Neuroendoscopic septostomy in unilateral and bilateral ventricular hydrocephalus.

PURPOSE: This study describes the results of septostomy (SPT) in terms of success and analysis of follow-up in a series of pediatric patients diagnosed with unilateral ventricular hydrocephalus (UHV) and biventricular hydrocephalus (BVH). METHODS: A total of 29 pediatric patients diagnosed with UVH or BVH were included in this study. In UVH, a neuroendoscopic SPT was performed (sometimes accompanied by NEFPFMO). In those diagnosed with BVH, an SPT combined with VPS was carried out. Demographic, etiological, clinical, and diagnostic variables and percentage of treatment success were collected. RESULTS: SPT was successful during follow-up when no VPS was required in UVH and only unilateral VPS was implanted in BVH. At the time of surgery, 16 patients needed a ventriculoperitoneal shunt. The first SPT was successful in 22 patients, requiring a second surgery in 7 patients, from the oncology group diagnosed with BHV. CONCLUSIONS: The surgical management of UVH and BVH still has some disclosure points to be reviewed. However, SPT seems to be a secure, non-traumatic, and efficient procedure.

Ganglioglioma espinal intramedular: caso clínico y revisión comparativa de la literatura / Intramedullary spinal cord ganglioglioma: Case report and comparative literature review

Introducción Los gangliogliomas espinales intramedulares (GGEI) representan el 35-40% de todos los tumores intramedulares en niños. Estos tumores presentan un algoritmo terapéutico y pronóstico diferente con respecto a otros tumores medulares, tales como los astrocitomas o los ependimomas espinales. El objetivo del estudio es revisar la literatura para esclarecer una vía diagnóstica y terapéutica de dicho tumor en base a un caso clínico de GGEI diagnosticado en nuestro centro. Método Se ha realizado una revisión literaria exhaustiva de los GGEI publicados desde 1911 hasta 2018 a través de la plataforma PubMed-NCBI, adjuntando de cada paciente, las características epidemiológicas, la localización, la clínica, el diagnóstico radiológico y el tratamiento. Resultados Se encontraron un total de 167 casos de GGEI, incluyendo nuestro caso. En nuestra muestra, el 52% de los pacientes pertenece al sexo femenino, siendo la década de edad más afectada la que va de los 0 a los 9 años (35% de los pacientes). El déficit motor se establece como síntoma principal en pacientes adultos en mayor proporción que en pacientes pediátricos. Radiológicamente, este tumor se presenta con mayor hiperintensidad y captación de contraste que los astrocitomas y los ependimomas, así como un mayor porcentaje de quistes intratumorales. La mutación BRAFV600E es menos frecuente en los gangliogliomas espinales que en los supratentoriales. La cirugía con resección total es el tratamiento de elección. Solamente el 19% de los pacientes de la muestra recibieron radioterapia y solo el 9% quimioterapia como única vía de tratamiento. Conclusiones Los GGEI son frecuentes en la población pediátrica y requieren de un alto nivel de sospecha para su correcto diagnóstico y tratamiento, ya que tienen 3 veces más riesgo de recurrencia que sus homólogos supratentoriales (AU)

Introduction Intramedullary spinal cord gangliogliomas (ISCGGs) account for 35-40% of all intramedullary tumors in children. These tumors have a different algorithm for treatment and prognosis than other medullary tumors, such as astrocytomas and spinal ependymomas. The objective of the study was to review the literature and examine an approach to diagnosing and treating this tumor based on a case report of ISCGG diagnosed at our center. Method An exhaustive review of cases of ISCGG published via the PubMed-NCBI platform between 1911 and 2018 was performed, and each patient's epidemiological characteristics, tumor location, symptoms, radiological diagnosis and treatment were appended. Results A total of 167 cases of ISCGG were found, including our own. In our sample, 52% of patients were female and the most commonly affected age group was 0-9 years of age (35% of patients). Motor deficit has been found to be the main symptom in a larger proportion of adults patients versus pediatric patients. On X-ray, this tumor shows greater hyperintensity and contrast uptake than astrocytomas and ependymomas, as well as a higher percentage of intratumoral cysts. The BRAFV600E mutation is less common in spinal as opposed to supratentorial gangliogliomas. Surgery with complete resection is the treatment of choice. Only 19% of the patients in the sample received radiotherapy, and only 9% received chemotherapy as their only line of treatment. Conclusions ISCGGs are common in the pediatric population and require strong suspicion for proper diagnosis and treatment, as the risk of recurrence of ISCGGs is 3 times greater than that of supratentorial gangliogliomas (AU)

Intramedullary spinal cord ganglioglioma: Case report and comparative literature review. / Ganglioglioma espinal intramedular: caso clínico y revisión comparativa de la literatura.

