Report of two cases of high cervical injury: an adequate functional result with timely surgical management.

Introduction: Odontoid fractures correspond to 9-15% of cervical spine fractures. Atlas fracture is rare (3-13%)8. Case presentation: Male with Anderson and D´Alonzo Type II Odontoid fracture with unstable fragment treated with occipitocervical fixation with occipital plate, C2-C3 transfacet screws; Female with type E Jefferson fracture + anterolateral atloaxial dislocation, treated with occipitocervical fixation, C2-C3-C4 transfacet screws. Discussion: Anderson and D'Alonzo Type II fractures and Jefferson type E fractures are a surgical emergency due to instability and neurological deficit.

Introducción: Las fracturas odontoideas corresponden del 9-15% de las fracturas de la columna cervical. La fractura del atlas es poco común (3-13%)8. Presentación del caso: Masculino con fractura de Odontoides tipo II de Anderson y D´Alonzo con fragmento inestable tratado con fijación occipitocervical con placa occipital, tornillos transfacetarios C2-C3; Femenino con fractura de Jefferson tipo E+luxación atloaxoidea anterolateral, tratada con fijación occipitocervical, tornillos transfacetarios C2-C3-C4. Discusión: Fracturas tipo II de Anderson y D´Alonzo y fracturas de Jefferson tipo E son una urgencia quirúrgica debido a inestabilidad y déficit neurológico.

Reconstruction of depressed skull fracture in school patients. Technique description.

OBJECTIVE: Depressed skull fractures are the result of trauma injuries. They are present in approximately 3% of patients who arrive to an emergency room with skull trauma. The main objective of surgical repair in depressed fractures is correction of cosmetic deformity and the prevention of infections. MATERIAL AND METHODS: A retrospective and transversal study was performed by our department between April 2016 and May 2017. Sixteen patients that underwent a craniotomy for skull trauma with depressed fracture were included in the study. The diagnosis was made by simple cranial CT scan alongside a three-dimensional reconstruction. RESULTS: Of the sixteen patients included, 5 were females (31.2%) and 11 males (68.8%). Twelve of the cases were an exposed fracture. In 7 cases, the fracture was located at parietal bone; 5 were located at frontal bone and 4 at the temporal bone. The average Glasgow coma score in the sample was 13. There were no complications nor deaths. CONCLUSIONS: The remodeling and repositioning of the autologous bone graft allow an adequate cosmetic result and it also avoids the placement of implants without increasing the costs and additional risks.

OBJETIVO: las fracturas de cráneo deprimidas son el resultado de lesiones traumáticas. Se encuentran en aproximadamente el 3% de los pacientes que se presentan en salas de emergencia con traumatismo craneal. El objetivo principal de la reparación quirúrgica en fracturas deprimidas es la corrección de la deformidad cosmética y la prevención de infecciones. PACIENTES Y MÉTODOS: se realizó un estudio retrospectivo y transversal en nuestro departamento entre abril de 2016 y mayo de 2017. Se incluyeron 16 pacientes que se sometieron a una craneotomía por traumatismo craneal y fractura deprimida. El diagnóstico se realizó mediante tomografía computarizada craneal simple con reconstrucción 3D. RESULTADOS: se incluyeron 16 pacientes, 5 casos femeninos (31,2%) y 11 masculinos (68,8%). En 12 casos se observó fractura expuesta. En 7 casos la fractura se localizó en el hueso parietal; 5 casos en el hueso frontal y 4 casos en hueso temporal. El puntaje promedio en la Escala de Coma de Glasgow fue 13. No hubo complicaciones o muertes. CONCLUSIONES: la remodelación y el reposicionamiento del injerto óseo autólogo permite un resultado cosmético adecuado evitando la colocación de implantes sin aumentar los costos y riesgos adicionales.

Pituitary macroadenoma apoplexy in a severe acute respiratory syndrome-coronavirus-2-positive testing: Causal or casual?

BACKGROUND: In December 2019, in Wuhan, a new virus emerged, causing severe acute respiratory syndrome (SARS) secondary to infection by a type of coronavirus, causing coronavirus disease (COVID-19). The pandemic caused by the new coronavirus has had implications in the central nervous system. COVID-19 is known to be characterized by coagulation activation and endothelial dysfunction, causing ischemic and hemorrhagic vascular syndromes. CASE DESCRIPTION: A 27-year-old male patient case with progressive decrease in visual acuity, associated with respiratory symptoms and intense headache. Multilobar infiltrate with a reticulonodular pattern is evident on chest CT scan. Brain CT scan with pituitary macroadenoma apoplexy was shown. SARS-Cov2 was confirmed, and respiratory support initiated. However, the patient died shortly afterward, secondary to pulmonary complications. CONCLUSION: The angiotensin-converting enzyme (ACE) II receptor is expressed in circumventricular organs and in cerebrovascular endothelial cells, which play a role in vascular autoregulation and cerebral blood flow. For this reason, is rational the hypothesize that brain ACE II could be involved in COVID-19 infection. Underlying mechanisms require further elucidation in the future.

Posterior bi-parietal decompressive craniectomy in refractory intracranial hypertension secondary to civilian gunshot wound. Case report and review of literature.

BACKGROUND: Decompressive craniectomy is recommended as second tier therapy for unresponsive intracranial hypertension in Traumatic Brain Injury. There have been reports of a Bi-Occipital craniectomy in cases where the focal injury is posterior. CASE DESCRIPTION: The work has been reported in line with the SCARE criteria. There is a 56-year-old male with Traumatic brain injury secondary to gunshot and intracranial hypertension, managed with biparietal craniectomy, after place a intracranial pressure monitor, whit good response to surgical and medical treatment, even with good outcome after hospitalization. CONCLUSIONS: In selected cases a posterior bi-parietal craniectomy can be performed in a safe way with acceptable results to treat refractory Intracranial hypertension. We propose that this neurosurgical technique can be used in patients with posterior focal injuries.