Use of Clamp-Like Devices to Fix Bifrontal Basal Craniotomies: Three Case Reports.

The three case reports presented here provide clinical evidence of a configuration to easily and successfully fix bifrontal basal craniotomies with a clamp-like fixation device (Cranial LOOP™, NEOS Surgery, Barcelona, Spain): A 72-year-old woman undergoing resection of a meningioma at the sphenoidal level, a 43-year-old man undergoing clipping of an anterior communicating artery aneurism, and a 55-year-old woman undergoing macroscopical resection of a meningioma on the olfactory groove had their surgery performed through a bifrontal basal craniotomy, and, once the intervention was completed, the fixation of the cranial flap was performed using Cranial LOOP™, with a configuration consisting of two Cranial LOOP™ L at the basal lateral level and two additional products at the posterior frontal level. The result of this fixation was very satisfactory with no settling or artifacts during the follow-up. These cases show that Cranial LOOP™ can be used to fixate bifrontal basal craniotomies.

Head and neck manifestations of an undiagnosed McCune-Albright syndrome: clinicopathological description and literature review.

Craniofacial fibrous dysplasia, characteristic of McCune-Albright syndrome (MAS), is usually present in patients with MAS-related acromegaly. We report here the first case of a patient with an undiagnosed MAS presenting with an acute hydrocephalus. A 21-year-old male with gigantism and craniofacial fibrous dysplasia consulted for rapidly progressive headache. An acute obstructive hydrocephalus due to a 39 × 35-mm cystic lesion in the third ventricle was discovered and operated, obtaining hydrocephalus resolution. Pathology described a colloid cyst material and a growth hormone-secreting pituitary adenoma. Genetic study revealed the mosaic GNAS R201H mutation in the pituitary tissue, confirming a MAS diagnosis. Adequate hormonal control was achieved postoperatively. Our results suggest that long-term untreated growth hormone excess in patients with MAS-related craniofacial fibrous dysplasia might end compromising cerebrospinal fluid flow. A prompt diagnosis and coordinated multidisciplinary treatment may help to avoid long-term deleterious impact of hyperfunctioning endocrinopathies in these patients.

Resultados quirúrgicos de fracturas cervicales traumáticas en pacientes con espondilitis anquilosante / Surgical outcomes of traumatic cervical fractures in patients with ankylosing spondylitis

Objetivo: La espondilitis anquilosante es una enfermedad reumática inflamatoria que afecta principalmente al esqueleto axial. La columna vertebral rígida puede secundariamente desarrollar osteoporosis, lo que aumenta aún más el riesgo de fractura vertebral. En este estudio, hemos revisado las fracturas en pacientes con espondilitis anquilosante que habían sido diagnosticados clínicamente para definir mejor el mecanismo de la lesión, déficit neurológico asociado y las estrategias de tratamiento. Métodos: Entre enero del 2004 y diciembre del 2014, 6 pacientes fueron revisados con espondilitis anquilosante y con complicaciones neurológicas después de caídas. El estudio de neuroimagen se obtuvo en todos los pacientes mediante el uso de la radiografía simple, TC y RM. La discapacidad se valoró según la escala de ASIA, se utilizó con el fin de evaluar el estado neurológico de los pacientes. La decisión quirúrgica se basó en relación con la afectación neurológica y la inestabilidad espinal. Resultados: Se identificaron un total de 6 lesiones cervicales en pacientes con espondilitis anquilosante: 2 presentaron fracturas por mecanismos de extensión y 4 por mecanismos de flexión. Todos los casos fueron intervenidos quirúrgicamente. Los 6 pacientes presentaron déficit neurológico postraumático y en 4 de ellos se observó mejoría neurológica tras la cirugía. Dos casos no mejoraron tras la cirugía. Uno de ellos presentó un grado de ASIA A y el otro paciente, que mejoró inicialmente con la cirugía, falleció por neumonía en el postoperatorio dos meses después. Conclusiones: Los pacientes con espondilitis anquilosante son altamente susceptibles a la fractura vertebral y lesiones de la médula espinal, incluso después de traumatismos leves. Se recomienda la TC inicial o la RM de toda la columna vertebral, incluso si los síntomas del paciente son leves. El paciente también debe tener la estabilización quirúrgica temprana para corregir la deformidad espinal y evitar el empeoramiento del estado neurológico del paciente

