[Osseous orbitotomies using a coronal flap: a retrospective study of 87 intraorbital lesions]. / Orbitotomías óseas mediante abordaje coronal: estudio retrospectivo de 87 lesiones intraorbitarias.

OBJECTIVE: To present our experience in 80 patients with intraorbital tumours and lesions who underwent 87 osseous orbitotomies with coronal incision during a 12 year period. MATERIAL, METHODS AND RESULTS: Hemangioma was the most frequent histologic diagnosis, being the intraconical retrobulbar compartment the most common location. Bilateral presentation of lesions occurred in 7 patients. Lateral and supero-lateral orbitotomies were preferably applied (87.35%). In 90.80% of cases some kind of osteosynthesis was employed, 51.75% with bio-resorbable plates. Intraoperative exposure or dura mater breakage occurred in 10 patients. 45 transitory and 21 permanent postoperative complications were seen, being the nervous ones (diplopia and ptosis) the most frequent. Most of these were spontaneously solved in a short time period. 15 patients required multi-disciplinary collaboration with neurosurgery. CONCLUSIONS: Coronal incision allows any bone orbitotomy, with security, guarantee and good aesthetic and functional results. Lateral and supero-lateral orbitotomies provide an ideal extradural approach to the retrobulbar compartment. An approach to the apex, orbital channel and medial compartment to the optic nerve, usually requires a combined neurosurgical approach through anterior cranial fossa. Orbitotomy fixation with bio-resorbable ostheosynthesis is an alternative to titanium plates. They can even be a first choice in paediatric age. The morbidity of this surgical technique is low.

Orbitotomías óseas mediante abordaje coronal: estudio retrospectivo de 87 lesiones intraorbitarias / Osseous orbitotomies using a coronal flap: A retrospective study of 87 intraorbital lesions

Objetivo. Presentar nuestra experiencia en 80 pacientes con tumores y lesiones intraorbitarias en los que se realizaron 87 orbitotomías óseas mediante abordaje coronal, durante un período de 12 años. Material, métodos y resultados. El diagnóstico histológico más frecuente fue el hemangioma, y la localización anatómica más frecuente la retrobulbar intracónica. La presentación bilateral de lesiones ocurrió en 7 pacientes. Las orbitotomías más utilizadas fueron la lateral y supero-lateral (87,35%). En un 90,80% de los casos se realizó algún tipo de osteosíntesis, un 51,75% con placas bio-reabsorbibles. La exposición o rotura de la duramadre intraoperatoria ocurrió en 10 pacientes. Se recogieron 45 complicaciones postoperatorias transitorias y 21 permanentes, las más frecuentes fueron las nerviosas (diplopia y ptosis) que se resolvieron espontáneamente en su mayoría en un corto intervalo de tiempo. En 15 pacientes se requirió colaboración multidisciplinar con neurocirugía.Conclusiones. La incisión coronal permite realizarcualquier orbitotomía ósea con seguridad, garantía ybuen resultado estético y funcional. Las orbitotomíaslateral y supero-lateral proporcionan un abordaje idealextradural al espacio retrobulbar. El acceso al ápex,canal orbitario y zona medial nervio óptico requierecomúnmente un abordaje combinado neuroquirúrgicoa través de fosa craneal anterior. La fijación de las orbitotomías mediante osteosíntesis biorreabsorbible constituye una alternativa a las placas de titanio, incluso puede ser de primera elección en la edad pediátrica. La morbilidad de esta cirugía es baja

Objective. To present our experience in 80 patients with intraorbital tumours and lesions who underwent87 osseous orbitotomies with coronal incision during a12 year period.Material, methods and results. Hemangioma wasthe most frequent histologic diagnosis, being the intraconical retrobulbar compartment the most commonlocation. Bilateral presentation of lesions occurred in 7patients. Lateral and supero-lateral orbitotomies werepreferably applied (87.35%). In 90.80% of cases somekind of osteosynthesis was employed, 51.75% withbio-resorbable plates. Intraoperative exposure or duramater breakage occurred in 10 patients. 45 transitoryand 21 permanent postoperative complications wereseen, being the nervous ones (diplopia and ptosis) themost frequent. Most of these were spontaneously solvedin a short time period. 15 patients required multi-disciplinary collaboration with neurosurgery.Conclusions. Coronal incision allows any bone orbitotomy,with security, guarantee and good aesthetic andfunctional results. Lateral and supero-lateral orbitotomies provide an ideal extradural approach to the retrobulbar compartment. An approach to the apex, orbitalchannel and medial compartment to the optic nerve,usually requires a combined neurosurgical approachthrough anterior cranial fossa. Orbitotomy fixationwith bio-resorbable ostheosynthesis is an alternative totitanium plates. They can even be a first choice in paediatric age. The morbidity of this surgical technique is low

