Disección didáctica de fibra blanca en cerebelo humano en tres pasos: entrenamiento microneuroanatómico / 3-Step didactic white matter dissection of human cerebellum: Micro-neuroanatomical training

Objetivos: Un buen conocimiento anatómico del cerebelo es fundamental para llevar a cabo abordajes al IV ventrículo (frecuentes en la neurocirugía pediátrica) de forma segura, evitando secuelas como el mutismo cerebeloso. El propósito del presente trabajo es realizar una disección didáctica del cerebelo humano centrándonos especialmente en los pedúnculos cerebelosos y en los núcleos dentados (DN); estructuras en riesgo durante estos procedimientos. Material y métodos :Se disecó el órgano, siguiendo el método de Klingler para fibras blancas, usando material de microcirugía estándar y específico, bajo un microscopio D. F. Vasconcellos M900 con aumento x6-x40. Se utilizó una cámara Canon EOS T7 con un objetivo de 18-55 mm y se editaron las imágenes con Adobe Lightroom Classic CC y Keynote. Se emplearon métodos especiales como la iluminación endoscópica con luz LED para la obtención de algunas fotografías. Resultados: Se logró disecar con éxito los DN del cerebelo y describir su relación con los pedúnculos cerebelosos, vermis inferior y velos medulares. Mediante esta guía de tres pasos (1. cara tentorial; 2. cara suboccipital; 3. estructuras del IV ventrículo) se consiguió mostrar los elementos más importantes para el estudio del órgano y caracterizar sus implicaciones en los distintos abordajes al IV ventrículo. Conclusiones: La mejor forma de completar el estudio de neuroanatomía es la disección de especímenes, ya que aporta una visión 3 D. La transiluminación con luz LED se reveló como una herramienta útil para el registro fotográfico de estructuras del IV ventrículo, lo que mejora la visión espacial. Su principal aplicación la encontramos en los velos medulares y forámenes de la fosa romboide, ya que son permeables a la luz. La guía de disección en tres fases propuesta en este trabajo puede ayudar a los neurocirujanos, en cualquier etapa de su formación, a comprender mejor el cerebelo (AU)

Objectives: A thorough understanding of cerebellum anatomy is essential in 4th ventricle approaches (more frequent in pediatric neurosurgery), avoiding relevant complications such as cerebellar mutism. The aim of the present work is to show the feasibility of a didactic dissection of human cerebellum focusing on cerebellar peduncles and dentate nucleus (DN), which are structures at high risk during these surgical procedures. Material and methods: The cerebellum was dissected according to the Klingler method for white matter, using standard and specific microsurgery tools. Surgical microscope magnification (x6-x40) provided by a D.F. Vasconcellos M900 was required. A Canon EOS T7 18-55 mm digital camera was used and Adobe Lightroom Classic CC and Keynote were selected as photo enhancing software. Special methods such as LED light endoscopic transillumination were used for photographical reasons. Results: DN dissection was successfully achieved and the relations between these nucleus and the cerebellar peduncles, inferior vermis and medullary velums were described. Through this three steps dissection guide (1. tentorial surface; 2. suboccipital surface; 3. 4th ventricle structures), the most relevant anatomical structures were shown and its implications in different 4th ventricle approaches were characterised. Conclusion: 3 D perspective provided by real specimen anatomical dissection is critical for learning neuroanatomy. ED transillumination was shown as a useful technique for the 4th ventricle structures photographic documentation which improves spatial recognition. This benefit can be applied for the study of the relations between the medullary velums and the rhomboid fossa foramina, which are permeable to light. The proposed three-steps dissection guide helps to a better understanding of human cerebellum and to gain self-confidence, allowing safer practice for neurosurgeons in all stages of their career (AU)

[Postoperative complications in Chiari I malformation: duroplasty and cerebrospinal fluid leak]. / Complicaciones postquirrgicas de la malformación de Chiari tipo I: duroplastia y fístula de líquido cefalorraquídeo.

