An Unusual Presentation of Pulmonary Edema During an Ice Dive at Altitude.

Military diving operations occur in a wide range of austere environments, including high-altitude environments and cold weather environments; however, rarely do both conditions combine. Ice diving at altitude combines the physiologic risks of diving, a hypothermic environment, and a high-altitude environment all in one. Careful planning and consideration of the potential injuries and disease processes affiliated with the aforementioned physiologic risks must be considered. In this case report, we describe a Navy diver who became obtunded secondary to hypoxia during an ice dive at 2,987 m (9,800 ft) elevation and was subsequently diagnosed with high-altitude pulmonary edema. Further consideration of the environment, activities, and history does not make this a clear case, and swimming-induced pulmonary edema which physiologically possesses many overlaps with high-altitude pulmonary edema may have contributed or been the ultimate causal factor for the diver's acute response.

Anatomical Basis of the Zygomatic-Transmandibular Approach: Operative Video.

Tumor growth in infratemporal fossa (ITF) and parapharyngeal space (PPS) is generally slow and generates very few clinical manifestations, so it is not uncommon for tumors to reach large dimensions at the time of diagnosis, making necessary to perform ample approaches. In zygomatic-transmandibular approach (ZTMA), the access of the ITF and PPS is obtained by a combination of a pterional craniotomy plus a zygomatic-mandibular osteotomy. Tumor excision is achieved by its initial dissection from all of the neurovascular structures of the middle fossa by the neurosurgical team and the final resection by the head and neck team from below. In the first part of this video, we present a brief anatomical-surgical description of the ITF and PPS and in the second part, we show case of a trigeminal schwannoma that could be successfully removed through a ZTMA. Using this approach, an ample and safe exposure of the ITF and PPS is achieved, without affecting the chewing or facial nerve function and with excellent cosmetic results, so it can be considered as a reliable surgical option, particularly in cases of giant tumors that affect these regions ( Figs. 1 and 2 ). The link to the video can be found at: https://youtu.be/oxVFhzT8HsQ .

"Qué hay de nuevo""Osseous Remodeling Technique of the Sella Turcica: A New Surgical Option for Primary Empty Sella Syndrome" / "What's new ""Osseous Remodeling Technique of the Sella Turcica: A New Surgical Option for Primary Empty Sella Syndrome"

La silla turca vacía (STV) o como se la denominó más recientemente, aracnoidocele selar, es una entidad clínico-radiológica con una prevalencia que, si bien no se conoce con exactitud, se estima que es entre el 2 al 20%1. Dos tipos de STV han sido descriptas según su etiología: primaria y secundaria. En la primaria, no existe antecedente de cirugía hipofisaria previa y se cree que se produce debido a un diafragma selar deficiente. Por otro lado, cuando se genera luego de la exéresis de un tumor hipofisario se denomina secundaria. Por lo general, la STV primaria es diagnosticada como un hallazgo incidental en resonancia magnética, en donde se evidencia una herniación aracnoidea y de líquido cefalorraquídeo (LCR) a través del diafragma selar, comprimiendo la glándula hipofisiaria contra el piso de la silla turca. Algunos pacientes pueden manifestar síntomas clínicos (síndrome de silla turca vacía), entre ellos, cefalea, alteraciones endocrinológicas, fístula de LCR y alteraciones visuales. La cirugía está indicada en estas dos últimas manifestaciones

Petroclival Meningiomas: A Simple System That Could Help in Selecting the Approach.

BACKGROUND: Petroclival meningiomas (PCM) represent a neurosurgical challenge due to their strategic location close to the brainstem. OBJECTIVE: To assess the applicability of a retrosigmoid approach (RSA) by analyzing the degree of displacement of the middle cerebellar peduncle (MCP) elicited by PCM. METHODS: Patients with PCM were prospectively included and divided into those whose imaging studies showed that the posterior end of the MCP was displaced by the tumor and were eligible for and underwent RSA (group A) and those who were not eligible for RSA and who underwent surgery via a posterior transpetrosal approach (group B). We compared tumor behavior, clinical characteristic of patients and surgical results. RESULTS: Twenty patients with PCM were enrolled and allocated to group A (n = 15) or group B (n = 5). The clinical manifestations were more severe in group B; tumors in this group were larger and gross total removal was achieved in only 1 patient (20%). In comparison, in 12 cases on group A, tumors could be totally removed (80%) and all of these patients could recover their quality of life after surgery. CONCLUSION: To our knowledge, this study is the first to consider displacement of the MCP when establishing a suitable surgical approach for PCM. Our results suggest that the RSA becomes increasingly suitable when peduncle displacement is greater. By using this method, it was also possible to identify two types of tumors: petroclivals (group A) and clivopetrosals (group B), that show some specific clinical and surgical differences.

