Quistes sinoviales lumbares: presentación de una serie de 10 casos y revisión de la literatura / Lumbar synovial cysts: presentation of a series of 10 cases and literature review

Introducción. Los quistes sinoviales lumbares son una causa infrecuente de dolor lumbar y radicular, aunque cada vez se describen con más frecuencia en la literatura. Objetivo. Analizar el tratamiento y resultados quirúrgicos de los quistes sinoviales lumbares intervenidos en nuestro centro en un período de 5 años. Material y métodos. Se realizó un estudio retrospectivo de pacientes tratados quirúrgicamente en nuestro servicio entre agosto de 2009 y septiembre de 2014, empleando la escala visual analógica para seguimiento clínico durante el año posterior a la cirugía. Resultados. Tras el tratamiento quirúrgico (exéresis del quiste con o sin artrodesis instrumentada con tornillos transpediculares), de 10 pacientes (5 mujeres y 5 varones) de edades comprendidas entre los 50 y 80 años (edad media 70,2 años), la evolución clínica fue satisfactoria en el 80% de ellos con resolución de su sintomatología. Conclusiones. Los quistes sinoviales lumbares deben ser considerados en el diagnóstico diferencial de pacientes con dolor lumbar y radicular. La mayoría de estos pacientes están en la 6.a década de la vida y presentan generalmente una espondilopatía degenerativa lumbar. En la actualidad, se recomienda la exéresis de los quistes sinoviales con artrodesis instrumentadas con tornillos transpediculares, ya que se considera que el aumento de movilidad podría ser una de las causas de su aparición; aunque todavía se necesitan más estudios al respecto, de ahí el interés de este trabajo (AU)

Introduction. Although they are freqqently described in the literature, lumbar synovial cysts are a relative uncommon cause of low back and radicular leg pain. Objective. To evaluate the treatment and surgical outcomes of the lumbar synovial cysts operated on in our hospital during a 5 year period. Material and methods. A retrospective study was conducted on patients surgically treated in our department from August 2009 to September 2014, using a visual analogue scale for the clinical follow-up in the first year after surgery. Results. After the surgical treatment (surgical removal of the synovial cyst with or without instrumented arthrodesis with transpedicular screws) of 10 patients (5 female and 5 male) with a mean age of 70.2 years (range 50-80), the clinical outcome was satisfactory in 80% of the patients, with the resolving of their symptoms. Conclusions. Lumbar synovial cysts have to be considered in the differential diagnosis in patients with low back and radicular leg pain. The majority of the patients are in their sixties and have lumbar degenerative spondylopathy. Nowadays, surgical resection of the lumbar synovial cysts and spinal fusion are the recommended treatment, because it is thought that the increased movement of the spine is one to the causes of the cyst formation. More studies are still needed, hence the relevance of this article (AU)

Lumbar synovial cysts: presentation of a series of 10 cases and literature review. / Quistes sinoviales lumbares: presentación de una serie de 10 casos y revisión de la literatura.

INTRODUCTION: Although they are freqqently described in the literature, lumbar synovial cysts are a relative uncommon cause of low back and radicular leg pain. OBJECTIVE: To evaluate the treatment and surgical outcomes of the lumbar synovial cysts operated on in our hospital during a 5 year period. MATERIAL AND METHODS: A retrospective study was conducted on patients surgically treated in our department from August 2009 to September 2014, using a visual analogue scale for the clinical follow-up in the first year after surgery. RESULTS: After the surgical treatment (surgical removal of the synovial cyst with or without instrumented arthrodesis with transpedicular screws) of 10 patients (5 female and 5 male) with a mean age of 70.2 years (range 50-80), the clinical outcome was satisfactory in 80% of the patients, with the resolving of their symptoms. CONCLUSIONS: Lumbar synovial cysts have to be considered in the differential diagnosis in patients with low back and radicular leg pain. The majority of the patients are in their sixties and have lumbar degenerative spondylopathy. Nowadays, surgical resection of the lumbar synovial cysts and spinal fusion are the recommended treatment, because it is thought that the increased movement of the spine is one to the causes of the cyst formation. More studies are still needed, hence the relevance of this article.

