BACKGROUND: A glomus vagale tumor is an infrequent paraganglioma primarily characterized by auditory symptoms, cranial nerve involvement, or autonomic symptoms. However, visual involvement is not commonly observed, and to date, no cases have been reported in the literature. OBSERVATIONS: The case involves a 62-year-old female patient with a history of right carotid body tumor resection. She presented to the emergency department with a sudden decrease in visual acuity and bitemporal hemianopsia, accompanied by a left parietal headache. Initial brain magnetic resonance imaging (MRI) revealed a pituitary macroadenoma, which was completely resected. However, postoperatively, the patient developed left amaurosis. Subsequent brain MRI showed the presence of hemostatic material mixed with blood in the sellar region, causing displacement of the optic chiasm. A repeat intervention was performed, identifying bleeding from both cavernous sinuses. Head and neck angiography demonstrated a right glomus vagale tumor with abundant blood drainage into the right cavernous sinus. Embolization of the glomus vagale tumor was performed, resulting in no further bleeding and improvement of symptoms. LESSONS: The aim of this case report is to describe a rare occurrence of bilateral visual disturbances caused by bleeding in both cavernous sinuses due to venous hypertension caused by a right glomus vagale tumor.
A 59-year-old woman was referred to the neuro-interventional team with complaints of headache, papilledema, and visual disturbances. Imaging and Lumbar puncture revealed signs consistent with idiopathic intracranial hypertension with stenosis of the right transverse venous sinus. The neurosurgery board chose to treat her with an endovascular approach and stenting. During the procedure, the right jugular vein revealed decreased blood flow. This led to a left jugular vein access through the confluence of venous dural sinuses. However, an incomplete confluence required the catheter to ascend the superior sagittal sinus before descending to the right transverse sinus. The carotid catheter system kept herniating up the SSS, risking rupture. Given the intraoperative findings and the available equipment, a more flexible coronary catheter system was chosen. This catheter device allowed plasty and successful stent deployment. A lumbar puncture was performed, and the patient was discharged. A follow-up MRI at five weeks showed signs of intracranial hypertension improvement and the patient reported Improvement in symptoms. To our knowledge, this is the first time this type of device has been used in this anatomical location for this pathology.
A 55-year-old man presented to the otolaryngology department complaining of aural fullness in his left ear after an episode of probable otitis 3 months before. magnetic resonance imaging revealed a soft tissue mass within the mastoid cavity that had destroyed the posterior wall of the middle ear with no apparent middle ear or sinonasal origin. The patient underwent a left canal wall-up tympanomastoidectomy, and the pathology report confirmed an inverted papilloma. Inverted papillomas are uncommon benign epithelial tumors related to a high recurrence rate and high risk of secondary malignant transformation after multiple surgeries. The patient has undergone 2 additional surgical interventions involving the neurosurgery team due to recurrent inverted papilloma that exerted a mass effect over the left cerebellar hemisphere. Despite no signs of recurrence on magnetic resonance imaging 5 years after the last surgery, at least 1 radiologic study per year is granted. Clinical multidisciplinary follow-up including nasal endoscopy and head and neck examination as a part of a stringent follow-up is essential to rule out synchronous nasosinusal inverted papillomas.
Papilloma, Inverted , Ear, Middle/diagnostic imaging , Ear, Middle/pathology , Ear, Middle/surgery , Follow-Up Studies , Humans , Male , Mastoid/diagnostic imaging , Mastoid/pathology , Mastoid/surgery , Mastoidectomy , Middle Aged , Papilloma, Inverted/diagnostic imaging , Papilloma, Inverted/surgery
BACKGROUND: Normal pressure hydrocephalus (NPH) is a common neurodegenerative syndrome among the elderly characterized by ventriculomegaly and the classic triad of symmetric gait disturbance, cognitive decline and urinary incontinence. To date, the only effective treatment is a cerebrospinal fluid shunting procedure that can either be ventriculo-atrial, ventriculo-peritoneal, or lumbo-peritoneal shunt. The conventional ventriculo-atrial shunt uses venodissection, whereas the peel-away is a percutaneous ultrasound (US)-guided technique that shows some advantages over conventional technique. We sought to compare perioperative complication rates, mean operating time and clinical outcomes for both techniques in NPH patients at our institution. METHODS: A retrospective cohort-type analytical study was conducted, using clinical record data of patients diagnosed with NPH and treated at our center from January 2009 to September 2019. Parameters to be compared include: Perioperative complication rates, intraoperative bleeding, mortality, and mean operating time. Perioperative complication rates are those device-related such as shunt infection, dysfunction, and those associated with the procedure. Complications are further classified in immediate (occurring during the first inpatient stay), early (within the first 30 days of surgery), and late (after day 30 of surgery). RESULTS: A total of 123 patients underwent ventriculo-atrial shunt. Eighty-two patients (67%) underwent conventional venodissection technique and 41 patients (33%) underwent a peel-away technique. Immediate complications were 3 (3.6%) and 0 for conventional and peel-away groups, respectively. Early complications were 0 and 1 (2.4%) for conventional and peel-away groups, respectively. Late complications were 5 (6.1%) and 2 (4.9%) for conventional and peel-away groups, respectively. Mean operating time was lower in the peel-away group (P = 0.0000) and mortality was 0 for both groups. CONCLUSION: Ventriculo-atrial shunt is an effective procedure for patients with NPH. When comparing the conventional venodissection technique with a percutaneous US-guided peel-away technique, the latter offers advantages such as shorter operating time and lower perioperative complication rates.
