Retroclival epidural haematoma: a diagnosis to suspect. Report of three cases and review of the literature.

Retroclival epidural haematoma (REDH) has been reported infrequently. It is a rare entity which is probably underdiagnosed. It is most commonly seen in the paediatric population and is generally associated with high-velocity injuries. We report three cases of paediatric patients diagnosed with REDHs: two of them secondary to high-energy trauma related to a motor-vehicle accident and the other a low-energy trauma after a slip while playing football. All three patients were managed conservatively by cervical immobilisation with favourable outcome. REDH is probably underdiagnosed by computed tomography scan. When the suspicion is high, sagittal reconstructions or magnetic resonance imaging should be considered to confirm the diagnosis. Usually, it is related to hyperflexion or hyperextension cervical injuries secondary to motor vehicle accident. However, it can also be observed in milder injuries.

[Comparison of intracranial meningioma outcome scales in operated patients older than 65 years old. Our experience between 2002-2012 and a literature review]. / Comparación de escalas pronósticas en pacientes mayores de 65 años intervenidos de meningioma intracraneal. Nuestra experiencia entre 2002-2012 y revisión de la literatura.

OBJECTIVE: Meningioma is the most common intracranial tumor in the elderly. Its incidence rate increases with age; so as life expectancy increases, meningiomas are diagnosed more frequently. A comparison is made between 4 outcome scales in this study: Clinical-Radiological Grading System, Geriatric Scoring Scale, SKALE (Sex, Karnofsky, ASA, localization and edema), and the Charlson score, to analyze which patients could benefit from surgery. MATERIALS AND METHODS: A total of 52 patients of 65 years and older operated in our hospital between 2002 and 2012 were identified, and a retrospective analysis was performed. All individual variables were collected and applied the scales to see their relationship with 3 month and annual mortality. The critical values of each scale were applied and their positive and negative predictive values were calculated. RESULTS: From the four scales, only the Clinical-Radiological Grading System and the SKALE had a significant statistical result when annual mortality was analyzed. None of them were associated with 3 month mortality. There was no statistically significant association between mortality and sex, edema, previous clinical history, and tumor location. But there was an association with age, tumor size and previous Karnofsky. CONCLUSION: The SKALE and the Clinical-Radiological Grading System are easy tools that can give an insight as regards patients who can benefit from a surgical treatment. Nevertheless, individualized patient analysis and neurosurgeon experience still have great importance.

[Giant cell tumor of the lumbar spine. Case report and review of the literature]. / Tumor de células gigantes de raquis lumbar. Caso clínico y revisión de la literatura.

We report the case of a 32-year-old patient complaining of chronic low back pain radiating to his left thigh. His MRI showed a lytic L1 vertebral body injury. A transpedicular biopsy confirmed the diagnosis of giant cell tumor. He underwent a L1 vertebrectomy and vertebral body replacement with a titanium cylinder using anterior approach, followed by the removal of the L1 posterior arch and the placement of pedicle screws through a posterior approach. The giant cell tumor is a rare benign primary bone tumor that can be locally aggressive and can potentially spread to other areas, usually to the lungs. Although it most frequently affects long bones, approximately 10% of tumors are located in the spine. To minimise the risk of recurrence, the elective management option is surgery.

Dumbbell malignant dorsal schwannoma embolized and operated by single posterior approach. / Schwannoma maligno dorsal en reloj de arena embolizado e intervenido por abordaje posterior único.

We report a case of a 41 years old patient complaining of chronic dorsalgia. MRI showed a well defined intradural extramedular dumbbell-shaped lesion, associated to a left paravertebral tumor at D5-D6 level. The tumor was embolizated prior to surgery. Following she underwent a D4-D6 laminotomy, left D5-D6 costotransversectomy and resection of the intracanal extradural part of the lesion with section of the left D5 nerve. Posteriorly, complete resection of the extracanal portion of the tumor was performed by a postero-lateral approach. The anatomopathologic diagnosis was a malignant schwannoma. After the surgery, the patient required adyuvant radiotherapic treatment. Malignant schwannoma is a very uncommon tumor which belongs to the malignant peripheral nerve sheath tumors (MPNST). It develops from Schwann cells. It is frequently associated with type 1 neurofibromatosis. MPNST usually present local recurrence and can metastatize.

Schwannoma maligno dorsal en reloj de arena embolizado e intervenido por abordaje posterior único / Dumbbell malignant dorsal schwannoma embolized and operated by single posterior approach

Se describe el caso de una paciente de 41 años con cuadro de dorsalgia crónica. Mediante RM se diagnosticó una lesión intradural extramedular bien delimitada con morfología en reloj de arena con gran componente paravertebral izquierdo en D5-D6. El tumor fue embolizado previo a la cirugía, realizándose posteriormente laminotomía D4-D6, costotransversectomía D5-D6 izquierdas y resección de la porción intrarraquídea extradural con sección del nervio D5 izquierdo. A continuación, se realizó una resección en bloque del componente extrarraquídeo por vía posterolateral. El diagnóstico anatomopatológico fue de schwannoma maligno, precisando posteriormente tratamiento radioterápico adyuvante. El schwannoma maligno es un tumor poco frecuente perteneciente al grupo de tumores malignos de la vaina del nervio periférico (MPNST), originado en las células de Schwann. Se asocia frecuentemente con la neurofibromatosis tipo 1. Los MPNST recurren con frecuencia a nivel locorregional y pueden dar metástasis a distancia

