Surgical approach to the treatment of pituicytoma. Report of five cases and a literature review.

Background: Pituicytoma (PTs) is a rare tumor of the sella and suprasellar region, derived from the pituicytes of the neurohypophysis, having distinct histological characteristics of glial neoplasms. We reported, the clinical data, neuroimaging studies, surgical approaches and pathology in five patients with PTs and also, we reviewed the literature. Methods: Retrospective chart from five consecutive patients with PTs treated at one University Hospital from 2016 to 2021 were reviewed. In addition, we conducted a search in PubMed/Medline databases using the term "Pituicytoma". Data regarding age, gender, pathological findings, and treatment modality applied were extracted. Results: All patients were female, aged 29-63, complaining of headaches, visual loss and field defects, dizziness and normal or abnormal levels of circulating pituitary hormones. Magnetic Resonance Imaging (MRI) showed in all patients a sellar and suprasellar mass, which was removed through an endoscopic transsphenoidal approach. Our third patient had a subtotal resection followed by close observation. Histopathology showed a glial non-infiltrative tumors with spindle cells, and a final diagnosis of pituicytoma was made. After surgery, visual field defects in all patients were normalized, and in two patients normal levels of plasma hormones were restored. After a mean of three years follow-up, the patients were managed post-operatively through close clinical observation and serial MRI. None of the patients had recurrence of the disease. Conclusion: PTs is a rare glial tumor of the sellar and suprasellar region that arises from neurohypophyseal pituicytes. Disease control may be achieved by total excision.

International and Multicenter Prospective Controlled Study of Dysphagia After Anterior Cervical Spine Surgery.

BACKGROUND: In the context of anterior approach to the cervical spine, dysphagia is a common complication and still without a clear distinction of risk factors. OBJECTIVE: To analyze the risk factors of dysphagia after cervical spine surgery. METHODS: Multicenter prospective study evaluated patients who underwent anterior cervical spine surgery for degenerative pathologies, studying surgical, anesthesia, base disease, and radiological variables (preoperatively, 24 hours, 1 and 3 weeks, and 6 months after surgery), with control group matched. Postoperative dysphagia was assessed by Swallowing Satisfaction Index and Swallowing Questionnaire; besides, based on multiple logistic regression model, a risk factor analysis correlation was applied. RESULTS: In total, 233 cervical patients were evaluated; most common level approached was C5-C6 (71.8%). All showed same decreasing trade for dysphagia incidence-with more cases on cervical group ( P < .05); severe cases were rare. At postoperative day 1, identified risk factors were approach to C3-C4 (4.11, P < .01), loss of preoperative cervical lordosis (2.26, P < .01), intubation attempts ≥2 (3.10, P < .01), and left side approach (1.85, P = .02); at day 7, body mass index ≥30 (2.29, P = .02), C3-C4 (3.42, P < .01), and length of surgery ≥90 minutes (2.97, P = .005); and at day 21, C3-C4 were kept as a risk factor (3.62, P < .01). CONCLUSION: A high incidence level of dysphagia was identified, having a clear decreasing trending (number of cases and severity) through postoperative time points; considering possible risk factors, strongest correlation was the approach at the C3-C4 level-statistically significant at the 24 hours, 7 days, and 21 days assessment.

Bilateral Radioscopically Guided Erector Spinae Plane Block for Postoperative Analgesia in Spine Surgery: A Randomized Clinical Trial.

BACKGROUND: We compare two perioperative pain management procedures(a radioscopicallyguided erector spinae plane [ESP] block versus the standard wound infiltration technique with local anesthetics) in patients undergoing lumbosacral spine surgery. METHODS: A randomized, double-blind clinical trial was performed, in which adults at our hospital undergoing lumbosacral surgery without fixation were randomly assigned to receive either the standard wound infiltration technique, employing long-term anesthetics, or a radioscopicallyguided ESP block. Postoperative pain severity, morphine consumption, number of patients immobilized due to wound pain, length of hospitalization, and complications were recorded. RESULTS: Over the first 7 postoperative hours, pain relief was superior in the ESP block group among patients who underwent diskectomies or one-level decompression (p< 0.0001). Using an ESP block also was statistically superior at decreasing all postoperative variables recorded in patients scheduled for multilevel decompression: visual analog scale (VAS) pain severity over the first 7 hours after the procedure (p = 0.0004); number of patients with wound pain 1 (p = 0.049), 7 (p< 0.0001), and 24 hours (p = 0.007) after surgery; length of hospitalization (p = 0.0007), number of patients immobilized for wound pain (p = 0.0004) and rescue morphine consumption (p< 0.0001). CONCLUSION: The ESP block is a safe procedure that seems to outperform the infiltration wound technique for postoperative pain management in patients undergoing open spinal surgery. Future studies are needed to verify its effectiveness for arthrodesis/fixation and minimallyinvasive procedures, and for chronic spine pain relief.

