[Chordoid glioma of the III ventricle. Case report and revision of the literature]. / Glioma cordoide del III ventrículo. Nuevo caso y revisión de la literatura.

Chordoid glioma of the third ventricle is an infrequent brain tumour that was described for the first time by Brat et al. in 1998; since then, only 39 cases have been reported. We present a new case of chordoid glioma of the third ventricle in a 51-year-old-man that was treated with total surgical removal, with a good initial postoperative evolution. Sudden death, most likely due to a massive pulmonary embolism, occurred in the third postoperative day. We present the histological characteristics of the tumour and review the literature regarding this entity.

Hernias discales calcificadas en la infancia / Calcified disc herniation in childhood

Las calcificaciones de los discos intervertebrales son muy infrecuentes en la infancia. Aunque su etiologíano está clara, se sabe que no se relacionan con procesos degenerativos. Cursan con clínica inespecífica de raquialgias, contracturas musculares y, a veces, febrícula. Aunque ocasionalmente estos discos se hernian, causando dolor radicular o, mucho más raramente, déficits neurológicos o disfagia, la clínica desaparece en la mayor parte de los casos con tratamiento conservador, y sólo excepcionalmente se precisan tratamientos más agresivos. En nuestra revisión de la literatura hemos encontrado solamente17 casos que requirieron tratamiento quirúrgico. En dos de estos casos el paciente estaba previamente diagnosticado de calcificaciones intervertebrales idiopáticas, pero no se habían descartado hernias preexistentes mediante resonancia magnética (RM). Presentamos un nuevo caso de una paciente diagnosticada a la edad de 10 años decalcificaciones discales idiopáticas, sin hernias discales en la RM, en la que 4 años después uno de los discos cervicales calcificados se hernió presentando un cuadro de radiculopatía cervical con déficit motor, precisando discectomía y artrodesis intersomática. Consideramos que este caso prueba definitivamente la teoría de Heinrichy cols., que considera la hernia calcificada en la infancia como la complicación de una patología previa, la calcificación del disco intervertebral. Se discuten los aspectos clínicos y terapéuticos de esta entidad

Calcification of intervertebral discs is a rare occurrence in children. Although the etiology of the calcification remains uncertain, it is no related with degenerative diseases. The clinical picture is non specific with neck pain, muscle contractures and, sometimes, low-grade fever. These symptoms generally disappear spontaneously, and surgery rarely becomes necessary. In our review of the literature, we have found only seventeen cases requiring surgical management. Two of these children had been previously diagnosed with calcified intervertebral discs, but at the time no herniation had been ruled out with magnetic resonance imaging (MRI). We report the case of a girl who was diagnosed, when she was ten years old, with intervertebral idiopatic calcifications. Four years later she presented with radiculopathy caused by the posterolateral displacement of a calcified cervical disc, wich required operative management. We think that this case supports the theory of Heinrich et al. that considers that the calcified hernia is a complication of a previous pathology, namely intervertebral calcification. Clinical and therapeutic aspects of this entity are discussed

[Calcified disc herniation in childhood]. / Hernias discales calcificadas en la infancia.

Calcification of intervertebral discs is a rare occurrence in children. Although the etiology of the calcification remains uncertain, it is no related with degenerative diseases. The clinical picture is non specific with neck pain, muscle contractures and, sometimes, low-grade fever. These symptoms generally disappear spontaneously, and surgery rarely becomes necessary. In our review of the literature, we have found only seventeen cases requiring surgical management. Two of these children had been previously diagnosed with calcified intervertebral discs, but at the time no herniation had been ruled out with magnetic resonance imaging (MRI). We report the case of a girl who was diagnosed, when she was ten years old, with intervertebral idiopatic calcifications. Four years later she presented with radiculopathy caused by the posterolateral displacement of a calcified cervical disc, which required operative management. We think that this case supports the theory of Heinrich et al. that considers that the calcified hernia is a complication of a previous pathology, namely intervertebral calcification. Clinical and therapeutic aspects of this entity are discussed.

[Bilateral pure T11-T12 facet dislocation without neurologic residual deficit]. / Luxación pura de facetas articulares T11-T12 sin secuelas neurológicas. Caso clínico.

