[Paragangliomas of the cauda equina: report of two cases]. / Paragangliomas de la cauda equina: a propósito de dos casos.

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compression of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma.

[Cranial reconsctruction with titanium mesh and hydroxyapatite cement]. / Reconstrucción craneal mediante malla de titano y cemento de apatita carbonatada.

We report the case of a 45 year old patient who was affected by an infectious disease of the temporal bone, after the surgical treatment of a meningioma in the greater sphenoid wing. This infection healed after the resection of the craniotomy flap. The remaining bone defect was reconstructed using a titanium mesh covered by hydroxyapatite cement (Norian). The result was excellent due to the strength of the titanium mesh and the volume and contour offered by the hydroxyapatite cement.

[Efficacy of arthrodesis in the posterior approach of cervical myelopathy: comparative study of a series of 36 cases]. / Eficacia de la artrodesis en el abordaje posterior de la mielopatía cervical: estudio comparativo de una serie de 36 casos.

OBJECTIVE: The effectiveness of arthrodesis associated to laminectomy as a treatment for cervical myelopathy has been retrospectively evaluated analysing the clinical evolution of 36 patients as well as the change in cervical column saggittal curvature comparing a group of patients with a simple laminectomy to another in whom laminectomy was accompanied by posterior arthrodesis. MATERIAL AND METHODS: 36 posterior approaches were performed to treat patients diagnosed of spondyloartrosic myelopathy between 1992 and 1999; 19 cases were treated with a simple laminectomy and other 17 also underwent arthrodesis with posterior instrumentation. The clinical evolution (using grades 0-5 on the Nurick scale) and cervical curvature have been evaluated for an average time interval of 40 months. RESULTS: Patients treated with laminectomy plus arthrodesis showed an average 1.24 point improvement on the Nurick scale in comparison to the 0.84 point improvement observed in patients treated with laminectomy alone. The cervical curvature attained a more physiological angulation in 53% of the patients with an arthrodesis and in 29% of the patients with simple laminectomy; curvature worsened in 7% of the patients with arthrodesis and in 24 degrees/a of those with laminectomy alone. CONCLUSION: Cervical myelopathy cases requiring a posterior approach for laminectomy obtain a better clinical evolution when an arthrodesis with posterior instrumentation is associated with the laminectomy. These patients also present improved cervical curvature as compared to the group without instrumentation.

Guillain-Barre syndrome following 2-chlorodeoxyadenosine treatment for Hairy Cell Leukemia.

A 68-year-old man, with Hairy Cell Leukemia developed a Guillain-Barré syndrome (G-B), 32 days after a single course of 2-Chlorodeoxyadenosine (CDA) at 0,14 mg/k/d, for five days in a two-hour-i.v. infusion and following a febrile neutropenia episode. In order to clarify whether this G-B case was related to an infection or to CDA neurotoxicity, we screened for infection-related autoimmune G-B and for antibodies (abs.) against gangliosides of peripheral nerves. Blood and urinary cultures were negative as well as serum anti-virus abs. However, serum anti-ganglioside abs. were positive for anti-asialo GM1 and anti-Gd1b. This latter finding was consistent with an autoimmune mechanism, not described until now as CDA neurotoxicity. In the present case, we do not have enough evidence to link CDA administration to the G-B syndrome. We think that it is necessary to exclude other causes of neurotoxicity before considering CDA adverse effect.

Malignant and atypical meningiomas: a reappraisal of clinical, histological, and computed tomographic features.

A series of 21 patients with atypical and malignant meningiomas is presented. Histological criteria such as high cellularity, typical and atypical mitosis, necrosis, infiltration of the underlying brain, poor differentiation, and distant metastasis define nonbenign meningiomas. Male predominance in this nonbenign group is significant when compared to a group of 205 benign meningiomas, which were also operated on. The malignant and atypical meningiomas are compared with the benign meningiomas, and special emphasis is placed on their computed tomographic features. The presence of tumor fringes (suggesting invasion of the brain substance) and intratumoral hypodense areas were both significant signs of malignancy of atypia. Radical surgical excision is still considered the treatment of choice.