INTRODUCTION: Intramedullary spinal cord gangliogliomas (ISCGGs) account for 35-40% of all intramedullary tumors in children. These tumors have a different algorithm for treatment and prognosis than other medullary tumors, such as astrocytomas and spinal ependymomas. The objective of the study was to review the literature and examine an approach to diagnosing and treating this tumor based on a case report of ISCGG diagnosed at our center. METHOD: An exhaustive review of cases of ISCGG published via the PubMed-NCBI platform between 1911 and 2018 was performed, and each patient's epidemiological characteristics, tumor location, symptoms, radiological diagnosis and treatment were appended. RESULTS: A total of 167 cases of ISCGG were found, including our own. In our sample, 52% of patients were female and the most commonly affected age group was 0-9 years of age (35% of patients). Motor deficit has been found to be the main symptom in a larger proportion of adults patients versus pediatric patients. On X-ray, this tumor shows greater hyperintensity and contrast uptake than astrocytomas and ependymomas, as well as a higher percentage of intratumoral cysts. The BRAFV600E mutation is less common in spinal as opposed to supratentorial gangliogliomas. Surgery with complete resection is the treatment of choice. Only 19% of the patients in the sample received radiotherapy, and only 9% received chemotherapy as their only line of treatment. CONCLUSIONS: ISCGGs are common in the pediatric population and require strong suspicion for proper diagnosis and treatment, as the risk of recurrence of ISCGGs is 3 times greater than that of supratentorial gangliogliomas.

Cervical myelomeningocele with CSF leakage: a case-based review.

BACKGROUND: The cystic spinal dysraphism of the cervical and upper thoracic region (CDCT) accounts for only 3.9 to 8% of spina bifida cystica lesions. The presence of external cerebrospinal fluid (CSF) leakage is infrequent and very few authors have reported about surgical complications. CASE REPORT: We present the case of a new born diagnosed of CDCT C1-C3 with a stalk of fibrovascular tissue, CSF leakage, hydrocephalus, and type Chiari II malformation, discuss about the chosen surgical technique and the associated complications, and make a review of the literature focusing on the main aspects of CDCT. CONCLUSIONS: The CDCT with a stalk of neuroglial and/or fibrovascular tissue originates from the dorsal surface of the spinal cord and penetrates into a cervical cystic sac. The presence of CSF leakage, hydrocephalus, and/or type Chiari II malformation can influence to decide the most appropriate surgical technique.

Tendencias de actuación de los cirujanos de columna respecto a la osteoporosis / Trends and attitudes of spine surgeons regarding osteoporosis

Antecedentes y objetivos: Con cada vez mayor frecuencia neurocirujanos y otros especialistas nos vemos afrontados al tratamiento de pacientes con osteoporosis que requieren una cirugía de fusión de columna. Pese a existir tratamientos farmacológicos efectivos e innovaciones en las técnicas quirúrgicas que pueden beneficiar a estos pacientes, se han reportado tasas bajas de diagnóstico y tratamiento preoperatorio de osteoporosis, además de una escasa participación de los cirujanos de columna en este ámbito. El objetivo de este estudio fue evaluar las tendencias en el diagnóstico y tratamiento respecto a la osteoporosis en los cirujanos de raquis de la comunidad neuroquirúrgica. Material y métodos: Se realizó una encuesta electrónica con 10 preguntas de opción múltiple a los miembros de la Sociedad Española de Neurocirugía (SENEC). Se valoraron: 1) papel del cirujano de columna frente a la osteoporosis en la artrodesis de raquis, 2) la influencia de osteoporosis en la seudoartrosis y 3) tendencias de tratamiento respecto a las fracturas vertebrales osteoporóticas. Resultados: Obtuvimos un total de 77 cuestionarios respondidos. En los pacientes con sospecha de osteoporosis, un 32,5% de los encuestados no se plantea ninguna medida para diagnosticarla antes de una artrodesis vertebral. En osteoporóticos sin tratamiento, un 37,7% procedería con la cirugía sin tratamiento o lo haría después de la cirugía. El 48% de los respondedores optaría por modificar su estrategia quirúrgica en los pacientes con osteoporosis. La técnica quirúrgica preferida fue la colocación de tornillos cementados (70%). En la seudoartrosis, el 46,1% no considera necesario el diagnóstico de osteoporosis para una reintervención. En las fracturas vertebrales osteoporóticas, el 80,5% de los cirujanos se plantea alguna medida que facilitara el tratamiento de la osteoporosis. Conclusiones: Una mayor participación del cirujano de columna mejoraría el diagnóstico y tratamiento preoperatorio de la osteoporosis en las cirugías de artrodesis vertebral y seudoartrosis. En las fracturas vertebrales existe una mejor concienciación para optimizar el tratamiento y el seguimiento de la osteoporosis