Objective: Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. Methods: Between January 2004 and December 2014, 6 patients with ankylosing spondylitis and neurological complications after injuries were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Surgical decision was based on relationship of neurological involvement and spinal instability. Results: A total of 6 cervical injuries were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 2 patients were associated with a hyperextension mechanism and 4 cases by flexion mechanism. Posttraumatic neurological deficits were demonstrated in all 6 cases and neurological improvement after surgery was observed in 4 of these cases. The two cases were not improved by the surgery was on a case by presenting a degree of Asia A and another patient who initially improved with surgery but died of pneumonia in the postoperative. Conclusions: Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status

Surgical outcomes of traumatic cervical fractures in patients with ankylosing spondylitis. / Resultados quirúrgicos de fracturas cervicales traumáticas en pacientes con espondilitis anquilosante.

OBJECTIVE: Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. METHODS: Between January 2004 and December 2014, 6 patients with ankylosing spondylitis and neurological complications after injuries were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Surgical decision was based on relationship of neurological involvement and spinal instability. RESULTS: A total of 6 cervical injuries were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 2 patients were associated with a hyperextension mechanism and 4 cases by flexion mechanism. Posttraumatic neurological deficits were demonstrated in all 6 cases and neurological improvement after surgery was observed in 4 of these cases. The two cases were not improved by the surgery was on a case by presenting a degree of Asia A and another patient who initially improved with surgery but died of pneumonia in the postoperative. CONCLUSIONS: Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.

Angiolipoma epidural lumbar / Lumbar spinal angiolipoma

Los angiolipomas espinales son tumores de carácter benigno poco frecuentes que habitualmente se localizan en el espacio epidural de la columna torácica y que representan del 0,14 al 1,2% de todos los tumores espinales. Los angiolipomas lumbares son aún más infrecuentes, representando solo el 9,6% de todos los angiolipomas extradurales. Presentamos el caso de una mujer que refería dolor lumbar de varios meses de evolución, que se intensificó en los 3 últimos días, sin antecedentes de traumatismo ni esfuerzo físico y que no presentaba déficit neurológico. En la resonancia magnética se apreciaba una masa extradural a nivel lumbar L1-L2 y de localización posterior que producía una disminución del diámetro anteroposterior del canal medular. La paciente después de la cirugía mejoró su sintomatología. En la mayoría de los casos es posible realizar una extirpación total de la lesión, siendo el pronóstico excelente incluso si la lesión es infiltrante. Por ello se aconseja no adoptar una actitud quirúrgica excesivamente agresiva de cara a conseguir una resección completa

Spinal angiolipomas are fairly infrequent benign tumours that are usually located in the epidural space of the thoracic column and represent 0.14% to 1.3% of all spinal tumours. Lumbar angiolipomas are extremely rare, representing only 9.6% of all spinal extradural angiolipomas. We report the case of a woman who complained of a lumbar pain of several months duration with no neurological focality and that had intensified in the last three days without her having had any injury or made a physical effort. The MR revealed an extradural mass L1-L2, on the posterior face of the medulla, decreasing the anteroposterior diameter of the canal. The patient symptoms improved after surgery. Total extirpation of the lesion is possible in most cases, and the prognosis is excellent even if the lesion is infiltrative. For this reason, excessively aggressive surgery is not necessary to obtain complete resection

[Lumbar spinal angiolipoma]. / Angiolipoma epidural lumbar.