Bilateral pure facets dislocation in the thoracic spine is rare, but when it does occur in almost every instance produces a severe spinal cord lesion. It is thought to be caused by a flexion distraction mechanisms in most of the cases. A case is presented of a male suffered a polytrauma with important thoracic, abdominal, and esqueletic injuries in a car accident. The patient was in a hospital during two weeks, and one month after the trauma a bilateral pure dislocation of T11-T12 facets was diagnosed. Diagnosis was made with radiographs and CT with sagittal reconstruction. After an open reduction and fixation, recovery was complete within the first postoperative week. Facet dislocation in the thoracic spine is associated in many cases with thoracic and abdominal injuries that worsen the clinical picture, and thus it may contribute to misdiagnosis of the facet dislocation, specially in the cases with no neurological symptoms, adding a risk of secondary spinal cord damage. High-resolution CT with sagittal reconstruction provides an adequate and rapid demonstration of the luxation and associated thoraco-abdominal damages. Facet dislocation are unstable injuries that require open reduction and fixation. Recovery of patients with incomplete lesions is frequent, however, recovery from complete lesions did not occur.

[Radioguided neurosurgery: a novel application of nuclear medicine]. / Neurocirugía radiodirigida: una aplicación novedosa de la Medicina Nuclear.

Brain tumours show uptake with Thallium-201 Chloride with high target/background rate and they would benefit from radioguided surgery. We report a patient with a brain tumor that was Thallium positive in a brain SPECT. On the next day in the operating room we injected 50 MBq of Thallium-201. At 40 minutes we confirmed tumour uptake with a gamma-probe and with a biopsy sample. After brain tumor resection was completed by conventional method, we found pathologic activity in tumoral bed with the gamma probe, that showed persistence of increased activity. After a new evaluation, residual tumor tissue was located in the pathological uptake area and was removed. Control CT showed complete resection, although the Thallium SPECT carried out after surgery showed faint uptake in the anterior pole of the surgical bed. Radioguided surgery was evaluated as a useful and promising technique by the neurosurgeon.

[Pyogenic brain abscesses: experience with 60 consecutive cases]. / Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos.

INTRODUCTION: Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years. MATERIAL AND METHODS: The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome. RESULTS: The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22% of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of anaerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical, catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4 patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainage-aspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years. CONCLUSIONS: The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainage-aspiration should be used as the first mode of treatment.

Anterior cervical osteophyte causing dysphagia as a complication of laminectomy.

Asymptomatic osteophytes of the anterior margins of the cervical vertebral bodies (VB) may occur in 20 - 30% of the population. On rare occasions, dysphagia or dyspnoea may be caused by such cervical osteophytes. We present the case of a 27-year-old woman with progressive dysphagia caused by a voluminous osteophyte secondary to chronic cervical instability after a laminectomy performed 8 years before. Progressive growth of the osteophyte was observed in sequential roentgenograms. As far as we know, this complication of cervical laminectomy has never been reported before. After resection of the osteophyte and arthrodesis of the affected segment the patient was cured.

Brucellar spinal epidural abscesses. Analysis of eleven cases.

Brucellar spinal epidural abscesses (BSEA) are rare and very few series of them have been reported. In order to evaluate the clinical characteristics, management and outcome of this entity, the clinical records and current status of a series of 11 patients have been retrospectively reviewed. A series of 11 patients treated for BSEA in our Service during a period of 12 years (1989-2000) have been retrospectively studied. Spinal epidural abscesses (SEA) were diagnosed by MRI, CT or at surgery. Brucellar aetiology of SEA was considered when seroagglutination tests were positive at a titre of 1/160 or higher, and/or Brucella spp. were isolated in the blood or sample cultures. Ten of the 11 cases were treated with rifampicin plus doxycycline and in the remaining patient streptomycin was added because of a poor initial response. Six patients underwent surgical decompression and debridement of the SEA. Outcome was excellent in nine cases and good in two. There was no mortality and only one patient recovered incompletely from preadmission neurological deficits. Although BSEA is considered to be an unusual complication of spondylitis, our findings show that in some cases it can follow direct haematogenous spread to the extradural space. Surgical treatment must be undertaken when major neurological deficits are present. If antibiotic treatment is chosen as the initial therapy, the possibility of sudden neurological deterioration must be taken into account. Contrary to the high morbi-mortality rates reported in pyogenic or tuberculous SEA, BSEA has a good prognosis with early diagnosis and appropriate management.

[Contralateral extradural hematoma during evacuation of a previous one]. / Desarrollo introperatorio de un hematoma extradural contralateral a otro previo.