Anatomía de las osteotomías dorsolumbares en fotografías en 3D / Anatomy of thoracolumbar osteotomies in 3D photographs

Introducción y objetivo: Existe evidencia contundente que demuestra la relación entre el balance sagital y la calidad de vida de los pacientes adultos con deformidad espinal, de manera que la corrección y realineación en ese plano se ha transformado en un objetivo primario en el tratamiento quirúrgico de dichas afecciones. Las osteotomías dorsolumbares permiten liberar el raquis para realizar dicha realineación sin el uso de fuerza indebida. Sin embargo, son técnicas complejas y con alta tasa de complicaciones intra y post operatorias. Teniendo en cuenta que el conocimiento anatómico de dichos procedimientos es clave, el objetivo de esta revisión consiste en realizar una descripción de las osteotomías dorsolumbares mediante el uso de fotografías en 3D de un preparado cadavérico de raquis lumbar. Materiales y métodos: Se utilizó un preparado cadavérico formolizado de raquis lumbar. Se realizaron las osteotomías espinales lumbares según la clasificación de Schwab et al., en los segmentos L3 y L4. Se tomaron imágenes fotográficas en 3 dimensiones utilizando equipo Nikon D90, con lente 50 mm Af 1.8G, flash Nikon SB700, y una barra regulable para fotografía 3D. Las imágenes fotográficas obtenidas fueron procesadas con los siguientes softwares con técnica anaglífica: Anaglyph Maker versión 1.08 y StereoPhoto Maker versión 4.54. Resultados: Se realiza una descripción de las osteotomías según la clasificación en 6 grados anatómicos de Schwab y colaboradores. Conclusión: La utilización de la técnica fotográfica 3D permitió demostrar el tipo y magnitud de resección ósea necesaria en cada grado de osteotomía.

Introduction and objective: There is strong evidence that shows the relationship between the sagittal balance and the quality of life of adult patients with spinal deformity. According to that, the correction and realignment of the sagittal plane has become a primary objective in the surgical treatment of these conditions. The dorsolumbar osteotomies allow the spine to be released, in order to perform that realignment without the use of undue force. However, they are complex techniques, with a high rate of intra and post-operative complications. Taking into account that the anatomical knowledge of these procedures is fundamental, the objective of this review was to describe the dorsolumbar osteotomies using 3D photographs of a cadaveric preparation of the lumbar spine. Materials and methods: A cadaveric formolized lumbar spine preparation was used. Lumbar spinal osteotomies were performed according to the classification of Schwab et al. Three-dimensional photographic images were taken using Nikon D90 equipment, with a 50mm AF 1.8G lens, Nikon SB700 flash, and an adjustable bar for 3D photography. The photographic images obtained were processed with the following software with anaglyphic technique: Anaglyph Maker version 1.08 and StereoPhoto Maker version 4.54. Results: A description of the osteotomies was made, according to the 6 anatomic grades classification developed by Schwab et al. Conclusion: The use of the 3D photographic technique allowed to demonstrate the type and magnitude of bone resection needed in each degree of osteotomy.

Análisis morfométrico del atlas por tomografía computada para la colocación de tornillos trans-masas laterales / Morphometric analysis of the atlas by computed tomography for the placement of lateral transmass screws

Objetivos: Realizar un análisis morfométrico del atlas por tomografía computada, determinando los valores promedio, medianos, y de variabilidad de dicha vértebra para la correcta colocación de tornillos trans-masas laterales. Introducción: Existe una significativa variabilidad interpersonal en los aspectos morfológicos del atlas, y dada su proximidad a estructuras neurovasculares (arteria vertebral, médula cervical, raíz de C2), hacen mandatario un exhaustivo planeamiento prequirúrgico para la elección de la técnica de artrodesis, tipo de tornillos a utilizar, y su trayectoria. Material y métodos: Se realizó un estudio de diseño de tipo exploratorio, descriptivo, observacional, retrospectivo, transversal. Se revisaron 99 tomografías computadas de la columna cervical. Se midieron parámetros morfométicos y angulaciones desde un "punto de entrada" en la masa lateral de C1, que fueron llamados A, B, C, D, E, F, G y H. Las mediciones de los parámetros a estudiar fueron realizadas con el programa RadiAnt DICOM Viewer (64-bit) y posteriormente volcadas a una ficha de registro de datos. Discusión: La distribución según género fue de 34 varones y 65 mujeres. Se encontró una diferencia estadísticamente significativa no solo en lo referente al género (masculino vs femenino; parámetros A, B, C, D, F, G, H p-valor < 0,05) de los parámetros medidos, sino también según lateralidad (derecha vs izquierda; parámetros C, E, F, G p-valor < 0,05). La investigación propone además la generación de una base de datos con información morfométrica del atlas. Conclusión: Existe una diferencia estadísticamente significativa en las propiedades morfológicas del atlas, tanto en lo relativo al género (masculino vs femenino), como en la lateralidad (derecha vs izquierda). Es por ello que el presente estudio enfatiza en la importancia de la realización prequirúrgica de una tomografía computada de la columna cervical superior para garantizar una efectiva y segura instrumentación a éste nivel, según el largo, ancho y trayectoria de los tornillos a utilizar.

