Involución espontánea de meningioma. Caso clínico y revisión de la literatura / Spontaneus involution of meningioma. Case report and literature review

Los meningiomas son tumores de las meninges cerebrales, de crecimiento lento y generalmente benignos, cuyo tratamiento es esencialmente quirúrgico. Presentan receptores de progesterona, y en menor medida de estrógeno, lo que les hace a veces tener crecimiento o disminución ligada a tratamiento hormonal. Es extremadamente raro que presenten involución espontánea. Presentamos el caso de un varón con un meningioma del planum esfenoidal. Como antecedentes tenía diabetes mellitus, miastenia gravis y un cáncer de próstata. Como tratamiento médico recibía, entre otros, análogos de la gonadotropina (leuprorelina), antiandrogénico (bicalutamida), agonistas β3 y bloqueantes α1. A los 15 meses del bloqueo hormonal se objetivó una reducción del tumor del 90% de su volumen. Los casos publicados previamente muestran que el tratamiento con análogos de la GnRH produce un crecimiento en algunos meningiomas. Existen otros casos publicados sobre reducción en pacientes diabéticos y en tratamiento con bloqueantes α1. Se revisa la literatura sobre meningiomas con involución espontánea (AU)

Meningiomas are tumors of the cerebral meninges, with slow growth and usually benign, whose treatment is essentially surgery. They have progesterone receptors, and to a lesser extent estrogen, which sometimes causes them to have growth or involution linked to hormonal treatment. Its spontaneous involution is extremely rare. We present the case of a male with a meningioma of the sphenoid planum. He had a history of diabetes mellitus, myasthenia gravis and prostate cancer. He was in treatment with analogs of GnRH (leuprorelin), antiandrogen (bicalutamide), β3 agonists and α1 blockers. 15 months after the hormonal blockade, a reduction of the tumor of approximately 90% of its volume was detected. Previous reports show that treatment with gonadotropin analogues produces growth in some meningiomas. Other reports of spontaneous involution affect diabetic patients and patients in treatment with α1 blockers. Literature focus on meningiomas with spontaneous involution is reviewed (AU)

Neurologically Asymptomatic Lumbar Traumatic Dislocation With Vascular Compression in a Patient With Ankylosing Spondylitis: Case Report.

BACKGROUND: Ankylosing spondylitis (AS) is associated with high rates of severe thoracolumbar fractures, in many cases with neurological deficits. It is currently a point of debate as to whether the optimal surgical treatment is posterior fixation and fusion or combined approaches. Vascular injuries in this kind of fracture are a challenging issue to solve in the management of these patients. METHODS: We are reporting the case of a 65-year-old man who presented an L4 traumatic fracture-dislocation. He had a long history of symptomatic AS. No neurological deficits were detected during the initial exploration. During the preoperative work-up, a lumbar spine computed tomography (CT) scan was taken with vascular reconstruction of the abdominal vessels. It confirmed the compression of the abdominal aorta, which had caused more than 90% stenosis. A posterior approach, an open reduction, and fixation with pedicle screws were performed, without hemodynamic or neurological changes. A postoperative angiography demonstrated a complete recovery of the vessel caliber, without contrast leaks. RESULTS: After a 2-year follow-up, the patient was pain free and the CT scan revealed bone fusion. CONCLUSIONS: The vascular structures involved in severe thoracolumbar fractures present a dangerous situation that should be considered in the choice of the surgical approach. The posterior approach alone may be a good option in the absence of vascular damage. However, due to risk of vessel rupture during the fracture reduction, vascular surgeons must take part in the surgery. LEVEL OF EVIDENCE: 5. CLINICAL RELEVANCE: The article provides help for surgeons who have to treat severe fractures in the context of ankylosing spondylitis.

Spontaneus involution of meningioma. Case report and literature review. / Involución espontánea de meningioma. Caso clínico y revisión de la literatura.

