Pleural effusion in a child with a correctly placed ventricle-peritoneal shunt.

Pleural effusions in children (PE) due to ventricle-peritoneal shunt (VPS) is very rare, with few cases reported. We present a new case of an infant with VPS who had a massive hydrothorax not associated with misplacement or migration of the distal catheter or with ascites. After the evacuation of the PE we managed the patient by adjusting the pressure of the adjustable valve (AV). Sequential thoracic ultrasounds showed a satisfactory outcome. We review the literature thoroughly and describe the possible pathophysiological mechanisms.

[Fluorescence-guided resection with 5-aminolevulinic acid of an intramedullary tumor]. / Resección de tumor intramedular guiada por fluorescencia con ácido aminolevulínico.

Fluorescence-guided resection with 5-aminolevulinic acid (5-ALA) has demonstrated its usefulness in the resection of malignant cerebral gliomas. It also seems useful for the treatment of other types of cerebral and intramedullary neoplasms. We present the case of a patient with an intramedullary tumor in who fluorescence- guided resection was useful for intraoperative localization, definition of small tumor nodules and in order to achieve a complete resection of the tumor.

[Intramedullary schwannomas. Report of two cases]. / Neurinomas intramedulares. Presentación de dos casos de un tumor infrecuente.

Intramedullary schwannomas are benign tumors that arise from clusters of Schwann cells embedded in the medullary parenchyma. They are very rare and account for 0.3 to 1.5 % of all spinal schwannomas. It is not known for certain why this happens, and several theories have been put forward. They do not exhibit any characteristic clinical picture, being pain the most frequent symptom. Imaging is also not specific and the correct diagnosis is attained most of the times after pathological examination. The goal of treatment must be complete removal, which is curative. We are presenting two patients in whom an intramedullary tumor was removed. The true nature of the lesions was suspected during the operation, but only after pathological examination was confirmed. A review of the literature has been undertaken, with special attention to the theories about the origin of these uncommon tumors.

[Isolated mesencephalic stroke related to a ruptured intracranial dermoid cyst]. / Ictus isquémico mesencefálico aislado secundario a ruptura de quiste dermoide.

Dermoids cysts are embrionary benign lesions that comprise approximately 0.04-0.25% of all intracranial tumors. Occasionally they break and spread their content into subarachnoid space and/or lateral ventricles causing several acute or delayed symptoms. Debut of this type of tumor as acute stroke is poorly reflected in literature. We present a 26-year-old woman with a isolated mesencephalic infarct secondary to spontaneous rupture of a dermoid cyst. We discuss the possible pathophysiological mechanisms for this condition and review the literature.

[Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review]. / Hematomas de cerebelo como complicación de drenaje lumbar. Presentación de dos casos y revisión de la literatura.

Remote cerebellar hematoma, a cerebellar hematoma occurring after performing a surgical procedure in an anatomical distant area from the cerebellum, is a rare complication. It has been reported after supratentorial surgery and, less often, after spinal surgery with dural opening with important loss of cerebrospinal fluid. We report the occurrence of remote cerebellar hemorrhage after lumbar spinal fluid drainage in two patients with suspected normal pressure hydrocephalus. They were managed conservatively with good outcome. We review the pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage.

Diffuse leptomeningeal seeding from benign choroid plexus papilloma.

Choroid plexus papillomas (CPP) are rare intracranial tumours with a favourable long-term outcome after surgical excision. Although they are histologically benign, local recurrences may occasionally occur, but leptomeningeal dissemination is exceptional. We report an unusual example of a fourth ventricle choroid plexus papilloma with diffuse leptomeningeal seeding. Neither the initial tumour nor the recurrence showed malignant histological features. Treatment with systemic and intrathecal chemotherapy was ineffective in this patient. We review the literature concerning leptomeningeal dissemination of benign choroid plexus papillomas.

