[Isolated paralysis of the hypoglossal nerve due to atlanto-occipital joint cysts]. / Paralisis aislada del nervio hipogloso ocasionada por quistes occipitoatloideos.

TITLE: Paralisis aislada del nervio hipogloso ocasionada por quistes occipitoatloideos.

Gangliogliomas intracraneales. Revisión de una serie de 20 pacientes / Intracranial gangliogliomas. A review of a series of 20 patients

Introducción: El ganglioglioma es un tumor primario, de bajo grado, del sistema nervioso central constituido por una población celular mixta de elementos gliales y neuronales. Representan entre el 0,4 al 2% de todos los tumores intracraneales y afectan fundamentalmente a niños y adultos jóvenes. Métodos: Entre los años 1995 y 2008 hemos tratado en nuestro hospital 20 pacientes (12 adultos y 8 niños) con ganglioglioma intracraneal. Revisamos retrospectivamente el sexo, el síntoma de inicio y la edad, sintomatología y tiempo de evolución, exploración neurológica, localización del tumor, aspecto en la tomografía computarizada y resonancia magnética, el tratamiento quirúrgico y la evolución. Todos los pacientes fueron intervenidos quirúrgicamente y la extensión de la resección fue evaluada de la hoja operatoria y del seguimiento neurorradiológico. Resultados: La media de edad de los pacientes fue de 26,4 años (rango 1-75) y el ratio mujer/varón fue de 1.5:1. Excepto en un caso, todos los pacientes debutaron con crisis epilépticas, con una duración media antes del diagnóstico de 7,4 años (rango 1-29). Diecisiete tumores estaban localizados en el lóbulo temporal (9 derechos y 8 izquierdos). Se realizó extirpación macroscópicamente completa en 17 pacientes y subtotal en los 3 restantes. Se presentaron 4 recidivas que fueron tratadas mediante reintervención, añadiéndose radioterapia en uno de los casos. El tiempo medio de seguimiento fue de 8,5 años (rango 22 meses-14 años), la supervivencia libre de enfermedad a los 5 años fue del 85% y la supervivencia global del 95%. Conclusiones: Las crisis epilépticas, que constituyen el síntoma más frecuente mejoran de forma significativa tras la extirpación quirúrgica. El tratamiento quirúrgico es la primera opción terapéutica en este tipo de tumores, y ante la presencia de resecciones subtotales o recidivas tumorales la mejor indicación de tratamiento es la reintervención. La radioterapia debe reservarse únicamente para las formas malignas (AU)

Introduction: A ganglioglioma is a type of primary central nervous system low grade tumour composed of mixed populations of glial and neuroepithelial elements. They accounts for 0.4 to 2% of all intracranial tumours and appear more commonly in children and young adults. Seizures, which are the most important symptom in these tumours, improve significantly after surgical excision. Methods: Between 1995 and 2008, 20 patients with (12 adults and 8 children) with intracranial ganglioglioma were treated at our hospital. Clinical information obtained by chart review included sex, age at onset of symptoms, clinical history, results of neurological examination, tumour location, CT and MRI appearance, surgical results and follow-up. All patients underwent tumour resection and the extent of surgery was determined from the surgical reports and postoperative imaging studies. Results: The median age of patients was 26.4 years (range, 1-75 years), and the female to male ratio was 1.5:1. Except in one case, all patients had seizures with a median duration before diagnosis of 7.4 years (range 1-29). Seventeen tumours were located in the temporal lobe (9 right and 8 left). Macroscopically complete excision was performed in 17 patients and subtotal in the remaining 3. There were 4 cases of recurrence treated by surgery and radiotherapy being added in one case. The mean follow up was 8.5 years (range 22 months-14 years) and disease free survival at 5 years was 85% and an overall survival of 95%. Conclusions: The seizures, which are the most frequent symptoms, significantly improved after surgical removal. Surgery is the first choice of therapy in these tumours, and in the presence of subtotal resection or tumour recurrence the best indication for treatment is repeat surgery. Radiotherapy should be reserved only for malignant forms (AU)

[Chronic subgaleal hematoma in a child. Case report]. / Hematoma subgaleal crónico en un lactante. Presentación de un caso.