The development of an extradural hematoma during the evacuation of a traumatic extracerebral hematoma is a very rare event. It occurs in patients with a severe head injury that present with both an extraaxial hematoma and a contralateral skull fracture. Recognition of the significance of a sudden increase in the cerebral tension after hematoma evacuation is the key for a pront diagnosis of the development of a contralateral lesion. We present the case of a patient with a severe head trauma and an extradural hematoma who developed a contralateral extradural hematoma during evacuation of the initial one. The development of a contralateral lesion was suspected by a sudden and unexpected increase in cerebral tension during evacuation of the first hematoma and confirmed by emergency CT scan. We think that the most important pathogenetic mechanisms involved in the development of a contralateral extradural hematoma are the rapid fall of intracranial pressure, the loss of tamponade effect achieved by the energetic use of antiedema measures and the evacuation of the ipsilateral hematoma.

Desarrollo intraoperatorio de un hematoma extradural contralateral a otro previo / Contralateral extradural hematoma during evacuation of a previous one

El desarrollo de un hematoma extradural contralateral durante la evacuación de un hematoma extraaxial de origen traumático es un hecho muy infrecuente. Generalmente se produce en pacientes con traumatismo craneoencefálico (TCE) grave en el que se aprecia un hematoma extraaxial y una fractura craneal contralateral. El rápido aumento de la tensión cerebral en el área operada tras la evacuación del hematoma inicial debe hacer sospechar el diagnóstico. Presentamos el caso de un paciente con un TCE grave y un hematoma extradural durante cuya evacuación se produjo el desarrollo de un hematoma extradural contralateral. Su existencia fue sospechada debido al repentino aumento de la tensión cerebral durante la evacuación del primer hematoma y diagnosticado tras realización de tomografía computarizada craneal (TC) de emergencia. La disminución de la presión intracraneal y la pérdida del efecto tampón tras la evacuación del hematoma inicial, se consideran los mecanismos patogénicos fundamentales en el desarrollo del hematoma contralateral (AU)

[Anterior cervical interbody fusion with treathed cylindrical bone versus bak-cace: a comparative study]. / Estudio camparativo de la artrodesis cervical con injerto óseo roscado e implante de titanio.

The authors conducted a prospective and randomized study in 44 consecutive patients requiring cervical interbody fusion following anterior cervical discectomy to compare the efficacy of heterologous threaded cylindrical bone (Unilab Surgibone) versus titanium implant (Bak-C; Spine-Tech, Minneapolis ). The patients were evaluated between two and five years postoperatively and the objectives of the study were to assess the potential differences in implant shifting, interespace collapse, angulation, maintenance of cervical alignment and lordosis, and clinical and radiographic fusion success rates between the two fusion substrates. Clinical results were satisfactory with both types of implant. However the threaded cylindrical titanium implant was found to be superior to the heterologous threaded cylindrical bone as an interbody substrate after single -and multiple- level anterior cervical decompression procedures with respect to maintenance of cervical interspace height, interspace angulation and radiographic fusion success rates.

Candida albicans spondylodiscitis.

Candida spondylodiscitis is a rare complication of a haematogenous dissemination of a candida infection, that usually affects immunocompromised patients. We present a case of a Candida albicans spondylodiscitis in a patient in whom a bacterial origin was suspected because of the antecedent of a Staphylococcus aureus bacteriaemia. After unfavourable evolution with initial antibiotic treatment, the correct diagnosis was reached after culture of the material obtained from surgical debridement. The clinical, diagnostic features, and the literature are reviewed.

Estudio comparativo de la artrodesis cervical con injerto óseo roscado e implante de titanio / Anterior cervical interbody fusion with treathed cylindrical bone versus bak-cace: a comparative study

Presentamos los resultados de un estudio comparativo prospectivo que hemos llevado a cabo en 44 pacientes operados entre los años 1996 y 1997 que padecían de radiculopatía cervical o mielopatía compresiva por hernia discal o espondilosis. Todos los pacientes fueron intervenidos mediante abordaje cervical anterolateral y tras la discectomía se les practicó una artrodesis intersomática, bien con injerto óseo roscado heterólogo (Unilab Surgibone®) o bien con implante de titanio (BAK-CR®).Los pacientes fueron evaluados en el postoperatorio entre 2 y 5 años. El interés de nuestro estudio se centró en la valoración radiológica de ambos implantes. Se examinaron diversos parámetros como: desplazamientos del implante, altura intersomática, ángulo vertebral, valoración de la fusión, pseudoartrosis y efecto sobre niveles cervicales adyacentes.Los resultados clínicos fueron buenos para ambos tipos de implante. La valoración radiológica fue superior para el implante roscado de titanio (AU)

[Isolated oculomotor palsy. An unusual presentation of chronic subural hematoma]. / Parálisis completa del tercer par craneal como forma de presentación en hematoma subdural crónico.

