Segmental T12 Vertebral Artery Injury Treated by Endovascular Coil Placement after Kyphoplasty for Symptomatic Spinal Angioma. Case Report of a Minimal Invasive Solution for a Complication of a Minimally Invasive Spine Procedure.

BACKGROUND: Vertebral angioma is a tumor defined as an abnormality of vascular tissue development. It usually has an asymptomatic behavior, being present in 10%-12% of autopsies and imaging studies. CASE DESCRIPTION: A 70-year-old man consulted because of a long history of low back pain. Imaging studies were compatible with vertebral angioma at T12; we decided to perform a minimally invasive surgical procedure, such as kyphoplasty. During surgery, there was a sharp decrease in pulmonary saturation, and the patient underwent a computed tomography scan evaluation confirming a left hemothorax due to segmental branch vascular injury at T12. Given the patient's poor medical condition and the complexity of an emergent open procedure in the thoracic spine, we decided to undertake a minimally invasive endovascular coil placement to repair the vascular injury. Due to a favorable outcome, we discharged the patient after 72 hours of surveillance. CONCLUSIONS: Even in the case of a complication to occur, we should always consider a minimally invasive solution to solve the problem because patients undergoing these procedures correspond to elderly patients with poor medical conditions or comorbidities.

Microsurgical Resection of Intraspinal Benign Tumors Using Non-Expansile Tubular Access.

BACKGROUND: Intraspinal tumors are 10 to 15 times less common than brain tumors. The midline approach with extensive laminectomies represents the current gold-standard for resection, causing instability, muscle damage, and kyphosis among other well-known complications. Minimally invasive series reported their results using retractor-based systems. We analyzed a patient series treated with a non-expansile tubular approach, describing the technique, grade of resection, and clinical outcomes. METHODS: A series of consecutive cases operated between 2016 and October 2018 were analyzed retrospectively. The database included age, sex, clinical presentation, intraspinal location (intra/extradural), number of laminotomies, grade of resection, surgical time, bleeding, and follow-up. The initial and follow-up clinical condition was analyzed using the Frankel scale. RESULTS: A total of 13 patients underwent surgery: 3 intraspinal/extradural (23%), 8 intradural/extramedullary (61.5%), and 2 intramedullary tumors (15.3%); these were classified as 5 meningiomas (38.4%), 4 neurofibromas (30.7%), 2 schwannomas (15.3%), 1 hemangioblastoma (7.6%), and 1 astrocytoma (7.6%). Eleven (84.61%) patients had complete motor improvement, 1 patient had partial improvement, and 1 patient had no improvement (7.6% each). An 18-mm working channel tube was used for extramedullary lesions and 20-mm tubes for intramedullary injuries. Total tumor resection was achieved in 11 patients (84.6%) and subtotal in 2 patients (15.38%) corresponding to intramedullary tumors. CONCLUSIONS: Although this study consisted of a small series, we have shown the possibility of resecting intraspinal tumors (some intradural-intramedullary) with non-expansile tubes in a safe and effective way with no complications. Most of the patients had complete neurological improvement at the end of follow-up.

Efectos del dehidro benzoperidol y del clorhidrato de diazepam sobre la actividad epileptoide inducida por el citrato de fentanyl en humanos / Effects of droperidol and diazepam upon epileptoid activity induced by fentanyl in humans

La presencia y características de fenómenos electroencefalográficos de actividad epileptoide se estudiaron en tres grupos de 8 pacientes durante 30 minutos a partir de la administración de los siguientes fármacos: Grupo I, citrato de fentanil 30 nM/Kg (15 mcg/Kg.) IV; Grupo II, citrato de fentanil 30 mM/Kg (15 mcg./Kg) IV y dehidrobenzoperidol 263 nM/Kg. (100 mcg./Kg.) IV; Grupo III, citrato de fentanil 30 nM/Kg. (15 MCG./Kg.) IV y clorhidrato de diazepam 877 nM/KG.) IV.). En 7 de los 8 pacientes del grupo I se registraron espigas aisladas y poliespigas (4-6 por segundo), predominantes en las derivaciones temporo-occipitales durante los 30 minutos de registro. En los grupos II y III, la incidencia de estos fenómenos electroencefalográficos epileptoides se redujo a 2 de 8 pacientes de cada grupo (P<0.02.X2 de Pearson para cada grupo comparado con el grupo I) y, en estos casos desaparecieron dentro de los 15 minutos inmediatos a la administración de los fármacos. El EEG de los pacientes de estos grupos II y III se caracterizó asimismo por la presencia de grupos de ondas theta hipersincrónicas. La asociación de dehidrobenzoperidol o clorhidrato de diazepam, con citrato de fentanil es conveniente en los procedimientos anestésicos para neurocirugía