Hematoma crónico expansivo intracerebral / Chronic expanding intracerebral hematoma

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[The usefulness of electromyographical monitoring with intraoperative brain mapping during motor lesionectomy]. / Utilidad de la monitorización electromiográfica durante la estimulación eléctrica cortical intraoperatoria en áreas motoras.

INTRODUCTION: Surgery for resection of supratentorial lesions near the motor areas and/or internal capsule carries an associated risk of damage to cortical or subcortical motor pathways. Intraoperative brain mapping, using direct cortical electric stimulation, is a surgical adjunct used during lesionectomy in functional cortex. The technique of observing movements elicited by electrical stimulation has proved useful for intraoperative localization of motor pathways but it is difficult observe the entire body at once. Thus, a small movement may be missed while attention is focused on another site. AIM: To determinate the usefulness of electromyographical monitoring in locating motor pathways during neurosurgery in functional cortex. PATIENTS AND METHODS: We recorded multichannel electromyography activity during cortical and subcortical electric stimulation in a consecutive series of 40 patients undergoing craniotomies for lesionectomy near motor cortex or subcortical motor tracts. Because the aim of the electromyography recordings was to sample as many muscles as possible, the two electrodes connected to each different amplifier input were placed in different muscles in the same region of the body. RESULTS: No motor responses were detected by either electromyographical monitoring or visual inspection in 20% patients. Electromyographical activity was the only indication of motor response in 17%. Motor responses were detected simultaneously by either electromyographical monitoring and visual inspection in 76%. CONCLUSIONS: Electromyography monitoring enhances the ability to detect the location of primary motor cortex and subcortical pathways with electrical stimulation during neurosurgery.

Utilidad de la monitorización electromiográfica durante la estimulación eléctrica cortical intraoperatoria en áreas motoras / The usefulness of electromyographical monitoring with intraoperative brain mapping during motor lesionectomy

Introducción. La resección de lesiones adyacentes a áreas sensitivomotoras conlleva el riesgo de lesionar las vías motoras corticosubcorticales. La realización de un mapa funcional de la corteza expuesta en la craneotomía mediante estimulación eléctrica cortical mejora notablemente los índices de resecabilidad lesional y reduce los riesgos de morbimortalidad. La valoración de la respuesta tras el estímulo consiste en detectar un movimiento o una contracción muscular en el paciente. En algunas ocasiones, debido a la posición del paciente, la iluminación o por tratarse de una contracción mínima, esta respuesta puede pasar desapercibida. Objetivo. Determinar la utilidad de la monitorización electromiográfica simultánea a la estimulación eléctrica corticosubcortical como ayuda a la localización de áreas motoras. Pacientes y métodos. Se registra la actividad electromiográfica simultánea en múltiples grupos musculares durante la estimulación eléctrica cortical y subcortical con electrodos de superficie en una serie consecutiva de 40 pacientes sometidos a craneotomías para resección de lesiones cercanas a áreas funcionales motoras. Al pretender monitorizar el mayor número posible de músculos, cada electrodo (activo e indiferente) se coloca en dos músculos adyacentes en la misma región del cuerpo por cada amplificador. Resultados. No se objetivaron respuestas motoras clínicas ni electromiográficas en el 20% de los pacientes. Se detectó sólo respuesta electromiográfica en el 17% de los pacientes. La respuesta motora clínica y electromiográfica fue simultánea en el 76% de los pacientes. Conclusiones. La utilización de monitorización electromiográfica durante el mapeo cortical con estimulación eléctrica facilita la localización de la corteza motora primaria y las vías motoras subcorticales (AU)

Associated risk of damage to cortical or subcortical motor pathways. Intraoperative brain mapping, using direct cortical electric stimulation, is a surgical adjunct used during lesionectomy in functional cortex. The technique of observing movements elicited by electrical stimulation has proved useful for intraoperative localization of motor pathways but it is difficult observe the entire body at onces. Thus, a small movement may be missed while attention is focused on another site. Aim. To determinate the usefulness of electromyographical monitoring in locating motor pathways during neurosurgery in functional cortex. Patients and methods. We recorded multichannel electromyography activity during cortical and subcortical electric stimulation in a consecutive series of 40 patients undergoing craniotomies for lesionectomy near motor cortex or subcortical motor tracts. Because the aim of the electromyography recordings was to sample as many muscles as possible, the two electrodes connected to each different amplifier input were placed in different muscles in the same region of the body. Results. No motor responses were detected by either electromyographical monitoring or visual inspection in 20% patients. Electromyographical activity was the only indication of motor response in 17%. Motor responses were detected simultaneously by either electromyographical monitoring and visual inspection in 76%. Conclusions. Electromyography monitoring enhances the ability to detect the location of primary motor cortex and subcortical pathways with electrical stimulation during neurosurgery (AU)

Malformaciones arteriovenosas en la infancia: a propósito de cuatro casos / Arteriovenous malformations in children: a report of four cases

Introducción y objetivo. Las malformaciones vascularesson la causa más corriente de hemorragia intracraneal (HI) notraumática tras la etapa neonatal. Las malformaciones arteriovenosas(MAV) son las malformaciones vasculares que con mayorfrecuencia causan síntomas en la infancia y la causa más habitualde HI en niños mayores de un año. Casos clínicos. Se revisaron lashistorias clínicas de todos los pacientes menores de 16 años quepresentaron un diagnóstico de MAV desde el año 2000 hasta laactualidad. Encontramos cuatro casos de edades comprendidasentre los 7 y los 15 años, todos ellos estudiados con tomografíacomputarizada y/o resonancia magnética y arteriografía cerebrales.Un paciente comenzó con cefaleas y otro presentaba alteracionesdel aprendizaje. Los otros dos empezaron con HI. Las manifestacionesclínicas más frecuentes de ésta fueron la disminución delnivel de conciencia y los vómitos. La arteriografía estableció eldiagnóstico definitivo en todos los casos. Se realizó tratamientoquirúrgico en tres casos (mediante cirugía, embolización por catétery radiocirugía estereoatáxica con excelente evolución posterior.Conclusiones. La hemorragia espontánea constituye el iniciomás frecuente de las MAV, pero a veces existen manifestacionesprevias que constituyen un reto diagnóstico y que deberían resultarel objetivo de futuras investigaciones, pues evitar la HI significaríareducir drásticamente la morbimortalidad de las MAV

