullary space, grow slowly, and spread laterally in the subarachnoid space. Finally we concluded that magnetic resonance imaging is the best imaging technique for diagnosis and total tumour resection improved the surgical results of spinal meningiomas.

[Simultaneous bilateral epidural haematomas]. / Hematomas epidurales bilaterales simultáneos.

INTRODUCTION: Epidural haematomas are one of the most common complications of closed head injuries. Bilateral extradural haematomas are rare, usually acute, and generally associated with severe trauma and a high mortality. OBJECTIVE: The purpose of this paper is to present six cases of bilateral extradural haematomas seen at our service during the last 24 years and found an incidence of 2.5% of all cases of extradural haematomas surgically treated. RESULTS: There were 5 males and 1 female with a mean age of 32.6 years (range 16-55). In 3 cases haematoma was across the midline and in the other 3 cases haematomas was found at different locations on either side. Skull fracture was present in all cases. Surgical approach was the primary treatment in all cases. Mortality in our series was 50%. CONCLUSIONS: Bilateral extradural haematomas is a rare condition and the prognosis is mainly dependent of the pre-operative neurological state.

Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge.

OBJECTIVE: This retrospective study aimed to evaluate the effective closure rate for spontaneous cerebrospinal fluid leaks with functional endoscopic sinus surgery and identify patient characteristics that may be associated with a need for additional therapy. METHOD: A retrospective analysis of patients with spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, intracranial pressure, clinical follow up, and complications were collected. RESULTS: Twenty-five patients had spontaneous cerebrospinal fluid leaks with evidence of idiopathic intracranial hypertension. The most common sites were the cribriform plate, followed by the ethmoid roof and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Post-operatively, all patients underwent lumbar drainage and acetazolamide therapy. CONCLUSION: Spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical or surgical means.

Intramedullary spinal neurofibroma diagnosed with computed tomography: report of a case.

A case of intramedullary neurofibroma of the cervical spine in a patient with no signs of von Recklinghausen's disease is presented. Intramedullary neurofibroma is extremely rare, accounting for less than 1% of spinal cord neurofibromas. This case is the first diagnosed with computed tomography.

Spontaneous spinal epidural hematoma diagnosed by MRI. Case report.

The case of a patient with a spinal epidural hematoma diagnosed by MRI is presented. There was no history of major trauma, anticoagulant use or coagulopathy. During the intervention didn't evidence an underlying tumor or vascular malformation.

Intradural extramedullar tuberculoma of spinal cord. Case report.

A case of intradural tuberculoma in an infant and the patient was diagnosed operated on successfully. The author's advice is to perform surgery followed by antituberculosis treatment during the recovery period.

[Primary lymphoma of the central nervous system. Review of etiological factors]. / Linfomas primarios del sistema nervioso central. Revisión de la casuística.

INTRODUCTION: The primary lymphoma of the central nervous system are between 1 to 2% of all the brain tumors. The most important risk factor for the development of this kind of lesions is both acquired and congenital immunologic deficiency. METHODS AND RESULTS: In this paper we'll try to study the 13 cases of primary lymphomas of the central nervous system from etiological, epidemiological, clinic, diagnostic, therapeutic and outcome point of view. CONCLUSION: Besides we will discuss the bibliography founded paying special attention to diagnostic and therapeutic features.

[Cemento-ossifying fibroma of the skull]. / Fibroma cemento osificante del cráneo.

Cemento-ossifying fibroma (cementoma) is benign fibro-osseous lesion of bone that generally is first seen during childhood or young adulthood as asymptomatic or painful intraosseous mass that commonly involved the maxilla. This paper describes the case of a young boy with a cemento-ossifying fibroma of the skull.

[Chronic subdural hematoma in patients over 80 years of age]. / Hematoma subdural crónico en el paciente mayor de 80 años.

INTRODUCTION: Chronic subdural hematoma (CSH) represents one of the most frequent types of intracranial hemorrhage. Most occur in elderly patients causing a variety of therapeutic problems associated to systemic diseases. PATIENTS AND METHODS: A retrospective study of 90 patients older than 80 years of age with chronic subdural hematoma treated in the last 15 years was undertaken. For clinical evaluation on admission and at discharge we used the classification of Markwalder. Surgical treatment was performed in all patients and a burr hole craniostomy with closed drainage system was used. RESULTS: On admission, 73 patients (80%) were in satisfactory condition (grades 0-2); 17 (20%) were grade 3 or 4. Seven (7.7%) patients died but none due to surgery. In 6 (6.6%) of the patients, surgical reintervention was required to remove a recurring CSH. In 76.6% of the patients, the results achieved were graded 0 or 1. CONCLUSIONS: In our experience CSH in elderly patients should be treated with minimal surgery with a simple drainage of the subdural space. The good results suggest that the procedure could be considered as a first procedure in these patients and that age or concomitant diseases do not appear to be poor prognostic factors.

[Spinal epidural abscess secondary to pharyngeal trauma due to food]. / Absceso epidural espinal secundario a traumatismo faríngeo alimentario.

INTRODUCTION: In recent years the incidence of spinal epidural abscesses has increased. Early diagnosis is very important, since once neurological deficit has become established this is often permanent. The commonest aetiological agent is Staphylococcus. Pain and fever are often the only symptoms before acute neurological deterioration. CASE REPORT: A 76 year old hypersensitive, diabetic man presented complaining of pain and a sensation of warmth in both arms. He had no fever or other symptoms. Some three weeks before admission to hospital a fish bone had become stuck in his pharynx, causing a purulent lesion there. This was treated with antibiotics. Cervical MR showed a mass at the level of C4 C5, compatible with epidural abscess. Following drainage and antibiotic treatment he recovered, with no sequelas. Staphylococcus was isolated from the purulent fluid. CONCLUSIONS: The possibility of epidural infection must be remembered in patients with fever and nerve root pain. Early diagnosis and suitable treatment, combining both surgery and prolonged treatment with antibiotics, are essential to prevent permanent neurological damage.