Objectives: To morphometrically analyze the atlas, using computed tomography, thereby defining mean, median and variability values of C1 for the correct placement of lateral mass screws. Introduction: Significant interpersonal variability exists among the various morphological characteristics of the atlas. Given the structure's close relationship to neurovascular structures like the vertebral arteries, cervical spinal cord, and cervical roots, exhaustive pre-surgical planning becomes mandatory. Such planning assists in the choice of arthrodesis technique, and the dimensions and trajectory of screws. Material and Methods: A retrospective, observational study was performed, for which the computed tomography (CT) scans of 99 cervical spines were reviewed. Morpho-metric parameters and angulations were measured from an "entry point" in the lateral mass at C1; these parameters were alphabetically labeled from A through H. The RadiAnt DICOM Viewer (64-bit) program was used to measure all parameters of interest, the values of which then were entered into a data collection file.Discussion: By gender, there were 34 men and 65 women. A statistically-significant difference was found between the two genders for all parameters except parameter E (all p-values < 0,05), and between the two sides (right vs. left) for parameters C, E, F, and G. Our results argue for the creation of a general database containing morphometric information on the atlas. Conclusion: Statistically-significant differences exist between men and women, and from right to left, among the morphometrical features of the atlas. This underscores the need for careful preoperative surgical planning, including the use of CT scanning to estimate optimum screw lengths and trajectories.

[Spino-pelvic sagittal parameters in an asymptomatic population in Argentina]. / Parámetros sagitales espino-pélvicos en una población asintomática Argentina.

OBJECTIVES: To assess and describe spinal and pelvic sagittal parameters in a series of 100 Argentinian volunteers. METHODS: Lateral full-spine X-rays were obtained prospectively from 100 volunteers (30 males and 70 females), average age 34.1 years. All the volunteers were asymptomatic at the time of the study. Full-length left lateral spine radiographs (36'' cassette) were made using Kodak Elite CR equipment. The authors made determinations for the digital X-rays using Surgimap®, version 2.2.9.9.2. The following parameters were recorded: C7 SVA, C2-C7 CL, TK, LL, TPA, T1SPi, PI, PT, SS, L4-S1 angle, L1-L4 angle, PI-LL mismatch and CTPA. The data were analyzed using Medcalc 11.2 software. Descriptive statistics were calculated for each parameter according to its own measure score and distribution. Estimates of 95% reference and confidence intervals were calculated for each parameter. P = 0.05 was set as the threshold for statistical significance. Volunteers were classified using the Roussouly morphometric classification system. RESULTS: Respective means for the above-listed variables were: CL -10.04, TK 30.14, T1SPi -6.5, L1-L4 -12.45, L4-S1 -46.16, CTPA 2.5, TPA 4.65, PT 11.22, PI 48.04, LL -59. 10, PI-LL -11.11, C7 SVA mm -23.68. Plus/minus two standard deviations (SD) for the variables were: CL (-33.26, 13.12); TK (17.15, 43.30); T1SPi (-11.78, -1.25), L1-L4 (-25.55, 0.25), L4-S1 (-64.44, -27.55), CTPA (0.33, 4.80), TPA (-8.64, 18.22), PT (-1.99, 24.75), PI (25.23, 71.44), LL (-78.74, -39.89), PI-LL (-29.10, 7.04), and C7 SVA mm (-79.45, 32.08). CONCLUSIONS: In this prospective series of 100 adult volunteers, normal values for spinal and pelvic sagittal parameters were determined in Argentinian adults.

[Trajectory of lumbar and sacral pedicular screws: Comparison between midline versus wiltse approach]. / Trayectoria de los tornillos pediculares lumbares y sacros: Comparación entre el abordaje por linea media versus el abordaje posterolateral tipo wiltse.

OBJECTIVES: To compare the posterolateral Wiltse approach and conventional Midline approach in short lumbosacral fusions in terms of the angle of convergence of pedicle screws. METHODS: We retrospectively reviewed computed tomography (CT) images of 76 lumbar and sacral pedicular screws that had been placed using a conventional midline approach (CA) (n = 38) and a Wiltse posterolateral approach (WA) (n = 38). All patients underwent short lumbosacral fusions from L3 to S1 for degenerative spinal disease. Screws with a bone gap >4 mm in any direction, cases with previous pedicular implants, and those with coronal plane curves >20° were excluded. RESULTS: Considering all implants, the angle of convergence was 23.3° (±15.8). The mean angulation in the WA group was 29.3° (±9.7), whereas in the CA group it was 17.2° (±0.6). This difference was statistically significant (P < 0.05). CONCLUSIONS: In short, lumbosacral fusion employing the Wiltse approach allowed placement of pedicle implants with more convergence than the conventional midline approach. The clinical relevance of this is unknown, and prospective randomized studies are needed to clarify this.