Background and objectives: Neurosurgeons and other specialists are increasingly having to treat patients with osteoporosis who require spinal fusion surgery. Although there are effective pharmacological treatments and innovations in surgical techniques that can benefit these patients, low rates of diagnosis and preoperative treatment of osteoporosis have been reported, in addition to the limited participation of spine surgeons in this area. The objective of this study was to evaluate trends in diagnosis and treatment of osteoporosis with regard to spine surgeons of the neurosurgical community. Material and methods: An electronic survey with 10 multiple-choice questions was issued to Spanish Neurosurgery Society (SENEC) members. The following were evaluated: 1) the surgeon's role regarding osteoporosis in spinal arthrodesis, 2) the influence of osteoporosis in pseudarthrosis, and 3) treatment trends in relation to osteoporotic vertebral fractures. Results: A total of 77 completed questionnaires were obtained. In patients with suspected osteoporosis, 32.5% of respondents did not consider any measure to diagnose it before spinal arthrodesis. In osteoporosis without treatment, 37.7% would proceed with surgery without treatment or would do so after surgery. A total of 48% of respondents would choose to modify their surgical strategy in patients with osteoporosis. The preferred surgical technique was the placement of augmentation screws (70%). In pseudarthrosis, 46.1% did not consider an osteoporosis diagnosis to be necessary for a reoperation. In osteoporotic vertebral fractures, 80.5% of surgeons considered some measure that would facilitate the treatment of osteoporosis. Conclusions: Greater participation of the spine surgeon could improve the diagnosis and preoperative treatment of osteoporosis in spinal arthrodesis surgery and pseudarthrosis. In vertebral fractures, there is greater awareness of the optimisation of treatment and monitoring of osteoporosis

Trends and attitudes of spine surgeons regarding osteoporosis. / Tendencias de actuación de los cirujanos de columna respecto a la osteoporosis.

BACKGROUND AND OBJECTIVES: Neurosurgeons and other specialists are increasingly having to treat patients with osteoporosis who require spinal fusion surgery. Although there are effective pharmacological treatments and innovations in surgical techniques that can benefit these patients, low rates of diagnosis and preoperative treatment of osteoporosis have been reported, in addition to the limited participation of spine surgeons in this area. The objective of this study was to evaluate trends in diagnosis and treatment of osteoporosis with regard to spine surgeons of the neurosurgical community. MATERIAL AND METHODS: An electronic survey with 10 multiple-choice questions was issued to Spanish Neurosurgery Society (SENEC) members. The following were evaluated: 1) the surgeon's role regarding osteoporosis in spinal arthrodesis, 2) the influence of osteoporosis in pseudarthrosis, and 3) treatment trends in relation to osteoporotic vertebral fractures. RESULTS: A total of 77 completed questionnaires were obtained. In patients with suspected osteoporosis, 32.5% of respondents did not consider any measure to diagnose it before spinal arthrodesis. In osteoporosis without treatment, 37.7% would proceed with surgery without treatment or would do so after surgery. A total of 48% of respondents would choose to modify their surgical strategy in patients with osteoporosis. The preferred surgical technique was the placement of augmentation screws (70%). In pseudarthrosis, 46.1% did not consider an osteoporosis diagnosis to be necessary for a reoperation. In osteoporotic vertebral fractures, 80.5% of surgeons considered some measure that would facilitate the treatment of osteoporosis. CONCLUSIONS: Greater participation of the spine surgeon could improve the diagnosis and preoperative treatment of osteoporosis in spinal arthrodesis surgery and pseudarthrosis. In vertebral fractures, there is greater awareness of the optimisation of treatment and monitoring of osteoporosis.