Isolated oculomotor palsy is an unusual symptom in chronic subdural hematomas and it is very rare as initial manifestation. We report a patient with a chronic subdural hematoma that presented with a complete third nerve palsy and normal consciousness. Complete recovery was achieved after surgical evacuation. Rebleeding within the hematoma cavity, most possibly favored by antiaggregating agents, was considered responsible for this rare presentation. In these cases expeditious surgical evacuation is indicated.

Parálisis completa del tercer par craneal como forma de presentación en hematoma subdural crónico / Isolated oculomotor palsy. An unusual presentation of chronic subural hematoma

La parálisis aislada del nervio motor ocular común es un síntoma raro en los hematomas subdurales crónicos (HSDC) y excepcional si lo consideramos como forma de presentación. Comunicamos el caso de un paciente con HSDC que presentó como comienzo una parálisis completa del tercer par craneal, con nivel de conciencia conservado y recuperación completa de su déficit tras la intervención quirúrgica. Consideramos que el resangrado en el interior de la cavidad del hematoma, favorecido por la toma de antiagregantes plaquetarios, pudo provocar esta sintomatología de herniación uncal. En estos casos está indicada la intervención quirúrgica urgente. (AU)

Solitary eosinophilic granuloma of the cervicothoracic junction causing neurological deficit.

We report a case of spinal eosinophilic granuloma with aggressive course. Initially, a conservative management was decided upon, but neurological deterioration of the patient prompted us to undertake a more aggressive attitude, with surgical excision and postoperative radiotherapy. The clinical and radiological features, and the different options of treatment are discussed, and the literature is reviewed.

[Rapid spontaneous resolution of acute subdural hematoma]. / Resolución precoz espontánea de hematoma subdural agudo intracraneal.

Acute subdural hematomas are usually neurosurgical emergencies, although a conservative therapy is indicated in selected cases. In some of these patients a progressive resolution is appreciated. However, rapid spontaneous resolution of an acute suddural hematoma is seldom reported. A patient with antecedent of chronic alcoholism and spontaneous resolution of acute subdural hematoma in less than 18 hours after the head injury is described. The possible mechanisms of this rapid resolution are discussed. A tear in the arachnoid with spilling of CSF into the subdural space and the effect of intracranial antihypertensive measures together with cerebral atrophy, are factors that possibly contribute to dilution and redistribution of blood with hematoma disappearing in CT scan.

Delayed pneumocephalus in shunted patients. Report of three cases and review of the literature.

Delayed pneumocephalus is a very rare complication of CSF shunt systems with only 37 cases so far reported. We report three additional cases with different mechanisms of production, clinical presentations and managements. While the first patient was treated with closure of the site of air entrance and shunt externalization, in the second case, modification of the shunt was enough to solve the pneumocephalus, even when a skull base fistula was suspected. The third one died during treatment from complications. The literature is reviewed with respect to the aetiology, clinical presentation, radiological findings and management of this problem.

Cord compression secondary to cervical disc herniation associated with calcification of the ligamentum flavum: case report.

OBJECTIVE AND IMPORTANCE: Calcification of the ligamentum flavum is a rare disease that occurs almost exclusively in elderly Japanese people. We report the case of a young Caucasian woman who presented with a C5-C6 disc herniation associated with a cervical calcified ligamentum flavum. CLINICAL PRESENTATION: The patient presented with a cord compression syndrome of 76 hours' evolution. At exploration, a Brown-Sequard syndrome at the C6 level was found. Magnetic resonance imaging and computed tomography led to a correct diagnosis and planning for decompression. INTERVENTION: We operated on the patient through a combined anterior and posterior approach. After the patient underwent anterior discectomy with intersomatic arthrodesis, we performed posterior decompression. During the operation, we observed that the dura mater could not be separated from the ligamentum, so an en bloc excision of both structures was performed. Microscopic examination indicated that the excised ligamentum had calcification, and total integration of the dura mater into the structure of the ligamentum was demonstrated. To our knowledge, this circumstance has never been described before. A posterior C3-C7 arthrodesis was performed to prevent postoperative kyphosis. Recovery was successful, with total recovery from neurological deficits 4 months later. CONCLUSION: Calcification of the ligamentum flavum is a progressive disease that starts early in life and becomes symptomatic later in life when spinal stenosis occurs. Magnetic resonance imaging and computed tomography provide adequate diagnosis and allow proper surgical planning for decompression. The presence of hyperintense areas within the spinal cord parenchyma, in the absence of a traumatic antecedent, does not preclude a complete recovery.