Absceso cerebral / Brain abscess

El absceso cerebral es una patología poco frecuente en la infancia, aunque grave, que puede presentar una alta morbimortalidad, a pesar de los avances diagnósticos y terapéuticos actuales. El germen causal depende de los factores predisponentes. La presentación clínica en niños es inespecífica, y requiere la sospecha precoz por parte del médico. La tomografía computarizada (TC) y/o la resonancia magnética (RM) son herramientas indispensables para realizar el diagnóstico de certeza. El tratamiento de la mayoría de los abscesos consiste en antibioterapia de amplio espectro y drenaje quirúrgico, aunque en la fase precoz de cerebritis puede responder sólo a tratamiento médico. Describimos una niña de 13 años diagnosticada de dos abscesos cerebrales originados a partir de una otitis media y que se encontraba en tratamiento antibiótico. Presentaba cefalea, vómitos y otalgia a su ingreso. El diagnóstico se hizo mediante TC. Se trató con antibioterapia de amplio espectro con buna penetración cerebral, con la que evolucionó a un aumento del tamaño del absceso y un empeoramiento clínico. Se realizó la aspiración estereotáxica de la lesión y la evolución fue favorable sin complicaciones postquirúrgicas (AU)

Brain abscess is uncommon but life- threatening infection in children with high mobility and mortality despite recent advances in diagnostic and therapeutic modalities. Predominant etiologic microorganisms vary depending on these predisposing factors. The clinical presentation in children can be nonspecific, and a high index of suspicion is required. Computed tomography (CT) and/or magnetic resonance imaging (MRI) are essential tools that enable the physician to diagnosis. Surgical drainage with antimicrobial therapy is the treatment of choice for most brain abscesses. In the early phase of cerebritis, infection can respond to long-term antibiotic therapy alone. We described a 13 years old girl with two brain abscesses originated form otitis media with antibiotic therapy. Diagnosis was given by CT. Initial treatment with broad spectrum antibiotics with good cerebral penetration was associated with an increase in the size of abscess and clinical worsening. Stereotactic aspiration of lesion and culture was performed and the patient showed improvement and there was any postoperative complication (AU)

[Cerebral hydatidosis. Analysis of a series of 23 cases]. / Hidatidosis cerebral. Análisis de una serie de 23 casos.

BACKGROUND: The aim of the present study was to contribute to the knowledge of cerebral hydatidosis so as to improve the prognosis of a benign condition with a malignant behavior, as it has a high relapse rate with a high morbidity. METHODS: A retrospective study of cerebral hydatidosis has been carried out in 23 patients, seen at the University Hospital Virgen del Rocío during the last 20 years. The following variables were recorded: 1) Sex and age at presentation; 2) epidemiological data; 3) number, size, localization and rate of growth of cysts; 4) latency period; 5) clinical features; 6) yield of imaging procedures; 7) surgical approaches and medical therapy; and 8) relapses and sequelae. A comparative study was made of patients aged 14 years or less and those above this age. RESULTS: The mean age of the patients was 15.1 +/- 10.3 years (65% were younger than 14 years). 24% were males. 65% came from Extremadura and 74% had a rural background. The latency period was 7.9 +/- 9.2 months (range 15 days-36 months), and it was shorter in children (4.2 +/- 3.8 vs 12.6 +/- 12.7 months) (p less than 0.05). 74% had a single cyst. The cyst size was greater in children (91 +/- 46 vs 67 +/- 35 mm), as it was the rate of growth, particularly in patients younger than 10 years (13.5 +/- 7 vs 9.2 +/- 2 mm/year) (p less than 0.001). 48% had intraparenchymal localization and 70% were in the right hemisphere. In two cases the localization was intraventricular and it was cerebellar in one. Cranial computed tomography was the imaging procedure with the highest yield. The diagnosis was confirmed with pathological examination. In 6 patients (26%) the Dowling and Orlando technique (hydatid delivery) was carried out without subsequent relapses. In 7 cases (30%), and owing to surgical technique difficulties or accidents, puncture and aspiration were carried out, with 4 relapses (57%). In 10 cases cyst rupture occurred, with 6 relapses (60%). The growth rate of the relapses was 9.4 +/- 6.5 mm/month. 87% had severe sequelae, associated with relapses and multiplicity, two patients died (9%). CONCLUSIONS: 1) Cerebral hydatidosis predominates in children and young adult males of a rural background; 2) usually there is a long latency period, which is shorter in children; 3) the size and the growth rate of the cysts is greater in children; 4) computed tomography is the imaging technique with the highest yield; 5) Dowling and Orlando technique is the most effective surgical procedure; 6) the incidence of relapses is high, depending on the type of surgical approach.