Meningiomas are tumors of the cerebral meninges, with slow growth and usually benign, whose treatment is essentially surgery. They have progesterone receptors, and to a lesser extent estrogen, which sometimes causes them to have growth or involution linked to hormonal treatment. Its spontaneous involution is extremely rare. We present the case of a male with a meningioma of the sphenoid planum. He had a history of diabetes mellitus, myasthenia gravis and prostate cancer. He was in treatment with analogs of GnRH (leuprorelin), antiandrogen (bicalutamide), ß3 agonists and α1 blockers. 15 months after the hormonal blockade, a reduction of the tumor of approximately 90% of its volume was detected. Previous reports show that treatment with gonadotropin analogues produces growth in some meningiomas. Other reports of spontaneous involution affect diabetic patients and patients in treatment with α1 blockers. Literature focus on meningiomas with spontaneous involution is reviewed.

Situación actual del uso de redes sociales en Neurocirugía en España / Current use of Social Media in Neurosurgery in Spain

Objetivo: Analizar la situación actual en España del uso de redes sociales en Neurocirugía. Materiales y métodos: Se realiza un estudio transversal y observacional entre febrero y marzo de 2017, mediante una búsqueda estructurada de las cuentas en Twitter, Facebook y YouTube de los servicios y unidades de Neurocirugía, sociedades científicas, publicaciones y asociaciones de pacientes relacionadas con la Neurocirugía. Se clasificaron según su popularidad. Resultados: Según nuestro estudio solo 5 servicios de Neurocirugía de la red pública tienen presencia en redes sociales, siendo inferior su popularidad a la de las unidades privadas. Las sociedades científicas y revistas neuroquirúrgicas tienen una presencia marginal, más aún en comparación con las de otras especialidades médicas. La popularidad de las asociaciones y grupos de apoyo es alta, sobre todo entre los pacientes, encontrándose mayor información sobre enfermedades que en las cuentas corporativas. Conclusiones: El uso en España de las redes sociales en Neurocirugía es bajo, en comparación con otras especialidades médicas. Existe un amplio campo de actuación para mejorar la popularidad de las cuentas, la difusión de la sociedad científica y la revista Neurocirugía y realizar funciones de promoción de la salud

Objective: To analyze the current situation in Spain of the use of Social Media in Neurosurgery. Materials and methods: We made an observational transversal study between February and March 2017, with a systematic search of the Facebook, Twitter and Youtube accounts from public and private neurosurgical units, scientific societies, peer-reviewed publications and patients groups in relation with Neurosurgical pathologies. We rank them according their popularity. Results: According of our search only 5 public neurosurgical services have social media accounts, being their popularity inferior to the private units accounts. In relation with the scientific societies and neurosurgical publications their presence in social media is marginal, even more in comparison to the accounts of other medical specialities. The popularity of associations of patients and supporting groups is high, especially among patients, finding there more information about their disease. Conclusions: The use in Spain of Social Media about Neurosurgery is low in comparison to other medical specialities. There is a huge field to improve the popularity of the accounts, making in them promotion of health and extend the diffusion of the scientific society and the peer-reviewed publication Neurocirugía

Current use of Social Media in Neurosurgery in Spain. / Situación actual del uso de redes sociales en Neurocirugía en España.

OBJECTIVE: To analyze the current situation in Spain of the use of Social Media in Neurosurgery. MATERIALS AND METHODS: We made an observational transversal study between February and March 2017, with a systematic search of the Facebook, Twitter and Youtube accounts from public and private neurosurgical units, scientific societies, peer-reviewed publications and patients groups in relation with Neurosurgical pathologies. We rank them according their popularity. RESULTS: According of our search only 5 public neurosurgical services have social media accounts, being their popularity inferior to the private units accounts. In relation with the scientific societies and neurosurgical publications their presence in social media is marginal, even more in comparison to the accounts of other medical specialities. The popularity of associations of patients and supporting groups is high, especially among patients, finding there more information about their disease. CONCLUSIONS: The use in Spain of Social Media about Neurosurgery is low in comparison to other medical specialities. There is a huge field to improve the popularity of the accounts, making in them promotion of health and extend the diffusion of the scientific society and the peer-reviewed publication Neurocirugía.