Sellar gangliocytomas (SGs) are rare, well-differentiated, low-grade neoplasias that commonly present along with a pituitary adenoma (PA). We describe a case of a 52-year-old woman with a 2-year history of headache, body weight increase, and recent onset of arterial hypertension and type 2 diabetes mellitus. Work-up tests revealed a normal hypophyseal profile, except for mild ACTH elevation, and a sellar mass on magnetic resonance imaging (MRI). A diagnosis of an enlarging pituitary macroadenoma was established, and to prevent symptom progression, the tumour was resected. Pathology showed 2 cell populations: ganglion and corticotrope cells. Three years after surgery, the patient no longer had a headache but persisted with arterial hypertension and type 2 diabetes mellitus. A literature review produced 207 cases of SGs. They typically present in women at 40 years of age and the most common clinical presentation are symptoms of acromegaly. Of the documented cases, 74 and 93% were treated with surgery alone or combined treatments (radiotherapy, radiosurgery, or pharmacotherapy), respectively. The majority of deaths associated with a SG came from the first half of the 20th century. In conclusion, this patient presented with a silent SG with likely pituitary hyperplasia. SGs are a challenging diagnosis, have a benign course, and may provide insights into PA tumourigenesis.
Pituitary carcinomas are rare tumors with heterogeneous behaviors. Their carcinogenesis is still unknown. Consequently, treatment is multimodal and not standardized. Dopamine (DA) agonists are used as first-line treatments, while radiotherapy and surgery may be used for local control of invasive tumors. We describe the case of a 35-year-old male who presented with an invasive prolactinoma, managed initially with a transsphenoidal resection, postsurgical radiotherapy and DA agonists. The patient posteriorly presented a sole metastatic lesion to the lumbar spine that was later managed with local radiotherapy. Due to pituitary recurrence of the lesion, multiple surgical resections were needed until further treatment was declined. The clinical course in this patient was unusual. He lived for 13 years after initial diagnosis, with a very invasive tumor without systemic chemotherapy. Radiotherapy is used in pituitary tumors in which surgery fails; we hypothesize that it contributed to the malignant transformation and the late resistance to DA agonists in our patient. Several biomarkers in tumoral tissue have been evaluated regarding their association with malignancy and aggressive behaviors, although more studies are still needed. Therapeutic strategies are limited, without evidence on the impact on overall survival and prognosis. Risk factors associated with early malignancy in pituitary prolactinomas include recurrent behavior, increase in prolactin levels with a stable sellar mass, and secondary development of DA agonist resistance. However, there are still no conclusive answers as to whether physicians should rigorously follow up these patients or provide direct therapy with aggressive approaches.