UNLABELLED: The surgical treatment of Chiari I malformation is to carry out a suboccipital decompression. It is described that postoperative complications may occur, especially if the dura is open and closed using a graft (duraplasty). Among them, one of the most important events due to its difficult handling is cerebrospinal fluid leak through the suture line. OBJECTIVE: To conduct a postoperative review to analyze the outcome of the patients and the occurrence of complications depending on the dural plasty used. MATERIAL AND METHODS: A retrospective study was carried out between 1997 and 2008, both inclusive, where we assessed 36 patients. All of them were studied with preoperative and postoperative craniospinal magnetic resonance, and by a thorough clinical examination performed before and after the surgery. The surgical procedure consisted of suboccipital decompression and resection of the posterior arch of C1 or C1 and C2 (depending on the extent of the caudal displacement of the tonsils), followed by duraplasty using either an autologous graft (pericranium) or a synthetic graft (Gore-tex). RESULTS: After a mean follow-up of 2 years, the clinical results were: excellent (55%), if there was a great clinical improvement; good (29%), if there was slight improvement; and bad (16%), if there was no improvement or there was worsening. In the 30 patients given a duraplasty (18 with an artificial graft, 12 with an autologous pericranium graft), 6 cases of cerebrospinal fluid leak appeared, although no significant association between the type of dural plasty and the presence of leak was observed. CONCLUSIONS: The best results were obtained for headaches, cervical pain and dizziness. Despite the fact that there were more cases of cerebrospinal fluid leak in patients receiving an artificial graft compared to patients with pericranium graft, there was no significant difference.

Complicaciones postquirúrgicas de la malformación de Chiari tipo I: duroplastia yfístula de líquido cefalorraquídeo / Postoperative complications in Chiari I malformation: duroplasty and cerebrospinal fluid leak

El tratamiento quirúrgico de la malformación deChiari tipo I consiste en realizar una descompresiónósea suboccipital. Está descrito que pueden producirsecomplicaciones derivadas de la cirugía, sobre todo sise realiza apertura dural y posterior cierre con injerto(duroplastia). Una de las más importantes por su difícilmanejo, es la fístula de líquido cefalorraquídeo en lazona quirúrgica.Objetivo. Llevar a cabo una revisión postquirúrgica,donde analizaremos la evolución de los pacientes y lacorrelación de las complicaciones respecto al tipo deplastia dural usada.Material y métodos. Se ha realizado un estudio retrospectivode los pacientes intervenidos en nuestro centroentre el año 1997 y 2008, ambos inclusive, recogiendoun total de 36 pacientes. A todos ellos se les realizó unestudio pre y postoperatorio con resonancia magnéticacraneoespinal, así como un examen neurológico antes ydespués de la intervención. La intervención quirúrgicaconsistió en una descompresión ósea suboccipital, juntocon la extirpación del arco posterior de C1 o C2 (dependiendodel descenso amigdalar), y duroplastia coninjerto autólogo (pericráneo) o con injerto heterólogo(Gore-tex).Resultados. Tras un seguimiento medio de 2 añosobtuvimos los siguientes resultados clínicos: excelente(55%), si hubo gran mejoría clínica; bueno (29%), sihubo leve mejoría; y malo (16%), si no hubo mejoría ohubo empeoramiento. En los 30 pacientes a los que seles realizó duroplastia (18 plastia artificial, 12 plastiaautóloga de pericráneo occipital), (..) (AU)

The surgical treatment of Chiari I malformation is tocarry out a suboccipital decompression. It is describedthat postoperative complications may occur, especiallyif the dura is open and closed using a graft (duraplasty).Among them, one of the most important events due toits difficult handling is cerebrospinal fluid leak throughthe suture line.Objective. To conduct a postoperative review toanalyze the outcome of the patients and the occurrenceof complications depending on the dural plasty used.Material and methods. A retrospective study wascarried out between 1997 and 2008, both inclusive,where we assessed 36 patients. All of them were studiedwith preoperative and postoperative craneoespinalmagnetic resonance, and by a thorough clinical examinationperformed before and after the surgery. Thesurgical procedure consisted of suboccipital decompressionand resection of the posterior arch of C1 or C1 andC2 (depending on the extent of the caudal displacementof the tonsils), followed by duraplasty using either anautologous graft (pericranium) or a synthetic graft(Gore-tex).Results. After a mean follow-up of 2 years, the clinicalresults were: excellent (55%), if there was a great (..) (AU)

[Solitary fibrous tumors of the meninges: report of three cases and literature review]. / Tumor fibroso solitario meníngeo: descripción de tres casos y revisión de la literatura.

We report 3 patients with fibrous solitary tumor of meningeal location where we described the histological study, as well as evolution after the surgical treatment. The described patients presented ages of 37, 52 and 65 years, after the resection has not appeared an objective sign of recurrence in any case after 4, 6 and 7 years of follow-up respectively. Checking the literature the tumor is indistinguishable clinical and radiolocally of the typical meningioma, doing necessary the use of inmunohistochemistry to do the differential diagnosis, where positiveness for CD34 and the negativeness for EMA define the fibrous solitary tumor. It is about a benign tumor, where total removing is the principal factor in prognosis, nevertheless there are cases of local recurrences and long-distance metastasis. We can find all these characteristics in the showed cases of the present article, having the uncertainty of its local or systemic relapse ability in the future.