[Chordoid glioma of the III ventricle. Case report and revision of the literature]. / Glioma cordoide del III ventrículo. Nuevo caso y revisión de la literatura.

Chordoid glioma of the third ventricle is an infrequent brain tumour that was described for the first time by Brat et al. in 1998; since then, only 39 cases have been reported. We present a new case of chordoid glioma of the third ventricle in a 51-year-old-man that was treated with total surgical removal, with a good initial postoperative evolution. Sudden death, most likely due to a massive pulmonary embolism, occurred in the third postoperative day. We present the histological characteristics of the tumour and review the literature regarding this entity.

[Calcified disc herniation in childhood]. / Hernias discales calcificadas en la infancia.

Calcification of intervertebral discs is a rare occurrence in children. Although the etiology of the calcification remains uncertain, it is no related with degenerative diseases. The clinical picture is non specific with neck pain, muscle contractures and, sometimes, low-grade fever. These symptoms generally disappear spontaneously, and surgery rarely becomes necessary. In our review of the literature, we have found only seventeen cases requiring surgical management. Two of these children had been previously diagnosed with calcified intervertebral discs, but at the time no herniation had been ruled out with magnetic resonance imaging (MRI). We report the case of a girl who was diagnosed, when she was ten years old, with intervertebral idiopatic calcifications. Four years later she presented with radiculopathy caused by the posterolateral displacement of a calcified cervical disc, which required operative management. We think that this case supports the theory of Heinrich et al. that considers that the calcified hernia is a complication of a previous pathology, namely intervertebral calcification. Clinical and therapeutic aspects of this entity are discussed.

[Pyogenic brain abscesses: experience with 60 consecutive cases]. / Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos.

INTRODUCTION: Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years. MATERIAL AND METHODS: The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome. RESULTS: The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22% of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of anaerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical, catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4 patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainage-aspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years. CONCLUSIONS: The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainage-aspiration should be used as the first mode of treatment.

[Hemifacial spasm as clinical presentation of intracranial meningiomas. Report of three cases and review of the literature]. / Espasmo hemifacial como presentación clínica de meningiomas intracraneales. Presentación de 3 casos y revisión de la literatura.

Hemifacial spasm (HFS) is a clinical entity consisting of brief clonic jerking movements of the facial musculature, beginning in the orbicularis oculi with downward spreading to other facial muscles. Apart from vascular loop compression at the root exit zone of the facial nerve, other causes of HFS are rare. It is exceptional as a form of presentation of intracranial meningiomas We report three cases of patients with meningiomas who presented with HFS, either as an isolated sign or associated with symptoms of rise intracranial pressure or focal deficit. We review the literature and discuss the possible physiopathological mechanisms responsible for this association.

Traumatic aneurysm of the superficial temporal artery as a complication of pin-type head-holder device. Case report.

BACKGROUND: Despite the widespread use of pin head-holder devices in neurosurgical procedures, associated complications are relatively infrequent and usually minor. Inadvertent puncture of a major scalp vessel is one of these complications. Usually it is not problematic but the injured vessel may develop a traumatic aneurysm with subsequent rupture. CASE DESCRIPTION: We report the case of a 51-year-old man who underwent a left pterional craniotomy for intracranial aneurysm surgery. The head was fixed with the Sugita pin head-holder. Three weeks after discharge, the patient returned to the hospital after an enlarging and pulsatile mass in his left temporal region in one of the pin puncture wounds ruptured and bled. The angiogram revealed a traumatic aneurysm of the superficial temporal artery, which was ligated and excised. CONCLUSION: The Sugita multipurpose head frame is one of the head-holders most frequently used in neurosurgical procedures. It provides some advantages over other pin head-holders, but its sharp point pins in addition to a rotational fixing mechanism instead of simple pressure might increase the risk of scalp vessel injury. A traumatic aneurysm should be suspected when a pulsating scalp mass develops in a patient who has recently undergone a surgical procedure with his head fixed in a pin head-holder device. Physicians must be aware of this possibility when considering the diagnosis of a temporal mass to avoid unexpected hemorrhage at the time of surgery.

