RESUMEN
We present a very rare case of a metastasising pleomorphic adenoma with spinal cord compression and review the small handful of cases with central nervous system (CNS) involvement in the literature. This case is unusual as most other reported cases are preceded by local recurrences; also, there is only one previous case of an MPA presenting with spinal cord compression. Metastasising pleomorphic adenoma is a rare malignant salivary gland tumour which, despite "benign" histological appearances produces secondary deposits in distant sites.
Asunto(s)
Adenoma Pleomórfico/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/secundario , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Glándula Submandibular/patología , Adenoma Pleomórfico/complicaciones , Anciano , Descompresión Quirúrgica , Humanos , Imagen por Resonancia Magnética , Masculino , Metástasis de la Neoplasia , Procedimientos Neuroquirúrgicos/métodos , Neoplasias de la Médula Espinal/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
Endoscopic transsphenoidal resection of skull base lesions has been introduced widely as an alternative to microscopic transmucosal approaches. We report the introduction of this technique to our unit, including the learning curve recognized for this procedure, comparing techniques in a concurrent case-control fashion. All patients operated on for sellar, suprasellar, or clival lesions were considered for endoscopic surgery, with 51 patients undergoing endoscopic surgery and 46 having microscopic surgery with the operating method determined by the availability of the ear, nose, and throat surgeon involved with the procedures. Endoscopic surgery compared favorably with microscopic surgery with respect to endocrine control, length of stay, diabetes insipidus, and cerebrospinal fluid leakage. A learning curve was found with a significant fall in complication rates between the first third and most recent third of the cohort. Endoscopic skull base surgery has superior results to microscopic approaches once the initial learning curve is overcome, but this can be done quickly and safely.