Resección microquirúrgica de schwannoma vestibular grado IVa con preservación de la función facial / Microsurgical resection of vestibular schwannoma grade IVa with preservation of facial function

Introducción: La cirugía de los schwannoma vestibulares constituye un desafío para los neurocirujanos. Debido a que se trata de un tumor benigno la resección completa de la lesión implica la curación del paciente. Sin embargo, este objetivo no siempre es fácil de lograr preservando la función de los nervios facial y acústico, especialmente en tumores de gran tamaño. Objetivos: Presentar detalles técnicos de la cirugía de resección de un schwannoma vestibular de gran tamaño (IVa) en el que se pudo preservar la función facial. Materiales y métodos: Se presenta el caso de una paciente femenina de 36 años que consultó por hipoacusia izquierda. En la RM preoperatoria se evidenciaba una lesión ocupante de espacio del ángulo pontocerebeloso izquierdo compatible con schwannoma vestibular con compresión del tronco encefálico y sin efecto de masa sobre el IV ventrículo (grado IVa). Mediante un abordaje suboccipital retromastoideo en posición de decúbito lateral se realizó la resección de la lesión en forma completa asistida por monitoreo del nervio facial. En todo momento se pudo preservar el plano aracnoideo que separaba el tumor de los nervios adyacentes. Resultados: Se logró una resección macroscópicamente completa con preservación de la función del nervio facial. La paciente permaneció internada por 96 hs en el postoperatorio sin complicaciones derivadas del procedimiento. Conclusión: La preservación del plano aracnoideo es un detalle técnico de mucha importancia para disminuir las posibilidades de lesión de los nervios facial y auditivo en la cirugía de resección de los schwannoma vestibulares.

Introduction: The surgery of vestibular schwannomas is a challenge for neurosurgeons.Because it is a benign tumor, complete resection of the lesion involves healing the patient. However, this objective is not always easy to achieve, preserving the function of both the facial and acoustic nerves, especially when dealing with large tumors. Objective: The objective of the video is to present some technical details of a large vestibular schwannoma (IVa) surgery in which the facial function could be preserved. Materials and methods: We present the case of a 36-year-old female patient who consulted for left hearing loss. The preoperative MRI showed a space- occupying lesion of the left pontocerebellar angle, which was compatible with vestibular schwannoma, with compression of the brainstem but with no mass effect on the IV ventricle (grade IVa). By means of a retromastoid suboccipital approach in the lateral prone position, the lesion was completely resected assisted by neurophysiological monitoring of the facial nerve. At all times, the arachnoid plane separating the tumor from the adjacent nerves was preserved. Results: A macroscopically complete resection was achieved preserving the facial nerve function. The patient stayed hospitalized for 96 hours during the postoperative period without any complication from the procedure. Conclusion: Preserving the arachnoid plane is a very important technical detail to reduce the possibilities of injury of the facial and auditory nerves in the vestibular schwannoma resection surgery.

Endarterectomía carotídea: monitoreo intraoperatorio con doppler transcraneano / Carotid endarterectomy: intraoperative TCD monitoring

Objective: To evaluate the usefulness of intraoperative monitoring with transcranial Doppler during the carotid endarterectomy. Description: In the last two years we performed 15 carotid endarterectomies with transcranial doppler intraoperative monitoring. In all case we didn’t use a shunt during the procedure based on the monitoring results. Results: All patients recovered without any neurological deficit. Conclusions: Intraoperative monitoring with transcranial Doppler seems to be a good method to determinate the use or not of a shunt during the procedure.

El desarrollo e implementación de la resonancia magnética intraoperatoria en neurocirugía (remain) y su aplicación en 83 intervenciones en la Argentina / Development of REMAIN for neurosurgery and application in 83 operative intervention in Argentina

Objective: To show implementation and development of an operating room in which we operated 83 patients using intraoperative MRI (REMAIN). Method: We used a side-opening-magnet, 0.23 Tesla, installed in a surgical area specially designed with all the advances of the modern operating rooms. Results: A great variety of neuro-surgical procedures can be made with REMAIN controls. The obtained images are clear, without devices and with an excellent definition of the anatomical structures and the pathology, that allows the neurosurgeon to make more precise and safer interventions. Conclusions: The images of REMAIN in a surgical scope, make possible that injuries can be identified and located with absolute precision. It is particularly useful in determining with exactitude the tumor-like limits, optimizing the surgical approaches, obtaining complete extirpations of brain injuries and controlling the possible intraoperative complications.