Se presentan dos pacientes sometidos a derivación ventricular por hidrocefalia idiopática y cisticercosis del cuarto ventrículo, respectivamente. En la resonancia magnética (RM) de control se encontró un aumento en el tamaño del cuerpo calloso con zonas de prolongación de los tiempos de relajación sin restricción en la secuencia de difusión. Las teorías fisiopatológicas mencionan: efectos mecánicos directos tras la colocación de la derivación, efecto compresivo crónico sobre el cuerpo calloso contra la hoz cerebral por la hidrocefalia, tracción de ramas perforantes de las arterias pericallosas que conduce a isquemia (probablemente ausente en estudios prequirúrgicos por el adelgazamiento del cuerpo calloso) y descompresión, luego de la derivación, que produce reexpansión del cuerpo calloso y edema intersticial del mismo. Los hallazgos pueden explicarse por el antecedente de derivación e hidrocefalia sin repercusión clínica aparente.(AU)
We report the cases of two patients with ventricular drainage due to idiopathic hydrocephalus and fourth ventricle cysticercosis, respectively. A follow-up MRI demonstrated increased volume of the corpus callosum with areas of prolonged relaxation without restriction on water diffusion sequences. Pathophysiologic theories include direct mechanical effects after the catheter insertion, chronic compression of the corpus callosum against the falx due to hydrocephalus, ischemia due to elongation of perforating pericallosal arteries not detected before shunting due to thinning of the corpus callosum, and decompressive changes leading to corpus callosum expansion and interstitial edema. These findings might be related to the history of ventricular shunt and hydrocephalus with no apparent clinical significance.(AU)
Se presentan dos pacientes sometidos a derivación ventricular por hidrocefalia idiopática y cisticercosis del cuarto ventrículo, respectivamente. En la resonancia magnética (RM) de control se encontró un aumento en el tamaño del cuerpo calloso con zonas de prolongación de los tiempos de relajación sin restricción en la secuencia de difusión. Las teorías fisiopatológicas mencionan: efectos mecánicos directos tras la colocación de la derivación, efecto compresivo crónico sobre el cuerpo calloso contra la hoz cerebral por la hidrocefalia, tracción de ramas perforantes de las arterias pericallosas que conduce a isquemia (probablemente ausente en estudios prequirúrgicos por el adelgazamiento del cuerpo calloso) y descompresión, luego de la derivación, que produce reexpansión del cuerpo calloso y edema intersticial del mismo. Los hallazgos pueden explicarse por el antecedente de derivación e hidrocefalia sin repercusión clínica aparente...
Humans , Female , Adult , Hydrocephalus , Magnetic Resonance Imaging , Corpus Callosum , Ventriculoperitoneal Shunt
Objetivos: En el presente trabajo se revisará nuestra serie de casos de Adenomas Corticotrópos silentes y revisar la literatura acerca de esta patología fascinante. Material y Método: Se revisaron las historias clínicas de 5 pacientes del Hospital Universitario Fundación Santa Fé de Bogotá en el periodo de enero de 1990 a enero de 2008, que se le realizó tratamiento para una masa sellar y se le realizó diagnóstico patológico de Adenoma Corticotrópos Silente. Discusión: Los adenomas de hipófisis corresponden entre el 17 por ciento de los tumores intracraneales. El 60 por ciento de estas lesiones se asocian a hipersecreción hormonal. Los adenomas corticotropos silentes son tumores hipofisarios que histológicamente muestran diferenciación corticotrópica con algún grado de secreción de ACTH pero sin la evidencia clínica de síndrome de Cushing. Conclusión: Aunque estos tumores sean clínicamente significativos y su histopatología fascinante, hay poca literatura y estudios clínicos con enfoque especial sobre estas lesiones. Estos tumores son muy importantes tenerlos en cuenta en la patología selar ya que su tratamiento requiere mayor dedicación y seguimiento a estos pacientes.
Objectives: In the present paper we want to review our series of silent corticotrofic adenomas and review the literature concerning this fascinating pathology. Material and Methods: we review the clinical history of 5 patients treated and diagnosed with Silent corticotrofic adenomas in University Hospital Fundacion Santa Fe de Bogota in the period of January 1990 till January 2008. Discussion: Pituitary adenomas count for 10 to 15 percent of intracranial tumors. In 60 percent of the cases there is a hormonal hypersecretory syndrome associated with these mass. Silent Corticotophic adenomas are pituitary tumors which histologically show a corticotrophic differentiation with secretion of ACTH but do not present with clinical evidence of Cushing disease. Although silent corticotophic adenomas are clinically significant and histologically fascinating there are only few clinical studies and medical literature with regard to these tumors. Conclusion: Although silent corticotophic adenomas are clinically significant and histologically fascinating there are only few clinical studies and medical literature with regard to these tumors. It is very important to take in regard this tumor in the pathology of the selar region since these patients demand a major dedication and a strict follow up.