Espondilolistesis traumática L5-S1: presentación de 3 casos / Traumatic spondylolisthesis L5-S1: presentation of 3 cases

Objetivo: Reportar 3 casos de espondilolistesis traumáticas de L5-S1, una entidad infrecuente, con pocos casos publicados en la literatura. Material y métodos: Se revisaron las historias clínicas de 3 pacientes operados por espondilolistesis traumáticas L5-S1 en el período 2010-2015. Caso 1, varón de 30 años que sufrió una caída del caballo, anterolistesis grado II. Se realizó una artrodesis L4-S2 con realineación y soporte anterior con TLIF L5-S1. Caso 2, varón de 38 años que consultó por lumbalgia intensa luego de accidente automovilístico. Se diagnosticó una anterolistesis grado II con fractura de la base de ambas facetas ascendentes de S1. Se realizó artrodesis L5-S1 con liberación radicular y realineación. Caso 3, varón de 12 años derivado 20 días luego de un politraumatismo por el derrumbe de una pared. Se diagnosticó una espondilolistesis con dislocación facetaria bilateral. Se realizó una artrodesis L5-S1 con descompresión radicular bilateral. Todos los casos fueron estudiados en el preoperatorio con Rx, TC e IRM. El seguimiento promedio fue de 2.7 años. En los 3 casos se logró un buen control del dolor y de los síntomas neurológicos. La fusión se constató con radiografías simples en el control alejado. Conclusión: En todos los casos se logró un buen resultado clínico e imagenológico con una artrodesis sólida, realizada en un solo tiempo quirúrgico por abordaje posterior.

Objective: To report our surgical results treating three patients with traumatic L5-S1 spondylolisthesis, an infrequent lesion of which only a few isolated cases have been published. Materials and Methods: We reviewed the charts of three patients who underwent surgery from 2010-2015. Case 1 was a 30-year-old man who had fallen off a horse and in whom grade II lytic anterolisthesis was diagnosed, for which L4-S2 fusion with a L5-S1 TLIF was successfully performed. Case 2 was a 38-year-old man with severe low back pain after a car accident. Grade II anterolisthesis was diagnosed secondary to bilateral fractures of S1 facets, for which L5-S1 fusion was done. Case 3 was a 12-year-old child with low back and leg pain after a wall collapsed on top of him, who was diagnosed with anterolisthesis and bilateral facet dislocation. In this patient, L5-S1 fusion and realignment was performed. All patients were studied with full spine x-rays, CT scans and MRI. Average follow-up was 2.7 years. Pain was controlled and neurological deficits improved over the duration of long-term follow-up. X-rays revealed successful fusion in all cases.Conclusions: In our three cases, we achieved excellent clinical and radiological results with solid fusion, performed during a single surgical procedure.

Anatomía quirúrgica en 3D de las osteotomías vertebrales cervicales / 3D surgical anatomy of cervical vertebral osteotomies

Objetivo: realizar osteotomías cervicales en preparados cadavéricos, siguiendo la clasificación moderna de 7 grados según Ames y colaboradores, tomando fotos 3D para poner en evidencia la magnitud de resección ósea de cada uno de los subtipos. Material y Métodos: Se utilizaron dos preparados cadavéricos formolizados con inyección vascular, realizándose imágenes fotográficas en 3 dimensiones de los mismos. Las fotografías fueron tomadas con una camara Nikon D90, con lente 50 mm Af 1.8G, flash Nikon SB700, y una barra regulable para fotografía. Se realizó sobre las preparaciones cadavéricas la disección cervical con incisión en línea media posterior y abordaje por vía anterior segun Smith y Robinson. Se efectuó la exposición muscular y esquelitización ósea con exposición de láminas, apófisis espinosas, facetas articulares, ligamentos, discos, apófisis unciformes y cuerpos vertebrales. Mediante la utilización de un drill neumático de alta velocidad se realizaron 8 osteotomías, 4 por vía posterior y 4 por vía anterior. Resultados: Las osteotomías realizadas por vía anterior fueron la discectomía anterior completa (denominada osteotomía grado I anterior), la corpectomía parcial o total incluyendo discectomía superior e inferior (denominada osteotomía grado III), la resección completa de la unión uncovertebral o articulación de Luschka (denominada osteotomía grado IV) y la resección vertebral completa o espondilectomía (denominada osteotomía grado VII). Por vía posterior, se realizaron la facetectomía parcial (denominada osteotomía grado I posterior), la facetectomía total u osteotomía de Ponte (denominada osteotomía grado II), la osteotomía de apertura angular (denominada osteotomía grado V) y la osteotomía de cierre angular o de sustracción pedicular (denominada osteotomía grado VI). Las imágenes fotográficas obtenidas fueron procesadas con los siguientes softwares con técnica anaglífica: Anaglyph Maker versión 1.08 y StereoPhoto Maker versión 4.54...