Introduction and aims. Vascular malformations are the most frequent cause of intracranial haemorrhage (IH) afterthe neonatal period that are not due to traumatic injury. Arteriovenous malformations (AVM) are the vascular malformationsthat most often give rise to symptoms in infancy and are the most common cause of IH in children over one year of age. Casereports. We reviewed the medical records of all patients under the age of 16 years diagnosed with AVM from the year 2000 tothe present. Four cases aged between 7 and 15 years were found, all of whom were examined with computerised tomographyand/or magnetic resonance imaging and cerebral arteriography scans. One patient started with headaches and another hadlearning disabilities. The other two began with IH, the most common clinical manifestations of which were a diminished levelof awareness and vomiting. The final diagnosis was established by means of arteriography in all cases. Surgical treatment wascarried out in three cases (using surgery, catheter embolisation and stereotaxic radiosurgery) and the patients’ progressfollowing the intervention was excellent. Conclusions. Spontaneous haemorrhage constitutes the most common presentingsymptom of AVM. However, there are sometimes earlier manifestations that are a challenge to diagnosis and which should bethe target of future research, since preventing IH would lead to a drastic reduction in the morbidity and mortality rate of AVM

[Arteriovenous malformations in children: a report of four cases]. / Malformaciones arteriovenosas en la infancia: a proposito de cuatro casos.

INTRODUCTION AND AIMS: Vascular malformations are the most frequent cause of intracranial haemorrhage (IH) after the neonatal period that are not due to traumatic injury. Arteriovenous malformations (AVM) are the vascular malformations that most often give rise to symptoms in infancy and are the most common cause of IH in children over one year of age. CASE REPORTS: We reviewed the medical records of all patients under the age of 16 years diagnosed with AVM from the year 2000 to the present. Four cases aged between 7 and 15 years were found, all of whom were examined with computerised tomography and/or magnetic resonance imaging and cerebral arteriography scans. One patient started with headaches and another had learning disabilities. The other two began with IH, the most common clinical manifestations of which were a diminished level of awareness and vomiting. The final diagnosis was established by means of arteriography in all cases. Surgical treatment was carried out in three cases (using surgery, catheter embolisation and stereotaxic radiosurgery) and the patients' progress following the intervention was excellent. CONCLUSIONS: Spontaneous haemorrhage constitutes the most common presenting symptom of AVM. However, there are sometimes earlier manifestations that are a challenge to diagnosis and which should be the target of future research, since preventing IH would lead to a drastic reduction in the morbidity and mortality rate of AVM.

[Aneurysmal bone cyst of the sphenoid sinus]. / Quiste óseo aneurismático del seno esfenoidal. A propósito de un caso

Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysplasia and giant-cell tumors. We report the case of a patient with an aneurysmal bone cyst in the sphenoid sinus causing vision dysfunction.

Quiste óseo aneurismático del seno esfenoidal. A propósito de un caso / Aneurysmal bone cyst of the sphenoid sinus

El quiste óseo aneurismático es una patología infrecuente que asienta generalmente en las metáfisis de huesos largos y vértebras. La afectación del seno esfenoidal es excepcional. Su origen se encuentra aún por definir, pero podemos considerarlos como un fenómeno vascular secundario a una lesión del hueso subyacente. Puede asociarse a otras enfermedades, presentes de forma metacrónica o sincrónica en distintas localizaciones de un mismo sujeto, como la displasia fibrosa poliostótica o los tumores de células gigantes. En este artículo se expone el caso de un paciente que presenta un quiste óseo aneurismático en el seno esfenoidal y alteración de la visión

Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysplasia and giant-cell tumors. We report the case of a patient with an aneurysmal bone cyst in the sphenoid sinus causing vision dysfunction

Candida cerebrospinal fluid shunt infection. Report of two new cases and review of the literature.

In this case report, we describe two patients with Candida shunt infection and review 22 cases from the previous literature. All of them had ventriculoperitoneal shunts, except one who had an external ventricular drain. The more outstanding predisposing factors were recent bacterial meningitis and/or neurosurgery (different from the shunt placement) and abdominal complications (intestinal perforation in three cases, and gastrostomy and lengthening of the distal catheter in one each). The clinical manifestations were hydrocephalus in 36%, fever in 31%, meningoencephalitis in 21%, and abdominal symptoms in 10%. The mean cerebrospinal fluid count was 78 cells/mm3 (with 77% lymphocytic predominance). Two patients died (9%); one of them was the only case in which the catheter was not removed. The recommended treatment is the replacement of the shunt and antifungal therapy with intravenous amphotericin B; in cases of poor clinical condition, the latter should also be given intraventricularly.

Neonatal cavernous hemangioma of the dura mater: case report.

A case of dural cavernous hemangioma, diagnosed prenatally as an intracranial mass by ultrasonography and surgically treated after elective delivery, is presented. The clinical and pathological features of this unusual type of congenital vascular malformation are reported, and the relevant literature is reviewed.