[Cauda equina syndrome caused by paraganglioma of the filum terminale]. / Paraganglioma del filum terminal como causa de síndrome de cauda equina.

Paragangliomas are neuroendocrine tumors that originate from cells migrating from the neural crest. They have a diverse localizations, and are common in the head, neck, mediastinum or retroperitoneum. Their growth in the filum terminale region is very infrequent. We report the case of a patient who suffered an acute cauda equina syndrome. We give a detailed description of the diagnostic process, radiological characteristics, treatment and the macro and microscopic properties of this tumor.

Paraganglioma del filum terminal como causa de síndrome de cauda equina / Cauda equina syndrome caused by paraganglioma of the filum terminale

Los paragangliomas son tumores neuroendocrinos originados a partir de células que migran de la cresta neural. Su localización es diversa, siendo frecuentes encabeza, cuello, mediastino o retroperitoneo. Su crecimiento en la región del filum terminal es muy poco frecuente. Presentamos el caso de una paciente que debuta con un cuadro agudo de cauda equina. Describimos en detalle el proceso diagnóstico, las características radiológicas, el tratamiento y las propiedades macro y microscópicas de este tumor (AU)

Paragangliomas are neuroendocrine tumors that originate from cells migrating from the neural crest. They have a diverse localizations, and are common in the head, neck, mediastinum or retroperitoneum. Their growth in the filum terminale region is very infrequent. We report the case of a patient who suffered an acute cauda equina syndrome. We give a detailed description of the diagnostic process, radiological characteristics, treatment and the macro and microscopic properties of this tumor (AU)

[Results of C1-C2 transarticular screw fixation in a series of 20 patients]. / Resultados de la fijación transarticular C1-C2 en una serie de 20 pacientes.

OBJECTIVE: C1-C2 transarticular fixation is an increasingly used surgical method of treating atlantoaxial instability. When properly performed, it can safely provide fusion rates near 100%, but techniques of fixation in this region allow only a small margin of error. We here report the results of C1-C2 transarticular fixation in a series of 20 patients in which different procedures were selected according to the presenting disorder in each case. METHODS: The study group included 9 men and 11 women with a mean age of 48 years (range 17 to 68 years). The causes of instabilities were rheumatoid arthritis in nine patients, type II and III Hangman's fracture of traumatic origin in nine (in association with other lesions in three cases), pseudoarthrosis after type II odontoid fracture in one, and type III complex C1 fracture in a patient with ankylosing spondylitis. Preoperative assessment included flexion and extension plain radiographs and computed tomography (CT) and magnetic resonance imaging (MRI) scans. Operations included transarticular screw fixation in all cases; in patients with rheumatoid arthritis it was associated with sublaminar fixation and bone grafting following Sonntag's technique in all but two cases. Postoperative results were evaluated in relation to the biomechanical stability and fusion was studied by flexion and extension radiographs and CT scans. Pain relief in patients with rheumatoid arthritis patients was assessed using a 0-10 visual analogic scale (V.A.S.). RESULTS: In the traumatic group, a consolidation of the fracture and radiologic stability was achieved in all cases. In patients with rheumatoid arthritis, pain improved in all but not the neurological deficit, and in all cases a C1-C2 biomechanical stability was reached despite interlaminar graft resorption in two (25%) cases. With respect to complications, a lesion of the vertebral artery occurred in one case, deviation of the screw in two cases, and breakage of the screw without clinical repercussion in two other cases. CONCLUSION: C1-C2 transarticular screw fixation was a useful technique to achieve satisfacory biomechanical stability in patients with atlatoaxial instability of both inflammatory and traumatic origin with a low rate of complications.