Humans , Male , Female , Aged , ACTH-Secreting Pituitary Adenoma/surgery , ACTH-Secreting Pituitary Adenoma/diagnosis , Corticotrophs , Pituitary Gland/pathology , Pituitary Neoplasms
Los hemangioblastomas son unos de los tumores más comunes en la fosa posterior de los pacientes adultos. Esta lesión es de rara ocurrencia en la medula espinal y corresponde a un rango de entre 1 y 5% de los tumores medulares espinales. Los hemangioblastomas tienen una asociación importante con la enfermedad de von Hippel-Lindau, son tumores histológicamente benignos y se asemejan mucho a los astrocitomas. Dependiendo de su localización, pueden presentar sintomatología neurológica importante y afectar en gran manera la funcionalidad de los pacientes. La resonancia magnética es el estudio de imagen de elección para diagnosticarlos. El tratamiento es quirúrgico y, gracias a los avances de la las técnicas microquirúrgicas, el pronóstico de los pacientes que los sufren ha mejorado. En este artículo presentamos un caso clínico de una paciente de 58 años que comenzó con un cuadro subagudo de parestesias en miembros superiores, le fue diagnosticado un tumor intramedular y fue llevada a cirugía para la resección de la lesión. La patología reportó un hemangioblastoma.
Hemangioblastoma is one of the most common tumors of the posterior fossa in the adult. These lesions are rare in the spine and they represent between 1 to 5% of the spinal intramedullary tumors.Hemangioblastomas are histologically benign tumors that may be difficult to differentiate from astrocytomas. Depending on their localization in the spinal cord, these lesions may present important neurological symptoms and may compromise functionally these patients. Magnetic resonance imaging is the gold standard for diagnosis. Treatment is surgical and due to the advancement in microsurgical techniques there has been an improvement in the prognosis of these patients. In this article we will present a case of a 58 year old patient who presented with pain of the upper limbs.An intramedullary tumor was diagnosed and she was taken to surgery. The pathological studies reported an hemangioblastoma. We will review the literature concerning this rare pathology of the spine.
Hemangioblastoma , Neoplasms , Spinal Cord
La hemorragia subaracnoidea (HSA) usualmente sugiere la presencia de una lesión vascular, tal como ruptura de un aneurisma o sangrado de una malformación arteriovenosa. El hallazgo de una HSA se considera una urgencia neuroquirúrgica y se debe tratar con mucha delicadeza. La HSA puede ser secundaria a otras causas, y por tal razón se debe estar pendiente de los examenes a realizar para conocer la causa de esta. Otra causa poco frecuente de HSA e la Trombosis de Senos Venosos (TSV). La TSV es difícil de diagnosticar y se complica aún más su diagnóstico cuando se presenta con HSA. El objetivo de este artículo es la presentación de un caso de trombosis de seno venoso y revisar la literatura al respecto.
Subarachnoid Hemorrhage (SAH) usually suggests the presence of a vascular lesion as a ruptured aneurism or a bleeding from an arterial-venous malformation. The finding of a SAH is considered a neurosurgical emergency and it should be treated as that. SAH can also be caused by other etiologies and for this reason the cause of this finding should be investigated. Cerebral Sinus Thrombosis is one rare cause of SAH. Cerebral Sinus Thrombosis is usually difficult to diagnose and the presence of a SAH increases the difficulty of diagnosing this entity. The objective of this article is to present a case report and to review the literature with respect to this case.
Humans , Female , Adolescent , Cerebral Angiography , Subarachnoid Hemorrhage/surgery , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/etiology , Sinus Thrombosis, Intracranial/surgery , Sinus Thrombosis, Intracranial/complications , Sinus Thrombosis, Intracranial/diagnosis
Objetivo: El dolor lumbar es una patología común cuyo origen multifactorial hace participar las estructuras articulares que son sometidas al proceso degenerativo desencadenado por el alto esfuerzo biomecánico de esta zona. El objetivo de este trabajo es presentar el síndrome facetario lumbar como una causa de dolor lumbar que puede ser diagnosticada y tratada con bloqueos articulares selectivos. Materiales y metodos: Fueron 37 pacientes que consultaron por dolor lumbar, sin radiculopatia y con características clínicas y gamagráficas sugestivas de un Síndrome Facetario Lumbar. Se realizaron un total de 63 bloqueos selectivos de una o varias articulaciones facetarias. El procedimiento fue realizado por el mismo observador (JCA) quien utilizó la técnica bajo visión fluoroscopia o bajo TAC, dirigido al espacio inter-articular o al ramo interno de la raíz dorsal. El análisis incluyo una evaluación clínica a los 8 días y a las 4 semanas del último procedimiento. Resultados: El análisis demostró como 83.7% de los pacientes tuvieron una mejoría en al menos 5 puntos de la escala visual análoga en el último control con respecto a la valoración inicial. Entre ellos, 15 (40.1 %) tuvieron una mejoría superior o igual a 8 puntos de la escala visual análoga. Conclusiones: Las articulaciones facetarias son una estructura anatómica con características particulares que la hacen un elemento generador de dolor. Su diagnóstico clínico y gamagráfico acompañado de bloqueo selectivo bajo visión radiológica permite obtener resultados clínicos interesantes.