Osseous Remodeling Technique of the Sella Turcica: A New Surgical Option for Primary Empty Sella Syndrome.

BACKGROUND: Empty sella is an anatomic finding that is usually asymptomatic. However, when patients with empty sella finding present with visual deficits, surgical treatment may be necessary. The main goal of surgery is to elevate sellar content through a transsphenoidal approach. The aim of this study was to demonstrate a new technique for precise reconstruction of the sellar floor using a heterologous bone block to restore the anatomic elements of the sella turcica. METHODS: Three patients with primary empty sella who presented with visual field defects were prospectively included. Surgery was performed through a microsurgical transsphenoidal approach and involved elevating the sellar content by using a tricortical heterologous bone graft, the dimensions of which were obtained considering the exact dimensions of each patient's sella turcica. The graft was premodeled outside the surgical bed and carefully introduced into the sella turcica to achieve the required elevation (chiasmapexy). RESULTS: Vision of all 3 patients improved, and the improvement persisted throughout the follow-up period. 2 patients, this improvement was noted immediately after surgery, and in the third patient, this change in vision occurred 1 week later. Long-term imaging studies showed the persistence of the bone graft in the sella turcica and the exact elevation of the sellar content at the end of the follow-up period. There were no complications in the present series. CONCLUSIONS: The technique presented here is simple and reproducible and allows an almost exact and persistent elevation of the sellar content.

Meningiomas intracraneales, evolución de pacientes tratados en INNN / Intracraneal meningiomas, evolution of patients treated at de National Institute of Neurology and Neurosurgery

La investigación desarrollada incluyó 110 casos diagnosticados de Meningioma intracraneal, en los cuales se observó la evolución, atendiendo al cuadro sintomático postquirúrgico y la calidad de vida de los pacientes despúes de la intervención y las posibles recidivas y reintervenciones ulteriores. La evolución fue buena, pues al momento de desarrollar el presente estudio 68 casos se mantenian con síntomas menores que no imposibilitaban su vida diaria, o estaban asintomáticos, lo que representa el 61,81 por ciento de la muestra estudiada

Meningiomas intracraneales, evolución de pacientes tratados en INNN / Intracraneal meningiomas, evolution of patients treated at de National Institute of Neurology and Neurosurgery

La investigación desarrollada incluyó 110 casos diagnosticados de Meningioma intracraneal, en los cuales se observó la evolución, atendiendo al cuadro sintomático postquirúrgico y la calidad de vida de los pacientes despúes de la intervención y las posibles recidivas y reintervenciones ulteriores. La evolución fue buena, pues al momento de desarrollar el presente estudio 68 casos se mantenian con síntomas menores que no imposibilitaban su vida diaria, o estaban asintomáticos, lo que representa el 61,81 por ciento de la muestra estudiada(AU)

Hemorragia intraparenquimatosa / Intraparenchymatous hemorrage

La enfermedad cerebrovascular constituye la tercera causa de muerte en Cuba, con una incidencia de 150-200 por cada 100 000 habitantes. Dentro de ella la hemorragia intraparenquimatosa abarca del 10-15 por ciento. Un estudio descriptivo retrospectivo de 111 pacientes con el diagnóstico de hemeorragia intraparenquimatosa, con o sin comunicación al espacio subaracnoideo y/o sistema ventricular, arroja interesantes datos sobre la etilogía más frecuente de esta patologia

Hemorragia intraparenquimatosa / Intraparenchymatous hemorrage

La enfermedad cerebrovascular constituye la tercera causa de muerte en Cuba, con una incidencia de 150-200 por cada 100 000 habitantes. Dentro de ella la hemorragia intraparenquimatosa abarca del 10-15 por ciento. Un estudio descriptivo retrospectivo de 111 pacientes con el diagnóstico de hemeorragia intraparenquimatosa, con o sin comunicación al espacio subaracnoideo y/o sistema ventricular, arroja interesantes datos sobre la etilogía más frecuente de esta patologia(AU)