[Contralateral extradural hematoma during evacuation of a previous one]. / Desarrollo introperatorio de un hematoma extradural contralateral a otro previo.

The development of an extradural hematoma during the evacuation of a traumatic extracerebral hematoma is a very rare event. It occurs in patients with a severe head injury that present with both an extraaxial hematoma and a contralateral skull fracture. Recognition of the significance of a sudden increase in the cerebral tension after hematoma evacuation is the key for a pront diagnosis of the development of a contralateral lesion. We present the case of a patient with a severe head trauma and an extradural hematoma who developed a contralateral extradural hematoma during evacuation of the initial one. The development of a contralateral lesion was suspected by a sudden and unexpected increase in cerebral tension during evacuation of the first hematoma and confirmed by emergency CT scan. We think that the most important pathogenetic mechanisms involved in the development of a contralateral extradural hematoma are the rapid fall of intracranial pressure, the loss of tamponade effect achieved by the energetic use of antiedema measures and the evacuation of the ipsilateral hematoma.

[Rapid spontaneous resolution of acute subdural hematoma]. / Resolución precoz espontánea de hematoma subdural agudo intracraneal.

Acute subdural hematomas are usually neurosurgical emergencies, although a conservative therapy is indicated in selected cases. In some of these patients a progressive resolution is appreciated. However, rapid spontaneous resolution of an acute suddural hematoma is seldom reported. A patient with antecedent of chronic alcoholism and spontaneous resolution of acute subdural hematoma in less than 18 hours after the head injury is described. The possible mechanisms of this rapid resolution are discussed. A tear in the arachnoid with spilling of CSF into the subdural space and the effect of intracranial antihypertensive measures together with cerebral atrophy, are factors that possibly contribute to dilution and redistribution of blood with hematoma disappearing in CT scan.

[Isolated oculomotor palsy. An unusual presentation of chronic subural hematoma]. / Parálisis completa del tercer par craneal como forma de presentación en hematoma subdural crónico.

Isolated oculomotor palsy is an unusual symptom in chronic subdural hematomas and it is very rare as initial manifestation. We report a patient with a chronic subdural hematoma that presented with a complete third nerve palsy and normal consciousness. Complete recovery was achieved after surgical evacuation. Rebleeding within the hematoma cavity, most possibly favored by antiaggregating agents, was considered responsible for this rare presentation. In these cases expeditious surgical evacuation is indicated.

[Contralateral mesencephalic injury due to tentorial uncal herniation. Magnetic resonance imaging of the Kernohan's notch]. / Lesión mesencefálica contralateral por hernia cerebral. Imagen en resonancia magnética de la hendidura de Kernohan (Kernohan's notch).

We report a case of a traumatic epidural hematoma with ipsilateral hemiparesis, due to the so-called Kernohan's notch. We document the injury with axial and coronal magnetic resonance imaging.

[Anterior cervical interbody fusion with treathed cylindrical bone versus bak-cace: a comparative study]. / Estudio camparativo de la artrodesis cervical con injerto óseo roscado e implante de titanio.

The authors conducted a prospective and randomized study in 44 consecutive patients requiring cervical interbody fusion following anterior cervical discectomy to compare the efficacy of heterologous threaded cylindrical bone (Unilab Surgibone) versus titanium implant (Bak-C; Spine-Tech, Minneapolis ). The patients were evaluated between two and five years postoperatively and the objectives of the study were to assess the potential differences in implant shifting, interespace collapse, angulation, maintenance of cervical alignment and lordosis, and clinical and radiographic fusion success rates between the two fusion substrates. Clinical results were satisfactory with both types of implant. However the threaded cylindrical titanium implant was found to be superior to the heterologous threaded cylindrical bone as an interbody substrate after single -and multiple- level anterior cervical decompression procedures with respect to maintenance of cervical interspace height, interspace angulation and radiographic fusion success rates.

