A Case Series of Stereotactic Biopsy of Brainstem Lesions through the Transfrontal Approach.

Background and Importance Brainstem lesions may be unresectable or unapproachable. Regardless, the histopathological diagnosis is fundamental to determine the most appropriate treatment. We present our experience with transfrontal stereotactic biopsy technique for brainstem lesions as a safe and effective surgical route even when contralateral transhemispheric approach is required for preservation of eloquent tissue. Clinical Presentation Twenty-five patients underwent surgery by transfrontal approach. Medical records were reviewed for establishing the number of patients who had postoperative histopathological diagnosis and postoperative complications. Twenty-four patients (18 adults and 7 children) had histopathological diagnosis. There were 18 astrocytomas documented, of which 12 were high grade and 6 low grade. The other diagnoses included viral encephalitis, post-renal transplant lymphoproliferative disorder, nonspecific chronic inflammation, Langerhans cell histiocytosis, and two metastases. No case was hindered by cerebrospinal fluid loss or ventricular entry. Complications included a case of mesencephalic hemorrhage with upper limb monoparesis and a case of a partially compromised third cranial nerve in another patient without associated bleeding. Conclusion Stereotactic biopsy of brainstem lesions by transfrontal ipsilateral or transfrontal transhemispheric contralateral approaches is a safe and effective surgical approach in achieving a histopathological diagnosis in both pediatric and adult populations.

[Supernumerary muscular masses of the anterior thoracic wall. Case report and review].

INTRODUCTION: On the anterior thoracic wall, some supernumerary muscular masses can be present, like the sternalis muscle, which is situated over the pectoralis major muscle fascia, deep to the subcutaneous tissue. Its fibers can be parallel or oblique to the sternum, and are clinically important due to the possibility that during certain radiologic procedures they can be confused with some types of breast pathologies. MATERIAL AND METHODS: Bibliographic review of supernumerary muscular masses of the anterior thoracic wall and case report in a colombian male cadaver of mixed ethnia, dissected by medical students at the Department of Morphology at the Universidad del Valle, in Cali, Colombia. RESULTS: In the right side of the anterior thoracic wall of the cadaver an anatomical variation of low occurrence in the general population, the sternalis muscle, was found. The muscle fibers had a vertical direction, parallel to the right sternal margin. Considering all the muscular fascicles, its dimensions were approximately 7,0 cms in length and 2,9cms in width. CONCLUSION: Having in mind the characteristics of the present anatomical variation, and that there can be some radiologic, surgical and clinical implications, it is important for the health professional to know the anatomy and epidemiology of the sternalis muscle.