Low Back Pain/epidemiology , Low Back Pain/physiopathology , Low Back Pain , Low Back Pain/therapy , Low Back Pain
Objetivo: determinar la utilidad actual de los procedimientos neuroquirúrgicos en el manejo de las secuelas espásticas de enfermedades neurológicas. Fuente de datos: la exploración de la literatura médica en el período comprendido entre 1984 y diciembre de 1999 a través de las bases de datos MEDLINE y LILACS.Los términos utilizados para la exploración fueron: spasticity, surgery, posterior rhizotomy, drezotomy, neurectomy, intratrecal drug administration, baclofen, mielotomy. Estudios seleccionados: aquellos que presentaban resultados clínicos de procedimientos neuroquirúrgicos utilizados para el manejo de la espasticidad. Debía cumplir con los parámetros preestablecidos: escala de Ashworth para la valoración del tono, escala de Penn para la frecuencia de espasmos y la determinación de los arcos de movimiento articular. Los procedimientos neuroquirúrgicos actualmente utilizados mostraron brindar una mejoría significativa en la mayoría de los casos. Estas técnicas van dirigidas a estimular los mecanismos fisiológicos inhibidores segmentarios y suprasegmentarios con la administración de sustancias directamente en el espacio intratecal como es el caso del baclofen (neuroestimulación química). Pueden ir dirigidos también a seccionar de manera selectiva, con parámetros electrofisiológicos, las fibras aferentes y/o eferentes del reflejo miotático, a nivel periférico con la neurotomía fascicular supraselectiva (NFS) y la rizotomía dorsal funcional selectiva (RDFS) y a nivel central directamente en contacto con la médula como es el caso de la drezotomía. Conclusión: los procedimientos neuroquirúrgicos actuales utilizados dentro de un contexto multidisciplinario ofrecen una mejoría significativa no sólo ortopédica y funcional sino de la calidad de vida de los pacientes con secuelas espásticas de enfermedades neurológicas.
Muscle Spasticity , Nervous System Diseases
Las heridas penetrantes del cráneo se presentan en numero cada vez mayor y causan diferentes síndromes clínicos, dependiendo del tipo de proyectil que las producen y las estructuras intracreneanas que lesionan. El pronóstico en estos pacientes se correlacionan con la graduación en la escala del Glagow y hay factores indicadores de mal pronóstico, por ejemplo, cuando el proyectil cruza la línea media o produce hemorragias ventriculares. El perfeccionamiento de las técnicas, al igual que la rapidez y amplitud en el tratamiento de este tipo de lesiones ha disminuido en forma progresiva la mortalidad quirúrgica.
Humans , Wounds, Gunshot/surgery , Wounds, Gunshot/physiopathology , Wounds, Gunshot/therapy , Craniocerebral Trauma , Skull
Trauma espinal es cualquier traumatismo capaz de comprometer los componentes estructurales de la columna, su contenido nervioso o ambos. El numero de personas paraplejicas o cuadriplejicas por lesiones medular traumatica es cada vez mayor como consecuencia de accidentes de transito, caidas y traumatismos durante competencias deportivas. En su gran mayoria se trata de adultos jovenes que se encuentran en plena etapa productiva, desde el punto de vista laboral, familiar, economico y social. Aunque el pronostico a largo plazo y la reintegracion de estos pacientes a una vida social util ha mejorado en los ultimos anos, todavia son muchos los que mueren durante la fase aguda de su enfermedad
Humans , Male , Female , Spinal Injuries , Spinal Injuries/diagnosis , Spinal Injuries/physiology , Spinal Injuries/rehabilitation , Spinal Injuries/therapy