Objective: to perform cervical osteotomies in cadaveric specimens, following the new classification of Ames et al. 3D pictures were taken to show the amount of bone resection on each subtype. Material & methods: Using two formolized cadaveric specimens with vascular injection, we took 3D pictures of osteotomies following the Ames et al classification of cervical osteotomies. The pictures were taken with a Nikon D90 camera, with a 50 mm lens Af 1.8G, Nikon SB700 flash, and an adjustable titanium frame designed to take 3D pictures. Anterior cadaveric dissections were made based on the Smith & Robinson technique. We also performed a posterior approach to expose laminar surfaces, spinous processes, facets complexes, ligaments, discs, uncovertebral joints and vertebral bodies. With the aid of a pneumatic drill, 8 osteotomies (4 anterior and 4 posterior) were progressively made and pictured. Results: The anterior osteotomies were: discectomy, corpectomy, discectomy with uncovertebral resection and spondilectomy. Posterior osteotomies were: partial facetectomy, complete facetectomy (Ponte), open wedge osteotomy and closing wedge osteotomy (pedicle substraction). Pictures were processed and fused with Anaglyph Maker 1.08 and StereoPhoto Maker 4.54...

Síndrome agudo de cauda equina por extrusión discal: presentación de 5 casos / Acute cauda equina syndrome by disc extrusion: presentation of 5 cases

OBJETIVO: describir y analizar 5 casos de síndrome agudo de la cauda equina (SACE) por hernia de disco lumbar (HDL). MATERIAL Y MÉTODOS: se revisaron las historias clínicas de 5 casos (2 masc. - 3 fem. / 27 a 47 años de edad). Comenzaron en forma súbita: lumbalgia 1, ciática unilateral 3, ciática bilateral 1, paresia 3, hipoestesia 2, anestesia en silla de montar 4, alteración esfinteriana 3 e impotencia sexual 1. El tiempo entre el inicio y la consulta fue de 4 a 11 días. El diagnóstico se hizo con RM en 4 y TAC en 1. Tenían una HDL extruída (L4-L5 en 3 casos / L5-S1 en 2 casos). RESULTADOS: fueron operados dentro de las 24 hs. de la consulta; se realizó microdiscectomía, recalibrado en 4 y microdiscectomía, hemilaminectomía en 1. El seguimiento promedio fue de 22.2 meses (11 a 44). La recuperación no fue completa en 3 pacientes. Persistieron como secuelas: retención urinaria 2, incontinência urinaria 1, impotencia sexual 1, hipoestesia en silla de montar 1. CONCLUSIÓN: en los 5 casos de SACE por HDL obtuvimos buenos resultados postoperatorios tomando una conducta quirúrgica precoz mediante procedimientos poco invasivos

OBJECTIVE: to describe and analyze 5 patients with acute cauda equina syndrome (ACES) caused by a lumbar disc herniation (LDH). Description: we review 5 patients (2 males - 3 females) with an average age of 31.2 years old (between 27-47 years). All start with acute symptoms: low back pain 1, unilateral sciatica 3, bilateral sciatica 1, motor deficit 3, hipoestesia 2, saddle and/or genital sensory disturbance 4, bladder or bowel disturbance 3 and sexual dysfunction 1. Time between symptoms onset and emergency room visit was 4-11 days. Diagnostic was made with MRI 4 and TAC 1. Everyone has a voluminous LDH (L4-L5 3 cases/ L5-S1 2 cases). PROCEDURE: all surgical procedures were made before 24 hs of the visit doing microdiscectomy, fenestration 4 and microdiscectomy, hemilaminectomy 1. Average follow up was 22.2 months (11-44m). Recovery was incomplete in 3 patients, bladder disturbance persisted in 3 cases, sexual dysfunction 1, perianal anesthesia 1. CONCLUSION: in 5 cases of ACES caused by LDH we had good surgical results using emergency microdiscectomy with minimally invasive techniques

Tarlov cysts: endoscope-assisted obliteration of the communication with the spinal subarachnoid space.

BACKGROUND AND OBJECTIVE: The physiopathology of Tarlov or perineural cyst (PC) symptoms is unknown, but probably its filling and distention with spinal cerebrospinal fluid makes them symptomatic. The objective of this study is to describe the endoscope-assisted obliteration of the communication between PCs and the spinal subarachnoid space (SSS). PATIENTS AND METHODS: From 2007 to 2011, four male and two female patients (median age: 45 years) with PCs were treated. They complained of lumbar, sciatic, and/or perineal pain. Physical examination was normal. The diagnosis was made by magnetic resonance imaging (MRI). All the cysts were located in the midline between S1 and S3. An endoscope-assisted obliteration between PC and SSS was performed. The outcome was evaluated clinically with the Odom scale and radiologically with an MRI. RESULTS: After a median follow-up of 25.83 months, the outcome was excellent (four cases), good (one case), and poor (one case). There were no complications. The postoperative MRI showed size and signal intensity changes in all PCs reflecting their exclusion from the SSS. CONCLUSIONS: The endoscope-assisted obliteration of the communication between PCs and the SSS is a simple technique that rendered excellent to good results in 83% of the cases.

