Tratamiento del histiocitoma fibroso maligno vertebral, reporte de caso y revisión de la literatura / Treatment of spinal malignant fibrous histiocytoma, a case report and literature review

Objetivo: Presentar un caso de histiocitoma fibroso maligno vertebral a nivel de la cuarta vértebra lumbar que recibió tratamiento por una espondilectomía L4 y colocación de expansor intervertebral y fijación posterior. Caso clínico: Paciente masculino de 47 años de edad sin antecedentes de importancia, que presenta dolor lumbar de 2 meses de evolución. Se trata de forma conservadora, con una leve mejoría del dolor; sin embargo, persiste con dolor lumbar con irradiación a miembros pélvicos de predominio izquierdo, acompañado de debilidad y claudicación. Clínicamente presenta paraparesia 3/5 e hipoestesia L4, L5 y S1 de predominio izquierdo. La tomografía axial computarizada de la región lumbosacra evidencia una lesión osteolítica en cuerpo de L4 de predominio izquierdo con invasión a canal lumbar con márgenes poco delimitados. En el estudio de resonancia magnética de columna lumbosacra se observa lesión hiperintensa en T2, heterogénea, de bordes irregulares, que involucra más del 60% del cuerpo vertebral de L4 con invasión al canal raquídeo que ocasiona compresión a raíces. Se manejó con una espondilectomía L4 y la colocación de un expansor intervertebral y fijación posterior. Conclusión: La espondilectomía es una opción viable y efectiva para el tratamiento del histiocitoma fibroso maligno. La localización lumbar baja conlleva abordajes combinados; sin embargo, el desafío es mayor, ya que requiere de un conocimiento de los grandes vasos abdominales y de una intervención multidisciplinaria

Objective: To present a case of spinal malignant fibrous histiocytoma in the fourth lumbar vertebra that received treatment by an L4 spondylectomy and placement of intervertebral expander and posterior fixation. Case report: A 47-year-old male patient with no relevant history presented with lumbar pain of 2 months' evolution. Treated conservatively, with slight improvement in pain, the patient persisted with low back pain irradiation to pelvic members, predominantly left-sided, accompanied by weakness and claudication. Clinically, he presented with paresthesias 3/5, hypoaesthesia L4, L5 and S1, predominantly left-sided. Lumbosacral computerized axial tomography evidence of an osteolytic lesion in the L4 body, predominantly left-sided, with invasion of the lumbar canal with poorly delimited margins; lumbosacral spine MRI showed hyperintense lesion in T2, heterogeneous, with irregular borders involving more than 60% of the vertebral body of L4 with invasion of the spinal canal causing compression to the roots. He was treated with an L4 spondylectomy and placement of intervertebral expander and posterior fixation. Conclusion: Spondylectomy is an effective option for the treatment of spinal malignant fibrous histiocytoma that involves combined approaches. However the challenge is greater since it requires a knowledge of the great abdominal vessels and multidisciplinary intervention

Treatment of spinal malignant fibrous histiocytoma, a case report and literature review. / Tratamiento del histiocitoma fibroso maligno vertebral, reporte de caso y revisión de la literatura.

OBJECTIVE: To present a case of spinal malignant fibrous histiocytoma in the fourth lumbar vertebra that received treatment by an L4 spondylectomy and placement of intervertebral expander and posterior fixation. CASE REPORT: A 47-year-old male patient with no relevant history presented with lumbar pain of 2 months' evolution. Treated conservatively, with slight improvement in pain, the patient persisted with low back pain irradiation to pelvic members, predominantly left-sided, accompanied by weakness and claudication. Clinically, he presented with paresthesias 3/5, hypoaesthesia L4, L5 and S1, predominantly left-sided. Lumbosacral computerized axial tomography evidence of an osteolytic lesion in the L4 body, predominantly left-sided, with invasion of the lumbar canal with poorly delimited margins; lumbosacral spine MRI showed hyperintense lesion in T2, heterogeneous, with irregular borders involving more than 60% of the vertebral body of L4 with invasion of the spinal canal causing compression to the roots. He was treated with an L4 spondylectomy and placement of intervertebral expander and posterior fixation. CONCLUSION: Spondylectomy is an effective option for the treatment of spinal malignant fibrous histiocytoma that involves combined approaches. However the challenge is greater since it requires a knowledge of the great abdominal vessels and multidisciplinary intervention.

[Implementation of intraoperative neurophysiologic monitoring in children and adults in secondary and tertiary health care facilities]. / Implementación del monitoreo neurofisiológico intraoperatorio en niños y adultos en el segundo y tercer nivel de atención.

INTRODUCTION: Intraoperative neurophysiological monitoring (IONM) is a procedure that uses neurophysiological techniques in order to evaluate the motor and sensitive systems during surgeries that endanger the nervous system. METHOD: The approach, scope, target population, and clinical questions to be answered were defined. A systematic search of the evidence was conducted step by step; during the first stage, clinical practice guidelines were collected, during the second stage systematic reviews were obtained, and during the third stage, clinical trials and observational studies were procured. The MeSH nomenclature and free related terminology were used, with no language restrictions and a 5-10 years frame. The quality of the evidence was graded using the CEPD and SIGN scales. RESULTS: Obtained using the search algorrhythms of 892 documents. Fifty-eight were chosen to be included in the qualitative synthesis. A meta-analysis was not possible due to the heterogeneity of the studies. CONCLUSIONS: Eighteen recommendations were issued and will support the adequate use of the IONM.

INTRODUCCIÓN: El monitoreo neurofisiológico intraoperatorio (MNIO) es un procedimiento que emplea técnicas neurofisiológicas con la finalidad de evaluar los sistemas motor y sensitivo durante cirugías que ponen en riesgo al sistema nervioso. MÉTODO: Se definieron el enfoque, los alcances, la población diana y las preguntas clínicas por resolver. Se realizó una búsqueda sistematizada de la evidencia por etapas. En la primera, se buscaron guías de práctica clínica; en la segunda, revisiones sistemáticas; y en la tercera, ensayos clínicos y estudios observacionales. Se utilizaron los términos MeSH y libres correspondientes, sin restricciones de lenguaje y con una temporalidad de 5 a 10 años. Se graduó la calidad de la evidencia utilizando las escalas CEPD y SIGN. RESULTADOS: Mediante los algoritmos de búsqueda se obtuvieron 892 documentos, y se seleccionaron 58 para la inclusión de la síntesis cualitativa. Debido a la heterogeneidad entre los estudios, no fue posible realizar metaanálisis. CONCLUSIONES: Se emitieron 18 recomendaciones, las cuales servirán como apoyo para la adecuada utilización del MNIO.

Intracranial arachnoid cyst.

BACKGROUND: Arachnoid cysts (ACs) contain a liquid similar to cerebrospinal fluid. Some communicate with the subarachnoid space and others do not. These cysts are reported to account for at least 1% of all intracranial mass lesions. Most patients present during the first two decades of life; however, presentation during adulthood is not uncommon. DISCUSSION: A literature review to identify studies relating to pathogenesis, epidemiology, genetics, presentation, radiology and treatment of ACs was conducted and indicated that symptoms depend on size and location. When ACs are symptomatic, they must be treated surgically. Surgical treatment of ACs can be accomplished by cystoperitoneal shunting or fenestration of the cyst either by craniotomy or endoscopic techniques. CONCLUSIONS: Currently, appropriate treatment is still controversial regarding which is the best technique. Expectative treatment should be considered in lower volume cysts and, even more, in asymptomatic patients diagnosed by other studies.