Spinal angiolipomas are fairly infrequent benign tumours that are usually located in the epidural space of the thoracic column and represent 0.14% to 1.3% of all spinal tumours. Lumbar angiolipomas are extremely rare, representing only 9.6% of all spinal extradural angiolipomas. We report the case of a woman who complained of a lumbar pain of several months duration with no neurological focality and that had intensified in the last three days without her having had any injury or made a physical effort. The MR revealed an extradural mass L1-L2, on the posterior face of the medulla, decreasing the anteroposterior diameter of the canal. The patient symptoms improved after surgery. Total extirpation of the lesion is possible in most cases, and the prognosis is excellent even if the lesion is infiltrative. For this reason, excessively aggressive surgery is not necessary to obtain complete resection.

Hemangioblastoma radicular extraforaminal de la raíz L4 derecha / Hemangioblastoma of the right L4 nerve root with radicular extraforaminal involvement

Los hemangioblastomas son tumores benignos, hipervasculares, cuya localización más frecuente es a nivel de la fosa posterior o la médula espinal. Los hemangioblastomas radiculares representan menos del 2% del total. Presentamos el caso de un paciente con un cuadro de dolor radicular en el territorio de la raíz L4 derecha a consecuencia de un hemangioblastoma radicular dependiente de dicha raíz. El diagnóstico primario de esta patología suele ser erróneo, sospechándose esta entidad únicamente durante el acto quirúrgico. Dada la gran vascularización que presentan, es aconsejable intentar una embolización prequirúrgica para disminuir así el sangrado intraoperatorio y evitar lesiones en raíces elocuentes. En nuestro caso, tras la devascularización del tumor y bajo control neurofisiológico, se consiguió una extirpación completa de la lesión sin evidenciarse déficit neurológico posterior

Hemangioblastomas are benign hypervascular tumours, which are frequently located at the posterior fossa or the spinal cord. Nerve root hemangioblastomas account for less than 2%of total cases. Sometimes the initial diagnosis can be inaccurate and the final diagnosis is not reached until the surgical procedure is performed. Given the high vascularisation of this particular kind of tumour, preoperative embolisation of the tumour is recommended to reduce surgical bleeding and minimise the risk of injuries to motor nerve roots. In this particular case, the patient presented with radicular pain in the right L4 nerve root territory originated by a radicular extraforaminal hemangioblastoma. After tumour devascularization and under neurophysiological control, total excision of lesion was achieved without posterior neurological deficit

[Hemangioblastoma of the right L4 nerve root with radicular extraforaminal involvement]. / Hemangioblastoma radicular extraforaminal de la raíz L4 derecha.

Hemangioblastomas are benign hypervascular tumours, which are frequently located at the posterior fossa or the spinal cord. Nerve root hemangioblastomas account for less than 2% of total cases. Sometimes the initial diagnosis can be inaccurate and the final diagnosis is not reached until the surgical procedure is performed. Given the high vascularisation of this particular kind of tumour, preoperative embolisation of the tumour is recommended to reduce surgical bleeding and minimise the risk of injuries to motor nerve roots. In this particular case, the patient presented with radicular pain in the right L4 nerve root territory originated by a radicular extraforaminal hemangioblastoma. After tumour devascularization and under neurophysiological control, total excision of lesion was achieved without posterior neurological deficit.

La eritropoyetina como factor de protección de la radioterapia sobre células del sistema nervioso central. Estudio in vitro / Erythropoietin as a protective factor in rat CNS cells receiving radiotherapy -an in vitro study