We report a case of a 41 years old patient complaining of chronic dorsalgia. MRI showed a well defined intradural extramedular dumbbell-shaped lesion, associated to a left paravertebral tumor at D5-D6 level. The tumor was embolizated prior to surgery. Following she underwent a D4-D6 laminotomy, left D5-D6 costotransversectomy and resection of the intracanal extradural part of the lesion with section of the left D5 nerve. Posteriorly, complete resection of the extracanal portion of the tumor was performed by a postero-lateral approach. The anatomopathologic diagnosis was a malignant schwannoma. After the surgery, the patient required adyuvant radiotherapic treatment. Malignant schwannoma is a very uncommon tumor which belongs to the malignant peripheral nerve sheath tumors (MPNST). It develops from Schwann cells. It is frequently associated with type 1 neurofibromatosis. MPNST usually present local recurrence and can metastatize

Comparación de escalas pronósticas en pacientes mayores de 65 años intervenidos de meningioma intracraneal. Nuestra experiencia entre 2002-2012 y revisión de la literatura / Comparison of intracranial meningioma outcome scales in operated patients older than 65 years old. Our experience between 2002-2012 and a literature review

Objetivo: Los meningiomas son los tumores intracraneales más frecuentes en el anciano. Su incidencia aumenta con la edad, por ello cada vez son diagnosticados con más frecuencia al incrementar la esperanza de vida. En nuestra muestra comparamos 4 escalas pronósticas: Clinical-Radiologic Grading System, Geriatric Scoring System, SKALE (Sexo, Karnofsky, ASA, localización y edema) y la escala de Charlson para analizar qué pacientes pueden beneficiarse de una cirugía. Material y métodos: Se realiza un análisis retrospectivo de 52 pacientes de edad mayor o igual a 65 años intervenidos en nuestro hospital desde el 2002 al 2012. Se recogen variables individuales y se aplican las 4 escalas buscando relación de ambos grupos con la mortalidad a los 3 meses y al año. Se utilizan los puntos de corte de cada una de las escalas y se determinan los valores predictivos positivo y negativo. Resultados: De las 4 escalas, solo la Clinical-Radiologic Grading System y la SKALE presentaron resultados estadísticamente significativos al analizar la mortalidad anual con los puntos de corte. Ninguna mostró relación con la mortalidad a los 3 meses. Sexo, edema, clínica previa y localización del tumor, no presentaron una relación estadísticamente significativa con la mortalidad. En cambio edad, tamaño y Karnofsky previo se correlacionaron significativamente con el pronóstico. Conclusión: Las escalas SKALE y Clinical-Radiologic Grading System son herramientas de fácil manejo que pueden ofrecer una visión orientativa sobre qué pacientes ancianos pueden beneficiarse de un tratamiento quirúrgico. Sin embargo, continúa teniendo gran importancia el análisis individualizado del paciente y la experiencia del neurocirujano

Objective: Meningioma is the most common intracranial tumor in the elderly. Its incidence rate increases with age; so as life expectancy increases, meningiomas are diagnosed more frequently. A comparison is made between 4 outcome scales in this study: Clinical-Radiological Grading System, Geriatric Scoring Scale, SKALE (Sex, Karnofsky, ASA, localization and edema), and the Charlson score, to analyze which patients could benefit from surgery. Materials and methods: A total of 52 patients of 65 years and older operated in our hospital between 2002 and 2012 were identified, and a retrospective analysis was performed. All individual variables were collected and applied the scales to see their relationship with 3 month and annual mortality. The critical values of each scale were applied and their positive and negative predictive values were calculated. Results: From the four scales, only the Clinical-Radiological Grading System and the SKALE had a significant statistical result when annual mortality was analyzed. None of them were associated with 3 month mortality. There was no statistically significant association between mortality and sex, edema, previous clinical history, and tumor location. But there was an association with age, tumor size and previous Karnofsky. Conclusion: The SKALE and the Clinical-Radiological Grading System are easy tools that can give an insight as regards patients who can benefit from a surgical treatment. Nevertheless, individualized patient analysis and neurosurgeon experience still have great importance

Tumor de células gigantes de raquis lumbar. Caso clínico y revisión de la literatura / Giant cell tumor of the lumbar spine. Case report and review of the literature

Presentamos el caso clínico de un paciente con dolor lumbar crónico irradiado a muslo izquierdo, diagnosticado por neuroimagen de lesión lítica en cuerpo vertebral de L1. Se realizó biopsia transpedicular que confirmó el diagnóstico de tumor de células gigantes. Fue intervenido quirúrgicamente mediante vertebrectomía L1 e implantación de cilindro de titanio sustitutivo por vía anterior y, a continuación, extirpación de arco posterior de L1 e implante de tornillos pediculares por vía posterior. El tumor de células gigantes es un tumor óseo primario benigno poco frecuente, de comportamiento agresivo localmente y con potencial capacidad de diseminación a distancia, generalmente a nivel pulmonar. A pesar de afectar más frecuentemente a los huesos largos, alrededor del 10% se localizan en el raquis. Con el objetivo de minimizar el riesgo de recurrencia, el tratamiento de elección es el quirúrgico

We report the case of a 32-year-old patient complaining of chronic low back pain radiating to his left thigh. His MRI showed a lytic L1 vertebral body injury. A transpedicular biopsy confirmed the diagnosis of giant cell tumor. He underwent a L1 vertebrectomy and vertebral body replacement with a titanium cylinder using anterior approach, followed by the removal of the L1 posterior arch and the placement of pedicle screws through a posterior approach. The giant cell tumor is a rare benign primary bone tumor that can be locally aggressive and can potentially spread to other areas, usually to the lungs. Although it most frequently affects long bones, approximately 10% of tumors are located in the spine. To minimise the risk of recurrence, the elective management option is surgery