[A clinico radiological study of patients with cavernous angiomas of the spinal cord]. / Estudio clinicorradiológico de pacientes con angiomas cavernosos medulares.

AIM: To define the spectrum of signs, symptoms and radiological features in patients with spinal intramedullary cavernous angioma. We analyze surgical management and clinical follow up in these patients. PATIENTS AND METHODS: 16 adult patients, 9 women and 7 men, were studied in our hospital each with one cavernous angioma of the spinal cord. All patients were diagnosed with magnetic resonance imaging. The lesion location was intramedullary in all patients, 6 patients cervical level and 10 thoracic level. RESULTS: In 12 patients surgical resection of the malformation was performed and histological results confirmed the spinal cavernous diagnostic. In 10 patients, the clinical outcome had improved in Frankel grade. In the four nonoperated cases, successive monitoring studies demonstrated no radiological progression and the clinical symptomatology has remained stable. CONCLUSION: Women in the fertile period appear to be predisposed to develop spinal cavernous angioma. The bleeding risk, in our study, didn t have any relation with CMA level. Magnetic resonance imaging features cannot predict the CMA evolution.

Estudio clinicorradiológico de pacientes con angiomas cavernosos medulares / A clinico-radiological study of patients with cavernous angiomas of the spinal cord

Objetivos. El propósito de este estudio es definir el espectro de síntomas y signos clínicos junto con los hallazgos radiológicos que se presentan en pacientes con cavernomas intramedulares (ACM); se analiza el tratamiento y la evolución clínica en estos pacientes. Pacientes y métodos. Presentamos 16 casos de pacientes, nueve mujeres y siete hombres, con ACM únicos estudiados en nuestro hospital clínicamente, y que se diagnosticaron radiológicamente mediante una resonancia magnética (RM) medular. La localización de las lesiones era en todos los casos intramedular, en seis pacientes en la región cervical, y en 10, en la dorsal. Resultados. Fueron intervenidos 12 de los pacientes. En ellos, se resecó la lesión y se comprobó anatomopatológicamente el diagnóstico de presunción. En cuanto a la evolución clínica posquirúrgica, en 10 mejoró su estado, según la escala de valoración de Frankel. Se ha controlado la evolución de los otros cuatro pacientes, no operados por rechazo voluntario de la intervención, y no se han presentado modificaciones clínicas o radiológicas reseñables. Conclusiones. Encontramos esta patología con mayor frecuencia en mujeres, con inicio de la sintomatología en la edad fértil de la vida. No observamos en nuestra serie una predilección de localización en cuanto al riesgo de sangrado. No hay un patrón de RM claro de predicción evolutiva de los ACM (AU)

Aim. To define the spectrum of signs, symptoms and radiological features in patients with spinal intramedullary cavernous angioma. We analyze surgical management and clinical follow-up in these patients. Patients and methods. 16 adult patients, 9 women and 7 men, were studied in our hospital each with one cavernous angioma of the spinal cord. All patients were diagnosed with magnetic resonance imaging. The lesion location was intramedullary in all patients, 6 patients cervical level and 10 thoracic level. Results. In 12 patients surgical resection of the malformation was performed and histological results confirmed the spinal cavernous diagnostic. In 10 patients, the clinical outcome had improved in Frankel grade. In the four nonoperated cases, successive monitoring studies demonstrated no radiological progression and the clinical symptomatology has remained stable. Conclusion. Women in the fertile period appear to be predisposed to develop spinal cavernous angioma. The bleeding risk, in our study, didn’t have any relation with CMA level. Magnetic resonance imaging features cannot predict the CMA evolution (AU)

[Endocranial invasion of inverted papilloma]. / Invasión endocraneal por papiloma invertido.

Inverted papilloma (PI) is a benign neoplasm of nose and paranasal sinuses. IP's pathophysiology is characterized by its capacity to be locally destructive, its ability to grow rapidly and its tendency to recur. IP's association with carcinoma is about 13 percent of cases. The surgical treatment of IP has evolved over the years, with a progression toward more radical en bloc extirpation. The paper reports an inverted papilloma case of nasal cavities, with destruction of frontal sinus roof and intracranial extension aside frontal lobe displacement.