Radiculopatía por hematoma espontáneo del músculo psoas ilíaco / Radicular compromise caused by a spontaneous psoas hematoma

Objetive: to describe a patient with radicular pain secondary to a psoas muscle hematoma. Description: a 76 years old female, suffering from hypertension and medicated with anticoagulants after a triple coronary stent, complained of lumbar pain treated with analgesics and physiotherapy. The pain persisted and the condition worsened with the appearance of proximal crural paresia. An MRI showed an increased volume of the right psoas iliac muscle due to a hematoma. Intervention: anticoagulants were suspended and a neurological evaluation was done. The pain, paresia and hematoma receded. Conclusion: spontaneous hematoma of the psoas muscle is an infrequent cause of radicular syndrome although it should be taken into consideration in patients medicated with anticoagulants.

Metástasis de calota / Calvarial metastasis

Objective. To describe five cases of cranial vault metastasis. Materials and methods. Clinical records and images of five patients with cranial vault metastasis were reviewed at the ¶Hospital de Clinicas÷ and ¶Hospital Español÷ from Buenos Aires, between January 2009 to June 2010. Results. Case 1, 63 years old female, complains for headache with aleatory response to medical therapy; MRI: right occipital bone lession; Pathological Finding: breast carcinoma metastasis. Case 2, 70 years old female, complains for palpable lession of the scalp; MRI: right fronto-parietal intraxial lession and right parietal cranial vault lession; Pathological Finding: endometrial carcinoma metastasis (primary, diagnosed 4 months before). Case 3, 76 years old female, with palpable lession in the scalp; MRI: left parietal cranial vault lesion. Pathological Finding: kidney carcinoma metastasis (primary, diagnosed in 2008). Case 4, 50 years old female and Case 5, 78 years old male, both complains for bone pain; serological findings and marrow bone biopsy compatible with multiplemyeloma; screening of the long bones and cranial vault demonstrate evidence of bone infiltration. Conclusion. Metastasis at the cranial vault often presents with headache or pain upon inspection of a palpable scalp lession. Images of the CNS involves CT scan (delimitate lession and differentiates litic from blastic metastasis) and MRI (shows the degree of dural and brain infiltration). Prevalence of cranial vault metastasis is greater than brain metastasis, but this underdiagnosis is due that the first are frequently course without symptoms.(AU)

Metástasis de calota / Calvarial metastasis

Objective. To describe five cases of cranial vault metastasis. Materials and methods. Clinical records and images of five patients with cranial vault metastasis were reviewed at the “Hospital de Clinicas” and “Hospital Español” from Buenos Aires, between January 2009 to June 2010. Results. Case 1, 63 years old female, complains for headache with aleatory response to medical therapy; MRI: right occipital bone lession; Pathological Finding: breast carcinoma metastasis. Case 2, 70 years old female, complains for palpable lession of the scalp; MRI: right fronto-parietal intraxial lession and right parietal cranial vault lession; Pathological Finding: endometrial carcinoma metastasis (primary, diagnosed 4 months before). Case 3, 76 years old female, with palpable lession in the scalp; MRI: left parietal cranial vault lesion. Pathological Finding: kidney carcinoma metastasis (primary, diagnosed in 2008). Case 4, 50 years old female and Case 5, 78 years old male, both complains for bone pain; serological findings and marrow bone biopsy compatible with multiplemyeloma; screening of the long bones and cranial vault demonstrate evidence of bone infiltration. Conclusion. Metastasis at the cranial vault often presents with headache or pain upon inspection of a palpable scalp lession. Images of the CNS involves CT scan (delimitate lession and differentiates litic from blastic metastasis) and MRI (shows the degree of dural and brain infiltration). Prevalence of cranial vault metastasis is greater than brain metastasis, but this underdiagnosis is due that the first are frequently course without symptoms.