[Frontal extranasal glioma]. / Glioma frontal extranasal.

Extranasal gliomas are very rare tumours, being difficult to diagnose preoperatively due to the unspecific nature of symptoms and, at times, of the test. A newborn baby, prenatally diagnosed with frontal tumour, which on exploration showed a mass at the root of the nose, red-violet in colour and which seemed to become tenser. Skull x-ray and brain ultra-sound were normal. Ultra-sound of the tumour area and TAC showed a mass with solid content, with possible intracraneal communication. Faced with this possibility, removal by neurosurgical procedures was performed with no communications with SNC being observed. Histological diagnosis: extra-nasal glioma. Tumours situated at the root of the nose can have normal skin covering whose aspect is similar to the tumour mentioned above. Test carried out may not show accurately whether the tumour communicates with SNC or not, which may lead to surgical errors. We recommend that these malformations be treated directly by surgical teams which include neurosurgical specialists.

Anterior cervical osteophyte causing dysphagia as a complication of laminectomy.

Asymptomatic osteophytes of the anterior margins of the cervical vertebral bodies (VB) may occur in 20 - 30% of the population. On rare occasions, dysphagia or dyspnoea may be caused by such cervical osteophytes. We present the case of a 27-year-old woman with progressive dysphagia caused by a voluminous osteophyte secondary to chronic cervical instability after a laminectomy performed 8 years before. Progressive growth of the osteophyte was observed in sequential roentgenograms. As far as we know, this complication of cervical laminectomy has never been reported before. After resection of the osteophyte and arthrodesis of the affected segment the patient was cured.

Neurinomas intramedulares. Presentación de dos casos de un tumor infrecuente / Intramedullary schwannomas. Report of two cases

Los schwannomas intramedulares son tumoresbenignos derivados de células de Schwann localizadasen el parénquima medular. Son muy infrecuentes, constituyendoentre el 0,3 y el 1,5% de los schwannomasespinales. Existen varias teorías que intentan explicarla presencia de células de Schwann intramedularesa partir de las que derivarían estas neoplasias. Lasintomatología no es específica, siendo el dolor elsíntoma más frecuente, pudiéndose añadir, además,cualquier signo de afectación medular según el nivelde localización. En las pruebas de neuroimagen, la sospechade otras lesiones intramedulares de origen glialmás frecuentes hace que el diagnóstico de schwannomaintramedular sea postquirúrgico la mayoría de lasveces. El tratamiento es quirúrgico, pudiendo llevarse acabo, habitualmente, una resección completa.En este artículo presentamos dos casos de pacientesintervenidas quirúrgicamente de sendas lesionesintramedulares, que resultaron ser neurinomas. Hacemosuna revisión de otros casos publicados en la literatura,exponiendo las teorías existentes acerca del origende estos tumores poco frecuentes (AU)

Intramedullary schwannomas are benign tumorsthat arise from clusters of Schwann cells embeddedin the medullary parenchyma. They are very rare andaccount for 0.3 to 1.5 % of all spinal schwannomas. Itis not known for certain why this happens, and severaltheories have been put forward. They do not exhibitany characteristic clinical picture, being pain the mostfrequent symptom. Imaging is also not specific and thecorrect diagnosis is attained most of the times afterpathological examination. The goal of treatment mustbe complete removal, which is curative.We are presenting two patients in whom an intramedullarytumor was removed. The true nature ofthe lesions was suspected during the operation, butonly after pathological examination was confirmed. Areview of the literature has been undertaken, with specialattention to the theories about the origin of theseuncommon tumors (AU)

Rapid spontaneous resolution of an acute extradural haematoma: case report.

A case of acute extradural haematoma with spontaneous resolution within 6 h of the head injury is presented. The literature is reviewed.