Biopsia estereotáctica cerebral guiada tomográficamente: Análisis de una serie de 192 casos / Tomographically guided stereotactic brain biopsy: Review of a series of 192 cases

Objective. Stereotactic CT-guided biopsy is a safe procedure for the diagnosis of brain lesions unsuitable for surgical treatment because of their location, number, histology or poor medical status. The objective of this study is to analyze the indications,demography, topography, anatomopathologic diagnosis and complications in a series of stereotactic CT-guided brain biopsies. Method. 192 CT assisted stereotactic brain biopsies in 186 patients were retrospectively reviewed from june 1998 to june of 2008. Results. 186 patients, 101males (54.3%) and 85 females (45.7%), were analyzed. Mean age was 54.5 years. 144 (75%) of the biopsies were performed in hemispheric lesions, 43 (22.4%) in “deep seated” localization. The most frequent anatomopathologic diagnosis were glioblastoma (36,5%) and anaplasic astrocytoma (17%). 90,62% of the biopsies were positive, 7,3% were negative and 2,08% nondiagnostic. Morbility rate was 3,64% and mortality 2,08%. Conclusion.Stereotactic brain biopsy is a safe and effective procedure providing tissue for definitive anatomopathological diagnosis; it offers low morbidity and mortality rate. Our findings are similar to the literature.

Hemangioma capilar medular: Reporte de un caso y revisión de la literatura / Spinal cord capillary hemangioma: Report of a case and bibliographical review

Objective. To describe a rare case of intramedullary capillary haemangioma of the thoracic spinal cord asociated with extensive cord edema and review of the literature. Description. A 65-yeard-old male pacient presented a 4-months history of dorsal back pain, progressive 4/5 paraparesis and sensory abnormality of the lower extremities. MR studies of the thoracic spine show a well-defined intramedullary mass at the D6 level, isointense on T1, hiperintense on T2 and homogeneous, strong enhancement with gadolinium, compatible with vascular lesion, asociated with extensive cord edema from D8-C2. Intervention. A D6-D7 laminectomy was performed and the tumor was completly removed en bloc by using standard microneurosurgical technique. Conclusion. It is very important to know about the existence of intramedullary capillary haemangiomas. Despite of being extremely rare, they are benign vascular neoplasms with a good outcome after their complete resection. Therefore, it´s necessary to distinguish them of other malignant tumors, to avoid overtreatment of these benign lesions.

Tratamiento quirúrgico de la neuralgia del trigémino: Experiencia en 10 años / Surgical treatment of trigeminal neuralgia: A 10 years experience

Introduction. Surgical treatment of trigeminal neuralgia remains a matter of debate since there are no studies comparing long term effectiveness of the different surgical techniques. We present our 10 year experience. Description. Series: 40 patients. Period: 1998 - 2008. Surgical techniques: microvascular decompression, radiofrequency thermorhizotomy and balloon compression. Analyzed parameters: age, sex, nerve root involved, pain relief, recurrence, complications, need to restart medication and reintervention. Discussion. Microvascular decompression offers better long term results, radiofrequency is adequate for special cases (higher recurrence rate), and balloon compression is better for V1 neuralgia. Our sample is too small for statistics, yet our findings are coincident with the literature. Conclusion. Better patient selection criteria for each technique are needed. Microvascular decompression should be the treatment of choice when possible. How to treat recurrence remains unanswered.

Quiste aracnoide espinal: presentacion de un caso / Spinal arachnoidal cyst: case presentation

Objective: to present a case of an extradural arachnoid dorsal cyst in a 30 year-old woman. Description: a patient (30 years, female) who refers eight-months history of radicular pain and progressive right leg weakness, with exacerbations and remissions. On examination the patient had righ hemihypesthesia with T-10 sensitive level and right leg 4/5 palsy. Magnetic resonance imaging showed an extradural cystic lesion in T11-T12 hypointense in T1 and hyperintense en T2, without contrast enhancement. The cyst contained fluid tha demonstrated the same signal as cerebrospinal fluid. Intervention: After laminectomy of T-10 and T-11 the cystic lesion was exposed. The cyst was filled with CSF-fluid like. A surgical resection of the cyst wall was made. A small dural defect that allowed communication between the cyst and the subarachnoid space was revealed during the surgery, and a closure was made with a suture. Histopathological examination confirmed a cystic lesion with a single-cell lining of meningothelial cells, that contained no neural tissue neither ganglion cells. Conclusion: extradural arachnoid cysts showed characteristic images in the MRI in the preoperative stage. There was no need to use other invasive methods such as myelography or mielotomography to decide the indication for surgery or the surgical technique. Definitive diagnosis is based on the free comunication with the subarachnoidal space and the lack of neural tissue in the histopatological examination, which allowed us to distinguish between extradural arachnoid cysts and Tarlov cysts