Congenital obstruction of the foramen of Monro causing unilateral hydrocephalus. A propos of a case / Oclusión congénita del foramen de Monro como causa de hidrocefalia unilateral. A propósito de un caso.

Isolated hydrocephalus of the lateral ventricle may result from unilateral occlusion of the foramen of Monro. The most common causes are tumours of the lateral ventricles or in the area of the third ventricle. Non-tumoural stenosis of the foramen is rare and can be due to inflammatory, vascular or congenital conditions. A full-term infant was prenatally diagnosed with unilateral hydrocephalus. After birth, progressive unilateral ventricular dilatation was confirmed in successive ultrasounds so surgery was indicated. The patient underwent endoscopic fenestration of the foramen of Monro and septostomy with good postoperative clinical evolution and reduction of ventricular size. Intraoperative findings demonstrated membranous obstruction of the right foramen of Monro. A successful treatment can be accomplished through a neuroendoscopic approach avoiding the use of ventricular shunts.

Oclusión congénita del foramen de Monro como causa de hidrocefalia unilateral. A propósito de un caso / Congenital obstruction of the foramen of Monro causing unilateral hydrocephalus. A propos of a case

La hidrocefalia aislada del ventrículo lateral puede ser provocada por la oclusión unilateral del foramen de Monro. Las causas más frecuentes son los tumores de los ventrículos laterales o en el área del tercer ventrículo. La estenosis no tumoral es poco frecuente y puede deberse a patologías inflamatorias, vasculares o congénitas. Se presenta el caso de un recién nacido a término diagnosticado prenatalmente de hidrocefalia unilateral. Tras el parto se confirmó en las sucesivas ecografías la dilatación ventricular unilateral motivo por el cual se indicó el tratamiento quirúrgico. El paciente fue sometido a la fenestración del foramen de Monro y septostomía por vía endoscópica, con buena evolución clínica y reducción del tamaño ventricular. Los hallazgos intraoperatorios demostraron la obstrucción por una membrana del foramen de Monro derecho. Se puede conseguir un tratamiento adecuado mediante neuroendoscopia, evitando implantar derivaciones ventriculares (AU)

Isolated hydrocephalus of the lateral ventricle may result from unilateral occlusion of the foramen of Monro. The most common causes are tumours of the lateral ventricles or in the area of the third ventricle. Non-tumoural stenosis of the foramen is rare and can be due to inflammatory, vascular or congenital conditions. A full-term infant was prenatally diagnosed with unilateral hydrocephalus. After birth, progressive unilateral ventricular dilatation was confirmed in successive ultrasounds so surgery was indicated. The patient underwent endoscopic fenestration of the foramen of Monro and septostomy with good postoperative clinical evolution and reduction of ventricular size. Intraoperative findings demonstrated membranous obstruction of the right foramen of Monro. A successful treatment can be accomplished through a neuroendoscopic approach avoiding the use of ventricular shunts (AU)

Tumor cerebral no conocido que se presenta con compresión del tronco cerebral tras punción dural accidental / Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture

Se trata de una primigrávida de 36 años de edad en su semana 41 de gestación con antecedentes de hiperemesis gravídica. Durante la analgesia epidural se produjo una punción dural accidental. En el posparto presentó cefalea persistente, tratada mediante analgésicos orales, cafeína, fluidoterapia y tetracosáctido, rechazando el parche hemático epidural. En el séptimo día posparto la paciente reingresó en el Servicio de Urgencias con deterioro del nivel de conciencia y datos de compresión del tronco cerebral. La tomografía computarizada y la resonancia magnética craneales mostraron un tumor de fosa posterior. Se realizó una craneotomía con carácter de urgencia, con recuperación neurológica completa. Resaltamos la importancia del diagnóstico diferencial de la cefalea pospunción dural y destacamos los signos de alarma ante los pacientes que no responden a los tratamientos convencionales (AU)