Neonatal subgaleal hematomas are under-diagnosed collections of blood beneath the galea, often caused by certain obstetric procedures such as use of forceps or vacuum. They generally have low volume and often resolve spontaneously. Occasionally, they can achieve a large volume and may endanger the live of the affected newborns. Rarely, they become chronic and exceptionally they may require surgical treatment. We report the case of a child under one year of age who was referred to our department because of a subgaleal hematoma secondary to vacuum-assisted delivery that required surgical treatment.

[Pituitary apoplexy. A review]. / Apoplejía pituitaria. Revisión del tema.

Pituitary apoplexy constitutes a syndrome that is characterized by the ischemic infarction or hemorrhage into a pituitary tumour. Clinically the patient develops sudden headache, meningismus, visual disturbances, even blindness, and occasionally decrease in level of consciousness. To diagnose it is basic to perform a cerebral MRI. Treatment consists in urgent sellar decompression by transsphenoidal surgery and substitute therapy with steroids.

Estimulación cerebral en el tratamiento del dolor neuropático / Intracraneal neuroestimulation in the treatment of the neuropatic pain

El dolor neuropático es aquel que tiene su origen en una lesión neurologica que afecta al sistema somato-sensorial. La estimulación cerebral para el tratamiento del dolor crónico puede realizarse en la corteza motora, los núcleos sensitivos del tálamo o la sustancia gris periaqueductal y paraventricular y la elección del centro dependerá sobre todo del tipo de dolor a tratar. La estimulación del cortex motor y la cerebral profunda han demostrado ser técnicas efectivas para el tratamiento tanto del dolor nociceptivo como del dolor neuropático. En la estimulación cortical se bloquean las proyecciones de la misma sobre los núcleos talámicos, modulando la transmision del dolor. En la estimulación directa del núcleo ventral posterior, se actúa directamente sobre el circuíto del dolor. Presentamos dos casos de pacientes afectadas de dolor neuropático tratadas, una con estimulación del cortex motor y la otra con estimulacón del nucleo ventrocaudal del tálamo (AU)

Intracranial neuroestimulation for pain relief is most frequently delivered by stimulating the motor cortex, the sensory thalamus, or the periaqueductal and paraventricular gray matter. The stimulation of these sites through motor cortex stimulation and deep brain stimulation has proven effective for treating the neuropathic and nociceptive pain. The motor cortex has extensive projections to some thalamic nuclei; indeed, converging evidence has suggested that modulation of motor cortex is critically involved with the pathophysiology of chronic pain. Deep brain stimulation of ventrocaudalis nucleous of the thalamus contralateral to the side of the most severe pain results in a blockade on the pain transmission. We present two patients with neurophatic pain treated one with motor cortex stimulation and the other with deep brain stimulation (AU)

Apoplejía pituitaria. Revisión del tema / Pituitary apoplexy. A review

La apoplejía pituitaria es un síndrome caracterizadopor una necrosis o hemorragia en el seno deun tumor hipofisario. Clínicamente cursa con cefalearepentina, signos de irritación meníngea, alteracionesen la agudeza visual, incluso ceguera y en ocasiones disminucióndel nivel de conciencia. Para el diagnósticoes fundamental la realización de pruebas radiológicas,siendo la de elección la resonancia magnética. El tratamientoconsiste en la descompresión quirúrgica sellartransesfenoidal urgente y terapia sustitutiva con altasdosis de corticoides (AU)

Pituitary apoplexy constitutes a syndrome that ischaracterized by the ischemic infarction or hemorrhageinto a pituitary tumour. Clinically the patient developssudden headache, meningismus, visual disturbances,even blindness, and occasionally decrease in level ofconsciousness. To diagnose it is basic to perform a cerebralMRI. Treatment consists in urgent sellar decompressionby transsphenoidal surgery and substitutetherapy with steroids (AU)

[Intracranial injury caused by captive bolt gun]. / Lesiones intracraneales originadas con pistola de bala cautiva.

Guns bullet or captive bolt is used as a weapon for stunning animals as a prelude to sacrifice. Placed in front of it induce an immediate loss of consciousness, thus achieving a "humanization" of process. It's use for suicide is rare, almost exclusively of people who have access to them because of their occupation, causing severe injuries to the brain. We analyse three cases presented in our service. One of them dies as a result of injuries.