Neuralgia del trigémino secundaria a endostosis del hueso temporal / Trigeminal neuralgia secondary to petrous endostosis

La compresión neurovascular de origen arterial se postula como principal mecanismo de producción de la neuralgia primaria del trigémino. A pesar de ser la causa más frecuente, existen otras patologías, como los tumores localizados en el ángulo pontocerebeloso, capaces de producir dolor trigeminal. Presentamos el caso de una paciente de 44años con neuralgia del trigémino derecha sin respuesta al tratamiento médico. La RM cerebral previa no muestra signos de patología estructural. Durante la descompresión microvascular del nervio trigémino se encuentra endostosis de la cara interna del peñasco que provocaba compresión del V par. Tras el fresado completo y la descompresión microvascular desaparece de manera completa el dolor en el postoperatorio inmediato, manteniendo asintomática al año de la cirugía. La endostosis del hueso temporal es una causa muy infrecuente de neuralgia del trigémino. Una adecuada revisión de los estudios preoperatorios permitiría la optimización del manejo quirúrgico definitivo

Arterial neurovascular compression is hypothesised to be the main cause of primary trigeminal neuralgia. Although it is the most common cause, other pathologies, such as tumours in the cerebellopontine angle, can cause trigeminal pain. We report a case of a 44-year-old female patient with right trigeminal neuralgia without satisfactory response to medical treatment. Cerebral MRI showed no structural injuries. During microvascular decompression of the trigeminal nerve, endostosis of the internal aspect of the petrous bone was found to compress the trigeminal nerve. The pain disappeared completely in the early postsurgical period, after the complete drilling of the endostosis and microvascular decompression. The patient remains asymptomatic one year later. Endostosis of the petrous bone is a rare cause of trigeminal neuralgia. A proper review of preoperative studies would enable the definitive surgical approach to be optimised

Treatment of chronic traumatic C7-T1 grade III spondylolisthesis with mild neurological deficit: case report.

Traumatic cervical severe spondylolisthesis is a rare and severe lesion which is typically associated with a spinal cord injury. Nevertheless, it occasionally has a pauci-symptomatic course which may delay its diagnosis. The authors report an exceptional case of a 33-year-old woman who had mild spasticity in her lower limbs and neck pain 9 months after a traffic accident. The computed tomographic scan and magnetic resonance image revealed C7-T1 grade III spondylolisthesis and spinal cord signal change. The initial cervical traction did not obtain a spinal realignment. An anterior-posterior approach was performed to achieve a correct spinal fusion. After 18 months of follow-up care, the patient's symptoms improved significantly and she began to lead a normal life again. The case underlines the importance of performing a correct initial diagnostic workup upon a patient. This would improve surgical management by avoiding a worsening of the initial neurological deficit during the realignment maneuvers in the chronic grade III, IV or V spondylolisthesis.

[Trigeminal neuralgia secondary to petrous endostosis]. / Neuralgia del trigémino secundaria a endostosis del hueso temporal.

Arterial neurovascular compression is hypothesised to be the main cause of primary trigeminal neuralgia. Although it is the most common cause, other pathologies, such as tumours in the cerebellopontine angle, can cause trigeminal pain. We report a case of a 44-year-old female patient with right trigeminal neuralgia without satisfactory response to medical treatment. Cerebral MRI showed no structural injuries. During microvascular decompression of the trigeminal nerve, endostosis of the internal aspect of the petrous bone was found to compress the trigeminal nerve. The pain disappeared completely in the early postsurgical period, after the complete drilling of the endostosis and microvascular decompression. The patient remains asymptomatic one year later. Endostosis of the petrous bone is a rare cause of trigeminal neuralgia. A proper review of preoperative studies would enable the definitive surgical approach to be optimised.

Fluorescence-guided resection with 5-aminolevulinic acid of meningeal sarcoma in a child.