Resultados de la fijación transarticular C1-C2 en una serie de 20 pacientes / Results of C1-C2 transarticular screw fixation in a series of 20 patients

Objetivo: La fijación transarticular C1-C2 es un procedimiento quirúrgico progresivamente más utilizado para el tratamiento de la inestabilidad de la columna cervical alta. Cuando dicha técnica se efectúa correctamente, es un procedimiento seguro que proporciona tasas de fusión cercanas al 100 por ciento, pero la fijación en esta región permite un escaso margen de error. Presentamos los resultados de la fijación transarticular C1-C2 en una serie de 20 pacientes en los que se seleccionaron diferentes técnicas según la causa de la inestabilidad cervical.Métodos: Se estudiaron a 9 varones y 11 mujeres con una media de edad de 48 años (rango 17 a 68 años). Las causas de la inestabilidad cervical fueron artritis reumatoide en nueve pacientes, fracturas tipo 11 y 111 de Hangman de origen traumático en nueve (con otras lesiones en tres casos), seudoartrosis tras fractura odontoide tipo 11 en un caso y fractura compleja tipo 111 de C1 en un paciente con espondilitis anquilopoyética. La evaluación preoperatoria incluyó radiografías cervicales en flexión y extensión, así como tomografía axial computadorizada (TAC) y resonancia magnética nuclear. En todos los casos se efectuó una fijación transarticular con tornillos (asociada a fijación sublaminar e injerto óseo según la técnica de Sonntag en siete de los nueve pacientes con artritis reumatoide). En el postoperatorio se evaluaron la estabilidad biomecánica y la fusión (por las radiografías cervicales y el TAC). Se utilizó una escala analógica visual (E.V.A.) de 0 a 10 para valorar la mejoría del dolor en el grupo con artritis reumatoide.Resultados: En todas las luxaciones traumáticas, se logró la consolidación de la fractura y la estabilidad radiológica. Todos los pacientes con artritis reumatoide experimentaron mejoría de dolor y en todos los casos se logró la estabilidad biomecánica C1-C2 a pesar de la reabsorción del injerto interlaminar en dos pacientes (25 por ciento). Con respecto a las complicaciones, hubo un caso de lesión de la arteria vertebral, desviación del tornillo Neurocirugía 2002; 13:429-436 en dos casos y rotura del tornillo sin repercusión clínica en otros dos casos.Conclusión: La fijación transarticular CI-C2 fue una técnica útil para lograr la estabilidad biomecánica en pacientes con inestabilidad de la columna cervical superior de origen traumático e inflamatorio, con un bajo porcentaje de complicaciones (AU)

Abnormal local-circuit neurons in epilepsia partialis continua associated with focal cortical dysplasia.

A limited cortical resection including the rolandic fissure and the pre- and postcentral cortical regions was carried out in a patient suffering from epilepsia partialis continua resistant to antiepileptic drugs. The histological examination revealed several foci of very large neurons distributed with no laminar organization in the depth of the rolandic fissure and in the crown of the primary motor and primary somatosensory areas; these lesions were consistent with focal cortical dysplasia. In addition, decreased numbers of neurons, astrocytosis and proliferation of capillaries, compatible with chronic tissue necrosis, were found in the inferior regions of the banks of the rolandic fissure. Subpopulations of local-circuit neurons were examined with parvalbumin, calbindin D-28k and somatostatin immunocytochemistry. Focal areas of cortical dysplasia contained abnormal immunoreactive neurons. Huge parvalbumin-immunoreactive cells were distributed at random and resembled axo-axonic (chandelier) and basket neurons. Abnormal calbindin D-28k-immunoreactive cells were reminiscent of double-bouquet neurons and multipolar cells. Very large somatostatin-immunoreactive cells were seldom observed in the dysplastic foci. On the other hand, areas of tissue necrosis displayed massive reduction of immunoreactive cells and fibers. Abnormalities in the morphology and distribution of local-circuit (inhibitory) neurons observed here for the first time in focal cortical dysplasia may have a pivotal role in the appearance and prolongation of electrical discharges and continuous motor signs in human focal epilepsy.

Cavernous angiomas of the cranial nerves. Report of two cases.

Two cavernous hemangiomas arising in the third and eighth cranial nerves, respectively, and presenting as space-occupying lesions are reported. The tumors posed problems in the preoperative differential diagnosis. The main clinicopathological features of these tumors are discussed.