Objetivo. Investigar el efecto de la eritropoyetina en cultivos celulares de corteza cerebral de ratas cuando se administra radioterapia. Materiales y métodos. El estudio se desarrolla con la obtención de corteza cerebral de embriones de 17 días de preñez de ratas Wistar. Las células cultivadas después de 72 horas de la extracción de la corteza se dividieron en dos grupos, a uno de ellos se le administró eritropoyetina alfa a una concentración de 30 pM y el otro era el grupo control. A los dos grupos de células se les radió con 6 Gy mediante un aparato Phoenix. Tras la radioterapia permanecieron 24 horas en la incubadora antes de fijarlas. Las células fueron fijadas con formaldehído al 4%. A continuación, con la técnica de TUNEL, se valoró el número de células apoptóticas en los cultivos radiados. Resultados. Se observó un porcentaje de apoptosis del 25,22% del grupo de cultivo sin eritropoyetina, mientras que en el grupo de células radiadas con eritropoyetina fue del 15,5%. Las variables cuantitativas se analizaron mediante el test t de Student y el resultado de la comparación entre los dos grupos fue estadísticamente significativo (p < 0,0001). Conclusión. En nuestro modelo experimental in vitro se comprobó que la eritropoyetina es eficaz en la prevención de la apoptosis en células del sistema nervioso central de ratas por radiación. Esto abre nuevos campos para la investigación del efecto protector del sistema nervioso (AU)

Aim. To investigate the effect of erythropoietin in cultured rat cerebral cortex cells receiving radiotherapy. Materials and methods. Cerebral cortex was taken from 17-day-old Wistar rat embryos and placed in culture. At 72 hours, the cultures were divided into two groups, one receiving 30 pM erythropoietin alpha and the other was the control group. Both groups received 6 Gy from a Phoenix apparatus and were incubated for another 24 hours before fixation in 4% formaldehyde. TUNEL technique was employed to calculate the number of apoptotic cells in the irradiated cultures. Results. Apoptosis affected 25.22% of the cells cultured without erythropoietin and 15.5% in the group receiving erithropoyetin. Student’s t-test was used to analyse quantitative variables and showed a significant difference in apoptosis between the two groups (p < 0.0001). Conclusion. Our in vitro experimental model demonstrated that erythropoietin effectively prevents apoptosis in irradiated rat SNC cells, opening new fields for investiga ion into protective agents for the nervous system (AU)

[Erythropoietin as a protective factor in rat CNS cells receiving radiotherapy -an in vitro study]. / La eritropoyetina como factor de proteccion de la radioterapia sobre celulas del sistema nervioso central. Estudio in vitro.

AIM: To investigate the effect of erythropoietin in cultured rat cerebral cortex cells receiving radiotherapy. MATERIALS AND METHODS: Cerebral cortex was taken from 17-day-old Wistar rat embryos and placed in culture. At 72 hours, the cultures were divided into two groups, one receiving 30 pM erythropoietin alpha and the other was the control group. Both groups received 6 Gy from a Phoenix apparatus and were incubated for another 24 hours before fixation in 4% formaldehyde. TUNEL technique was employed to calculate the number of apoptotic cells in the irradiated cultures. RESULTS: Apoptosis affected 25.22% of the cells cultured without erythropoietin and 15.5% in the group receiving erithropoyetin. Student's t-test was used to analyse quantitative variables and showed a significant difference in apoptosis between the two groups (p < 0.0001). CONCLUSION: Our in vitro experimental model demonstrated that erythropoietin effectively prevents apoptosis in irradiated rat SNC cells, opening new fields for investigation into protective agents for the nervous system.

TITLE: La eritropoyetina como factor de proteccion de la radioterapia sobre celulas del sistema nervioso central. Estudio in vitro.Objetivo. Investigar el efecto de la eritropoyetina en cultivos celulares de corteza cerebral de ratas cuando se administra radioterapia. Materiales y metodos. El estudio se desarrolla con la obtencion de corteza cerebral de embriones de 17 dias de preñez de ratas Wistar. Las celulas cultivadas despues de 72 horas de la extraccion de la corteza se dividieron en dos grupos, a uno de ellos se le administro eritropoyetina alfa a una concentracion de 30 pM y el otro era el grupo control. A los dos grupos de celulas se les radio con 6 Gy mediante un aparato Phoenix. Tras la radioterapia permanecieron 24 horas en la incubadora antes de fijarlas. Las celulas fueron fijadas con formaldehido al 4%. A continuacion, con la tecnica de TUNEL, se valoro el numero de celulas apoptoticas en los cultivos radiados. Resultados. Se observo un porcentaje de apoptosis del 25,22% del grupo de cultivo sin eritropoyetina, mientras que en el grupo de celulas radiadas con eritropoyetina fue del 15,5%. Las variables cuantitativas se analizaron mediante el test t de Student y el resultado de la comparacion entre los dos grupos fue estadisticamente significativo (p < 0,0001). Conclusion. En nuestro modelo experimental in vitro se comprobo que la eritropoyetina es eficaz en la prevencion de la apoptosis en celulas del sistema nervioso central de ratas por radiacion. Esto abre nuevos campos para la investigacion del efecto protector del sistema nervioso.