BACKGROUND: The usefulness of fluorescence-guided resection with 5-aminolevulinic acid for malignant brain gliomas was demonstrated by Stummer. However, there are several articles in the literature showing the usefulness of the technique for other types of tumors, including benign tumors, such as ependymomas or meningiomas. Meningeal sarcomas are rare, highly aggressive malignant tumors, predominately affecting the pediatric population and have a poor prognosis in spite of treatment. Surgical treatment thereof should consist of the most complete resection possible. METHODS: In this article, we present the case of a seven-year-old boy who received surgical treatment for a left frontal tumor after oral administration of 5-aminolevulinic acid (5-ALA); the definitive histological diagnosis of which was meningeal sarcoma. The technique was useful for achieving a complete resection, as the lesion emitted intense fluorescence, and after resection of the lesion with the usual technique, intraoperative fluorescent spots were observed in the resection bed that were also tumor. Imaging tests performed 5 years after surgery ruled out recurrence of the tumor. CONCLUSION: To our knowledge, this is the first case published in the literature of meningeal sarcoma in a child in which intraoperative fluorescence with 5-ALA was used to achieve a complete resection.

Tumor elusivo dorsal. Presentación de un caso excepcional y revisión de la bibliografía / Elusive thoracic spine tumour. Report of an exceptional case and literature review

Los tumores elusivos espinales han sido descritos en la literatura científica previamente. En la mayoría de los casos se trata de neurinomas de la cauda equina. Presentamos el caso de una mujer cuyo diagnóstico radiológico de presunción es el de neurinoma a nivel D10.Se decide extirpación microquirúrgica de la lesión, y tras la laminectomía, correctamente emplazada, no se encuentra el tumor. El reporte de tumores espinales intradurales extramedulares con desplazamiento en el espacio subaracnoideo es muy infrecuente, siendo a nivel dorsal excepcional. Es difícil predecir los casos en los que este extraño fenómeno pueda darse, pero parecen una constante los cambios en la clínica del paciente según la posición, el pequeño tamaño de la lesión y la escasa adherencia a estructuras vecinas. El neurocirujano debe disponer de los recursos necesarios para solventar una exploración en blanco tras la laminectomía, llegado el caso

Elusive tumours in the spine, most of them schwannomas of the cauda equina, have been reported very rarely. We present the case of a woman with a preoperative radiological diagnosis of schwannoma at D10 level in whom a laminectomy was performed to remove the tumour. Although the laminectomy was correctly positioned, there was no tumour upon opening the dura and the laminectomy had to be extended cephalad to find and remove the tumour. Mobile intradural extramedullary spinal tumours, the so-called «elusive tumours», occur very rarely, and it is exceptional when they are located in the thoracic spine. Knowing preoperatively which tumour is going to behave in this way is almost impossible. However, in the reported cases there are common features such as symptoms changing with different body positions, small tumour size and weak attachment to nearby structures. Neurosurgeons must be able to resolve this situation when confronted with a negative correctly-positioned laminectomy

[Elusive thoracic spine tumour. Report of an exceptional case and literature review]. / Tumor elusivo dorsal. Presentación de un caso excepcional y revisión de la bibliografía.

Elusive tumours in the spine, most of them schwannomas of the cauda equina, have been reported very rarely. We present the case of a woman with a preoperative radiological diagnosis of schwannoma at D10 level in whom a laminectomy was performed to remove the tumour. Although the laminectomy was correctly positioned, there was no tumour upon opening the dura and the laminectomy had to be extended cephalad to find and remove the tumour. Mobile intradural extramedullary spinal tumours, the so-called «elusive tumours¼, occur very rarely, and it is exceptional when they are located in the thoracic spine. Knowing preoperatively which tumour is going to behave in this way is almost impossible. However, in the reported cases there are common features such as symptoms changing with different body positions, small tumour size and weak attachment to nearby structures. Neurosurgeons must be able to resolve this situation when confronted with a negative correctly-positioned laminectomy.