Diagnóstico diferencial en patología tumoral de la base de cráneo anterior / Differential diagnosis in tumor pathology of the anterior skull base

Objective. To describe a series of tumoral lesions of the anterior fossa that were treated at the Hospital de Clinicas during a determined lapse of time.Material and Methods. We evaluated the image archive and medical charts of all the patients operated on between January 2005 and May 2009 at the Neurosurgery Division of the Hospital de Clínicas. Results. From a total of 142 surgeries for expansive supratentorial lessions, 19 were for lessions of the anterior skull base (n=19) of which 7 were meningiomas (36%); four patients with gliomas (21%); one with GBM (5%); one with astrocitoma (5%); two with oligodendroglioma (10%); three patients presented tumors of the paranasal sinuses (15%); two had mucoceles (10%); one with squamous cell carcinoma (5%); three with orbital tumors; one with fibrous bone dysplasia (5%) and one with metastasis of a meduloblastoma of the posterior fossa (5%). Conclusion. The most frequent pathology found at this site is the meningioma, and secondly, gliomas. The third in frequency are the paranasal sinus tumors whose most malignant pathology is the squamous cell carcinoma. Our findings are statistically correspondent to other large series in literature.(AU)

Malformación de Chiari y siringomielia: experiencia 2000-2008 / Chiari malformation and syringomyelia: experience 2000-2008

Objetive: to describe the postoperative outcome of patients with Chiari malformation (CM) and/or syringomyelia (SM). Methods: the clinical records of patients with CM and SM, treated from 2000 to 2008, were retrospectively reviewed. Data about sex, age, previous history, admission symptoms, magnetic resonance imaging (MRI), treatment modalities, outcome (Odom´s sacale) and postoperative complications were collected. Results: we treated 17 patients (1 male, 16 women); mean age: 39 years old (10-66). The admission symptoms were: pain in 11 cases, cerebellum/brain stem in 4 cases and spinal cord in 14 cases. Diagnosis was made by MRI: CM type I with SM 9 cases, CM I without SM 6 cases, CM type II with SM 1 case and idiopathic SM 1 case. MC II had myelomeningocele and ventricular shunting surgery at 3 months old. In 15 cases we performed a suboccipital craniectomy with duraplasty and C1 posterior arch resection (n:12) or C1-C2 posterior arch resection (n:3). One case had surgery al another institution and 1 case was not operated because symptoms did not progressed. SM persisted in 4 of the operated cases; in 3 of them a syringopleural shunting (SPS) was performed. In the idiopathic SM a SPS was also performed, but it became obstructed 3 months later. Complications were: meningitis 1 case, CSF fistula 1 case and meningitis + CSF fistula 1 case. In CM outcome after 1 year was: excellent-good in 13 cases, fair in 1 case and poor in 2 cases. Conclusion: in patients with CM and/or SM, postoperative clinical outcome was excellent-good in 13/16 cases.(AU)

Diagnóstico diferencial en patología tumoral de la base de cráneo anterior / Differential diagnosis in tumor pathology of the anterior skull base

Objective. To describe a series of tumoral lesions of the anterior fossa that were treated at the Hospital de Clinicas during a determined lapse of time.Material and Methods. We evaluated the image archive and medical charts of all the patients operated on between January 2005 and May 2009 at the Neurosurgery Division of the Hospital de Clínicas. Results. From a total of 142 surgeries for expansive supratentorial lessions, 19 were for lessions of the anterior skull base (n=19) of which 7 were meningiomas (36%); four patients with gliomas (21%); one with GBM (5%); one with astrocitoma (5%); two with oligodendroglioma (10%); three patients presented tumors of the paranasal sinuses (15%); two had mucoceles (10%); one with squamous cell carcinoma (5%); three with orbital tumors; one with fibrous bone dysplasia (5%) and one with metastasis of a meduloblastoma of the posterior fossa (5%). Conclusion. The most frequent pathology found at this site is the meningioma, and secondly, gliomas. The third in frequency are the paranasal sinus tumors whose most malignant pathology is the squamous cell carcinoma. Our findings are statistically correspondent to other large series in literature.

Malformación de Chiari y siringomielia: experiencia 2000-2008 / Chiari malformation and syringomyelia: experience 2000-2008

Objetive: to describe the postoperative outcome of patients with Chiari malformation (CM) and/or syringomyelia (SM). Methods: the clinical records of patients with CM and SM, treated from 2000 to 2008, were retrospectively reviewed. Data about sex, age, previous history, admission symptoms, magnetic resonance imaging (MRI), treatment modalities, outcome (Odom´s sacale) and postoperative complications were collected. Results: we treated 17 patients (1 male, 16 women); mean age: 39 years old (10-66). The admission symptoms were: pain in 11 cases, cerebellum/brain stem in 4 cases and spinal cord in 14 cases. Diagnosis was made by MRI: CM type I with SM 9 cases, CM I without SM 6 cases, CM type II with SM 1 case and idiopathic SM 1 case. MC II had myelomeningocele and ventricular shunting surgery at 3 months old. In 15 cases we performed a suboccipital craniectomy with duraplasty and C1 posterior arch resection (n:12) or C1-C2 posterior arch resection (n:3). One case had surgery al another institution and 1 case was not operated because symptoms did not progressed. SM persisted in 4 of the operated cases; in 3 of them a syringopleural shunting (SPS) was performed. In the idiopathic SM a SPS was also performed, but it became obstructed 3 months later. Complications were: meningitis 1 case, CSF fistula 1 case and meningitis + CSF fistula 1 case. In CM outcome after 1 year was: excellent-good in 13 cases, fair in 1 case and poor in 2 cases. Conclusion: in patients with CM and/or SM, postoperative clinical outcome was excellent-good in 13/16 cases.