Tumores vertebrales de la región cervical alta / Tumours of the upper cervical spine

Los tumores vertebrales originados en los primeros segmentos cervicales son poco frecuentes. Exponemos nuestra experiencia en el manejo de estas lesiones. Material y métodos Se revisaron de forma retrospectiva las historias clínicas de pacientes intervenidos en nuestro centro entre enero de 2000 y junio de 2011.Resultados Presentamos una serie de 9 pacientes con tumores en C1-C2-C3. De ellos 2 fueron metastáticos. Seis de los restantes 7 casos correspondían a tumores malignos primarios: 3 cordomas, 2 plasmocitomas y un condrosarcoma. El paciente restante fue diagnosticado de osteocondroma. El síntoma con el que comenzaron fue cervicalgia en todos los casos. Se practicó un doble abordaje anterior y posterior en 3 pacientes, abordaje posterior en 3 y abordaje exclusivamente anterior en otros 3. En 7 casos se realizó una escisión intralesional. A los tumores malignos se les administró tratamiento adyuvante en forma de radioterapia y/o quimioterapia. Conclusiones Los tumores cervicales altos suelen ser en general malignos y precisan un tratamiento encaminado a la resección en bloque, la estabilización y la administración de tratamientos adyuvantes. Sin embargo, esta resección no es técnicamente posible en múltiples ocasiones. Este hecho empeora el pronóstico y concede gran importancia a la administración de tratamientos adyuvantes(AU)

Objective: Vertebral tumours arising in the upper cervical spine are rare. We present our experience in managing these neoplasms. Material and methods: We retrospectively reviewed the case histories of patients treated a tour institution between January 2000 and June 2011.Results: There were 9 patients with tumours in C1-C2-C3: 2metastases, 3 chordomas,2 plasmocytomas, 1 chondrosarcoma and 1 osteochondroma. All patients complained of neck pain at the time of diagnosis. Three patients underwent an anterior and posterior approach, 3 an exclusively posterior approach and 3 an exclusively anterior surgical approach. Tumour resection was intralesional in 7 cases. Chemo-radiotherapy was used as adjuvant therapy in patients with malignant tumours. Conclusions: Vertebral tumours in the upper cervical spine are usually malignant. Achievingen bloc resection is particularly challenging and is technically unfeasible in many cases. This worsens the prognosis and makes adjuvant treatment very important (AU)

[Tumours of the upper cervical spine]. / Tumores vertebrales de la región cervical alta.

OBJECTIVE: Vertebral tumours arising in the upper cervical spine are rare. We present our experience in managing these neoplasms. MATERIAL AND METHODS: We retrospectively reviewed the case histories of patients treated at our institution between January 2000 and June 2011. RESULTS: There were 9 patients with tumours in C1-C2-C3: 2metastases, 3chordomas, 2plasmocytomas, 1chondrosarcoma and 1osteochondroma. All patients complained of neck pain at the time of diagnosis. Three patients underwent an anterior and posterior approach, 3 an exclusively posterior approach and 3 an exclusively anterior surgical approach. Tumour resection was intralesional in 7 cases. Chemo-radiotherapy was used as adjuvant therapy in patients with malignant tumours. CONCLUSIONS: Vertebral tumours in the upper cervical spine are usually malignant. Achieving en bloc resection is particularly challenging and is technically unfeasible in many cases. This worsens the prognosis and makes adjuvant treatment very important.