[Filum terminale ependymomas. Analysis of a serie of 20 consecutive cases]. / Ependimomas del filum terminal. Análisis de 20 casos consecutivos.

OBJECTIVE: to analyze the clinical, radiological and surgical outcome of a series of filum terminale ependymomas. Patients and methods. This retrospective study involved 20 patients with 21 ependymomas of the filum terminale encountered during a 21 year period (1988- 2008). All patients were diagnosed using MRI and surgically treated. RESULTS: the male: female ratio was 1:1.5, and the mean age at diagnosis was 44.8 years (range 15-64). First symptom included radicular pain (12 cases) and lumbar pain in the other 8 cases, with average symptom duration of 8.7 years (range 0-6-32). All patients underwent open biopsy, seventeen tumours received gross-total resection and 4 received subtotal resection. Histologically, 20 tumours were myxopapillary ependymomas (grade I) and 1 case a grade II ependymoma. The mean follow-up period was 8 years (range 1-18 years). CONCLUSIONS: filum terminale ependimomas are slow growing tumours of the cauda equina with a high incidence in young adults. The most common presentation is with low back pain long time evolution. Although ependymomas of the filum terminale are thought to be benign, local recurrence is not uncommon.

Ependimomas del filum terminal. Análisis de 20 casos consecutivos / Filum terminale ependymomas. Analysis of a serie of 20 consecutive cases

Objetivos. Analizar las características clínicas,radiológicas y los resultados quirúrgicos de una serie de ependimomas del filum terminal. Pacientes y método. Se estudia retrospectivamente 20 pacientes con 21 ependimomas del filum terminal tratados durante un período de 21 años (1988-2008).Todos los pacientes fueron diagnosticados con resonancia magnética e intervenidos quirúrgicamente. Resultados. La relación varón-mujer fue de 1:1.5 yla media de edad al diagnóstico de 44.8 años (rango 15-64). El primer síntoma fue dolor radicular (12 casos) y lumbalgia en los 8 restantes, con una duración mediade la sintomatología antes del diagnostico de 8.7 años(rango 0.6-32). Todos los pacientes fueron intervenidos quirúrgicamente realizándose resección completa de 17 tumores y subtotal de 4. Histológicamente 20 tumoresfueron ependimomas mixopapilares (grado I ) y un caso grado II. El período de seguimiento fue de 8 años (rango1-18).Conclusiones. Los ependimomas del filum terminal, son tumores de crecimiento lento con una mayor incidencia en adultos jóvenes. La forma de presentación más habitual es con dolor lumbar con un largo tiempo de evolución. Aunque la mayoría son tumores de bajo grado histológico, tienen una especial tendencia a crecer y las recidivas locales no son raras (AU)

Objective. To analyze the clinical, radiological and surgical outcome of a series of filum terminale ependymomas. Patients and methods. This retrospective study involved 20 patients with 21 ependymomas of the filumterminale encountered during a 21 year period (1988-2008). All patients were diagnosed using MRI and surgicallytreated. Results. The male: female ratio was 1:1.5, and the mean age at diagnosis was 44.8 years (range 15-64).First symptom included radicular pain (12 cases) and lumbar pain in the other 8 cases, with average symptom duration of 8.7 years (range 0-6-32). All patients underwent open biopsy, seventeen tumours received gross-total resection and 4 received subtotal resection. Histologically, 20 tumours were myxopapillary ependymomas(grade I) and 1 case a grade II ependymoma.The mean follow-up period was 8 years (range 1-18years).Conclusions. Filum terminale ependimomas are slow growing tumours of the cauda equina with a highincidence in young adults. The most common presentation is with low back pain long time evolution. Although ependymomas of the filum terminale are thought to be benign, local recurrence is not uncommon (AU)

[Isolated hypoglossal nerve palsy secondary to an atlantoccipital joint synovial cyst. Case report and literature review]. / Parálisis aislada del nervio hipogloso secundaria a quiste articular atlanto-occipital. Presentación de un caso y revisión de la literatura.