A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was treated with oral analgesics, oral caffeine, fluid therapy, and tetracosactide. She refused an epidural blood patch. On the seventh day postpartum, the patient was re-admitted to the Emergency Department with decreased level of consciousness and signs of brainstem compression. Cranial computed tomography and magnetic resonance imaging showed a posterior fossa tumour. An emergency craniotomy was performed with complete neurological recovery. This case emphasises the need to consider the differential diagnoses of post-dural puncture headache and to highlight the warning signs in patients who do not respond despite treatment with conventional therapy (AU)

[Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture]. / Tumor cerebral no conocido que se presenta con compresión del tronco cerebral tras punción dural accidental.

A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was treated with oral analgesics, oral caffeine, fluid therapy, and tetracosactide. She refused an epidural blood patch. On the seventh day postpartum, the patient was re-admitted to the Emergency Department with decreased level of consciousness and signs of brainstem compression. Cranial computed tomography and magnetic resonance imaging showed a posterior fossa tumour. An emergency craniotomy was performed with complete neurological recovery. This case emphasises the need to consider the differential diagnoses of post-dural puncture headache and to highlight the warning signs in patients who do not respond despite treatment with conventional therapy.

[Cabergoline-induced tension pneumocephalus in a patient with giant invasive prolactinoma. Case report]. / Neumoencéfalo a tensión causado por el tratamiento con cabergolina en un pacientecon prolactinoma invasivo gigante. A propósito de un caso.

Treatment of patients with prolactinomas consists primarily of dopamine agonists (DA). When these drugs reduce the size of invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. Pneumocephalus and cerebrospinal fluid leakage have been reported. A 56 year old male was admitted to the emergency unit with an intracranial hypertension syndrome. He had been treated for 2 weeks with cabergoline after an invasive prolactinoma was discovered. Brain CT showed frontal interhemispheric pneumocephalus on the previous tumor cavity, and bony defect on the sellar floor. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and subtotal tumor removal were performed. The literature is reviewed looking for possible pathophysiological mechanism, prevention and treatment.

Neumoencéfalo a tensión causado por el tratamiento con cabergolina en un paciente con prolactinoma invasivo gigante. A propósito de un caso / Cabergoline-induced tension pneumocephalus in a patient with giant invasive prolactinoma. Case report

El tratamiento de los pacientes con prolactinomas consiste principalmente en el uso de agonistas dopaminérgicos (AD). Cuando estos fármacos reducen el tamaño de prolactinomas invasivos, los espacios intra y extracraneal pueden llegar a comunicarse. El neumoencéfalo y la fístula de líquido cefalorraquídeo (LCR) han sido descritos. Un paciente varón de 56 años acude al servicio de urgencias con un síndrome de hipertensión intracraneal. Tras haber sido diagnosticado de un prolactinoma invasivo, había sido tratado con cabergolina durante 2 semanas. El TC craneal mostró neumoencéfalo frontal interhemisférico en la cavidad que ocupaba previamente el tumor, y un defecto óseo en el suelo de la silla turca. Se realizó evacuación del pneumoencéfalo, reparación de los defectos craneales y meníngeos y exéresis subtotal del tumor. Se revisa la literatura, los posibles mecanismos fisiopatológicos, modos de prevención y tratamiento (AU)

Treatment of patients with prolactinomas consists primarily of dopamine agonists (DA). When these drugs reduce the size of invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. Pneumocephalus and cerebrospinal fluid leakage have been reported. A 56 year old male was admitted to the emergency unit with an intracranial hypertension syndrome. He had been treated for 2 weeks with cabergoline after an invasive prolactinoma was discovered. Brain CT showed frontal interhemispheric pneumocephalus on the previous tumor cavity, and bony defect on the sellar floor. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and subtotal tumor removal were performed. The literature is reviewed looking for possible pathophysiological mechanism, prevention and treatment (AU)

[Bifid sternum. a case report (author's transl)]. / Bifidez esternal completa A propósito de un caso

A newborn with bifid sternum and early surgical management is reported.