Cuidados técnicos durante la artroplastia cervical: presentación de dos casos / Technical pitfalls during cervical arthoplasty: Report of two cases

Objective: to describe and analyze two cases of cervical arthroplasty with spinal misalignment. Description: Both, a 44 year old female (case 1) with a 9 months history of myeloradiculopathy and a 50 year old female (case 2) with a 2 year history of cervicobrachial pain had a C5-C6 posterolateral discal hernia diagnosed by magnetic resonance. As medical treatment failed, both patients were taken to surgery. Intervention: In both cases we performed a cervical arthroplasty using a 14mm Bryan cervical disc prosthesis. There were no intraoperative complications. Case 1 had a postoperative sagittal misalignment: and plate angle was -10° (preoperative +3°). This was caused by an inappropriate use of the manual stabilizer. Case 2 had a postoperative coronal misalignment: coronal angle was 18° (preoperative 0°). This was caused by the asymmetric anterior ostheophyte and end plate drilling. At the latest follow-up, 6 and 3 months respectively, case 1 still had muscular pain and case 2 was asymptomatic. Conclusion: In both cases misalignment problems could have been avoided with a proper surgical technique and were not inherent to the insertion technique.

Reoperaciones en patología degenerativa cervical / Reoperations un degenerative cervical pathology

Objetivo. Analizar los resultados obtenidos en los casos de reoperaciones en patología degenerativa de la columna cervical. Método. Se revisaron restrospectivamente las historias clínicas de 14 casos (6 varones - 8 mujeres / edad media 55,70 años) de repoeraciones cervicales (10 derivados - 4 propios) por patología degenerativa entre los años 2000-2005. La primera cirugía fue: discectomía anterior con injerto autólogo (1 caso) y placa (3 casos), laminoplastía expansiva (5 casos), corpectomía anterior con injerto autólogo y placa (3 casos), laminectomía (1 caso) y microforaminotomía posterior (1 caso). El diagnóstico previo a la segunda cirugía fue: pseudoartrosis (1 caso) y luxación de placa (1 caso), compresión mecánica (10 casos), osteomielitis (1 caso) e inestabilidad (1 caso). Se decidió reoperarlos por estar sintomáticos. En el postoperatorio fueron evaluados con las escalas de Odom o Zeidman-Ducker a los 3 meses. Resultados. Las reoperaciones se realizaron entre 3 y 36 meses después de la primera cirugía: curetaje, injerto y placa (1 caso), recolocación (1 caso) y extracción de placa (1 caso), curetaje y laminectomía (1 caso), osteosíntesis posterior (1 caso), corpectomía (1 caso) y laminoplastía expansiva (8 casos). En 5/6 casos evaluados con la escala de Odom la evolución fue excelente y el 5/8 casos evaluados con la escala de Zeidman-Ducker su mielopatía mejoró 1 grado. Los que no mejoraron fue por la presencia de comorbilidades o daño medular permanente. Conclusión. En los casos de patología cervical degenerativa, la reoperación tuvo buenos resultados evolutivos en el 71 de los casos. Palabras clave: columna cervical, discectomía anterior, laminoplastía expansiva, reoperaciones.(AU)

Objective: To analize the outcome of cervical spine reoperations in cases with degenerative pathology. Method: We retrospectively reviewed the clinical records of 14 cases (6 males - 8 female / median age 55.70 years-old) of cervical spine reoperations (10 referrals - 4 of our own) with degenerative pathology during the years 2000-2005. The first surgery was: anterior discectomy with autologous graft (1 case) and plate (3 cases), expansive laminoplasty (5 cases), anterior corpectomy with autologous graft and plate (3 cases), laminectomy (1 case) and posterior microforaminotomy (1 case). The diagnosis previous to the second surgery was: pseudarthrosis (1 case) and plate luxation (1 case), mechanical compression (10 cases), osteomyelitis (1 case) and instability (1 case). they were reoperated beacause they were symptomatic. Postoperative outcome was evaluated according to Odom or Zeidman-Ducker scales at 3 months. Results: Reoperations were performed between 3 and 36 months after the first surgery: curetage, graft and plate (1 case), replating (1 case) and plate extraction (1 case), curetage and laminectomy (1 case), posterior fixation (1 case), corpectomy (1 case) and expansive laminoplasty (8 cases). In 5/6 cases, evaluated with the Odom scale the outcome was excellent and 5/8 cases evaluated with the Zeidman-Ducker scale mielopathy improved 1 grade. Those who did not improve had co-morbidities or permanent cerival myelopathy. Conclusions: In these cases presented with cervical degenerative pathology, reoperation has a good outcome in 71 of them. Key words: anterior descectomy - cervical spine - expansive laminoplasty - reoperations.(AU)