Hypoglossal nerve palsy is commonly associated with the involvement of other cranial nerves. His injury is rarely isolated. We present a patient in which paralysis is due to the presence of a "juxtafacet cyst" of the atlanto-occipital joint. We review the anatomy of the hypoglossal nerve, different therapeutic options, the differential diagnosis and papers published to date.

Parálisis aislada del nervio hipogloso secundaria a quiste articular atlanto-occipital. Presentación de un caso y revisión de la literatura / Isolated hypoglossal nerve palsy secondary to an atlantoccipital joint synovial cyst. Case report and literature review

La parálisis del nervio hipogloso se asocia comúnmente con la afectación de otros pares craneales. Su lesión aislada es infrecuente.Presentamos el caso de un paciente en el cual la parálisis es debida a la presencia de un quiste yuxtafacetario a nivel de la articulación atlanto-occipital derecha. Revisamos la anatomía del nervio hipogloso, las diferentes opciones terapéuticas así como el diagnóstico diferencial y los trabajos publicados hasta la fecha (AU)

Hypoglossal nerve palsy is commonly associated with the involvement of other cranial nerves. Hisinjury is rarely isolated. We present a patient in which paralysis is due to the presence of a “juxtafacet cyst”of the atlanto-occipital joint. We review the anatomy of the hypoglossal nerve, different therapeutic options,the differential diagnosis and papers published to date (AU)

[Chronic subdural hematoma associated with arachnoid cyst. Report of 12 cases]. / Hematoma subdural crónico asociado a quiste aracnoideo. Presentación de 12 casos.

INTRODUCTION: We designed this study to investigate the clinical, neurological, and radiological outcome of patients with chronic subdural hematoma related to an intracranial arachnoid cysts. PATIENTS AND METHODS: Medical records of 12 cases of patients with arachnoids cyst complicated with chronic subdural hematoma were retrospectively reviewed. RESULTS: Between January 1984 and April 2008, 12 patients (0.9%) of 1.253 cases of chronic subdural hematoma surgically treated in our hospital had associated arachnoid cyst. Arachnoid cysts were located in the middle fossa (10 cases) and convexity (2 cases). The most frequent symptom was headache (6 cases), followed by seizures (3 cases). Eleven patients underwent burr hole and drainage; the oldest patient was treated conservatively. CONCLUSIONS: Patients with AC, especially when these are located in temporal fossa, appear to harbour a life-long risk of contracting subdural hematoma. Hematoma evacuation is adequate at first operation and if arachnoid cyst is symptomatic or preoperative symptoms persist, additional arachnoid cyst surgery should be considered.

[Epidural haematoma due to an headrest in an adult]. / Hematoma epidural secundario al empleo de cabezal autoestático en un adulto.

A head fixation device with pins is commonly used for immobilization of the patients during neurosurgical procedures. Despite its appropriate management, it may be the cause of some serious complications such as skull perforation and intracranial injuries.We report the case of a 19-years-old young admitted for a endoscopic third ventriculostomy who developed an epidural haematoma due to the penetration of the skull by a pin.

Hematoma epidural secundario al empleo de cabezal autoestático en un adulto / Epidural haematoma due to an headrest in an adult

El cabezal autoestático es un instrumento utilizadohabitualmente en las intervenciones neuroquirúrgicas ya pesar de su utilización adecuada, puede ser el causantede algunas complicaciones graves como la perforacióncraneal y el desarrollo de hemorragias intracraneales.Presentamos el caso de un paciente varón de 19 añossometido a una ventriculocisternostomía endoscópicay que presentó un hematoma epidural secundario ala penetración intracraneal de uno de los pinchos delcabezal (AU)

A head fixation device with pins is commonly usedfor immobilization of the patients during neurosurgicalprocedures. Despite its appropiate management, maybe the cause of some serious complications such as skullperforation and intracranial injuries.We report thecase of a 19-years-old young admitted for a endoscopicthird ventriculostomy who developed an epidural haematomadue to the penetration of the skull by a pin (AU)

Aracnoiditis lumbosacra secundaria a derivación lumboperitoneal / Lumbosacral arachnoiditis secondary to a lumboperitoneal shunt

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Papiloma de plexos coroideos extraventricular / Extraventricular choroid plexus papilloma

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