[Abdominal metastasis of a pineal germinoma in a child with a ventriculo-peritoneal shunt]. / Metástasis abdominales de germinoma pineal en niño con derivación ventriculoperitoneal.

We present a case of germinal tumor of the pineal gland, treated with a ventriculo-atrial shunt, cytostatics and radiotherapy. Two and a half years later, in Spite of the clinical remission of the cerebral tumor a metastasis appeared in the abdominal cavity. After reviewing the current literature, the necessity of using millipore filters in the CSF derivation systems when dealing with malignant cerebral tumors to avoid the spreading of malignant cells through the CSF.

[Spontaneous regression of an aneurysmal bone cyst of the vertebrae after partial excision. Bibliographic review]. / Regresión espontánea de un quiste óseo aneurismático de localización vertebral tras su extirpación parcial. Revisión bibliográfica.

A case of a lumbar aneurysmal bone cyst is presented in a 5 year-9 month old girl. The characteristics of this tumor are described, specifically in the spinal area, with particular reference to the diagnostic and therapeutic difficulties referred, taking into account the existing bibliography. The partial resection has been curative, as it has been frequently written about in publication worldwide and which suggest that surgery does not have to be aggressive in unapproachable cases and that radiotherapy is unnecessary.

Surgical experience with arteriovenous malformations in children.

The authors report their surgical experience with 15 cases of arteriovenous malformations in children operated on in the last decade. Subarachnoid hemorrhage was the main clinical manifestation in 12 patients. Epilepsy was a secondary feature in 3 of these. Cortical areas were involved in 7 cases while the other 8 had the malformation in medial or deep structures of the brain. No mortality occurred from surgery. A radical excision was achieved in 12 cases, while in 3 cases remnants of the lesion were shown by postoperative angiography. Nine patients recovered from surgery without neurological impairment. Two children with left-sided arteriovenous malformations showed mild speech disturbances and 2 others with midline lesions suffered from hypotonus and ataxia.

Medulloblastomas: a review of 11 cases.

The authors review 11 cases of medulloblastomas, 9 of which were diagnosed and treated in the last 6 years. All were uniformly treated by surgery, radiotherapy and chemotherapy, according to the SIOP protocol. Complications and results are described.

[Intradural lumbar disk hernia. Contribution of 2 cases]. / Hernie discale lombaire intradurale. Apport de deux cas.

Two new cases of intradural herniated disks are added to those previously reported in the literature. It's frequency in our casuistry is of 0.27%, similar to that of other series. Predisponent factors and incidence at different levels are reviewed. Acute or subacute clinical on-set, level of lesion and an early surgical treatment seems to influence the evolution of these patients. Recent observations with C.T. with metrizamide and cytological study of L.C.R. with Cytospin suggest a more precise preoperative diagnosis than the myelography. The final diagnosis has been casual after intradural exploration when there were no correlation between the extradural exploration and the clinical and radiological picture. The pathological study of the intradural herniated disk don't differ from the usual extradural herniated disk.

[Intrasellar abscess into a cyst of the Rathke's pouch (authors' translation)]. / Abcès intrasellaire au sein d'un kyste de la poche de rathke.

The authors report a case of abscessified cyst the pouch of Rathke similar to that published by Obenchain in 1972 and Menault in 1979. The clinical picture was determined for recurrent meningeal burst without signs of intracraneal pressure nor optochiasmatic involvement. The spinal fluid showed pleocitosis and hyperprotein. No bacterial growth was demonstrated. Antibiotic therapy had no effect on the clinical follow-up. C.T. was unable to show the location of the lesion evidenced by pneumocisternography. Though a subfrontal approach was emptied an abscess in the sella turcica, with walls formed for tissue of he Rathke's pouch. A few months later a new meningeal burst occurred and a recurrence of the abscess was confirmed at operation. The follow-up was of progressive neurological deterioration with exitus letalis a few days later. Abscessified sella tumors ahd been rarely reported in the literature : chromophobe adenoma appeared most frequently and only in 3 cases within craniopharyngiomas. Diagnostic difficulties arise from the lack of focal symptoms and from the failure of some neuroradiological procedures to demonstrate the lesion. The high risk of recurrence and the poor prognosis of these abscess will be discused. Although a similar embryological origin the cyst the Rathke's cleft and the craniopharingiomas present pathological aspects that made each other differenciable.