A pure extradural hemangioblastoma mimicking a dumbbell nerve sheath tumor in cervical spine: illustrative case.

BACKGROUND: Spinal extradural hemangioblastomas (HBs) are quite uncommon, with most reported cases involving the thoracic and lumbar areas. Therefore, the presence of a dumbbell-shaped pure extradural cervical HB is exceptional, making preoperative diagnosis particularly challenging. OBSERVATIONS: The authors report a case of a 27-year-old woman who presented to their outpatient clinic with progressive cervicobrachialgia and numbness in the left arm. Magnetic resonance imaging showed a C5-6 intradural extramedullary lesion, and, despite some atypical features, the diagnosis of a possible neurogenic tumor was made. A multidetector computed tomography scan and angiography confirmed the expansion and remodeling of the left neural foramen as well as the highly vascularized nature of the mass. Preoperative embolization of the lesion was performed. Complete tumor resection was accomplished, followed by a C5-6 posterior fusion. Histopathology and immunohistochemistry revealed an HB. LESSONS: HBs should be considered among the differential diagnosis of cervical extradural tumors. Exhaustive preoperative workup and surgical planning are decisive in order to attain gross-total resection with favorable outcomes.

Hidrocefalia infantil en el África subsahariana: impacto de los cuidados perioperatorios en el archipiélago de Zanzíbar / Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago

INTRODUCCIÓN: La hidrocefalia infantil en países de bajo y mediano ingreso, representa uno de los problemas éticos y sanitarios más conflictivos con los que se enfrenta el desarrollo de la salud a nivel internacional. Las estimaciones más optimistas señalan que 200.000 nacidos anualmente desarrollarán una hidrocefalia o nacerán con un defecto del tubo neural en África oriental, central y sur de África (ECSA). Se calcula que menos del 10% de estos niños serán operados mediante derivaciones ventriculoperitoneales y, en general, en condiciones de mala calidad o con un índice de complicaciones muy elevado. OBJETIVO: Describir las características generales, la epidemiología y los datos demográficos de la hidrocefalia infantil de los pacientes atendidos en el Instituto NED en el archipiélago de Zanzíbar y valorar los detalles clínicos y los resultados a medio plazo del impacto de los cuidados de enfermería implantados. MATERIAL Y MÉTODOS: Se trata de un estudio observacional descriptivo y analítico de carácter retrospectivo, en pacientes diagnosticados y tratados de hidrocefalia infantil, en el período comprendido entre septiembre del 2016 y septiembre del 2018. Con la implantación de una serie de protocolos perioperatorios de enfermería en dichos pacientes, se describieron y analizaron los resultados obtenidos. RESULTADOS: Un total de 96 pacientes fueron atendidos de hidrocefalia infantil. Un 51% (n = 49) de estos pacientes eran varones, con una media de edad de 9,25 meses. Todas las madres de los pacientes fueron controladas durante el embarazo, pero solamente un 8% de ellas fueron tratadas con ácido fólico durante su gestación. El 81% de los niños nacieron mediante parto vaginal o parto espontáneo no complicado. Con respecto a la etiología, el 27,1% de la hidrocefalia tratada estaba asociada a una causa infecciosa y un 35,4% a una causa desconocida. Se realizaron 67 cirugías de derivación ventriculoperitoneal y 15 ventriculostomías endoscópicas. La tasa de complicaciones fue del 23,17%. CONCLUSIONES: Los resultados de esta investigación indican que la hidrocefalia infantil en Zanzíbar tiene una etiología, una evolución y unas complicaciones similares o menores que las descritas hasta la fecha en el África oriental. El hecho de implantar una serie de protocolos perioperatorios y cuidados estandarizados de enfermería influyen positivamente en los resultados obtenidos. En la actualidad, el Mnazi Mmoja Surgical NED Institute es uno de los escasos centros en África del Este con un registro exhaustivo de la actividad asistencial y el primer centro sanitario que oferta una formación continuada al personal de enfermería

INTRODUCTION: Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate. OBJECTIVE: To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care. MATERIAL AND METHODS: This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed. RESULTS: A total of 96 patients were treated for childhood hydrocephalus. 51% (n = 49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%. CONCLUSIONS: The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses

Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago. / Hidrocefalia infantil en el África subsahariana: impacto de los cuidados perioperatorios en el archipiélago de Zanzíbar.

INTRODUCTION: Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate. OBJECTIVE: To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care. MATERIAL AND METHODS: This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed. RESULTS: A total of 96 patients were treated for childhood hydrocephalus. 51% (n=49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%. CONCLUSIONS: The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses.

Cervical intramedullary solitary fibrous tumor: Case report and review of the literature.

BACKGROUND: Solitary fibrous tumors (SFTs) are benign tumors derived from mesenchymal tissues that predominantly occur in the pleura. Establishing the diagnosis of these very rare intramedullary spinal lesions, with no clear-cut pathognomonic radiographic characteristics, is particularly challenging. CASE DESCRIPTION: Two males, 30 and 41 years of age, presented with progressive cervical myelopathies attributed to a cervical intramedullary exophytic tumor with associated spinal cord edema. One patient showed that the lesion was highly vascularized. Both patients underwent surgical excision of firm, solid, focal, and, particularly in one of them, very vascular/hemorrhagic tumors; at surgery, there was some adherence between the tumors and the cord tissue, but gross-total resections were achieved in both cases, demonstrated on postoperative MR scans. Histological and immunohistochemical findings confirmed the diagnosis of SFT (WHO Grade I). After a 6-month postoperative period, both patients neurologically improved and had no MR evidence of tumor recurrence. CONCLUSION: Intramedullary cervical exophytic SFTs are extremely rare. Although these solid tumors may present with hemorrhagic features and at surgery demonstrate significant adherence to the pial/cord surface, complete surgical resections are feasible resulting in good outcomes.

Anatomía microquirúrgica en 3D del tracto corticoespinal y de la vía del lemnisco basada en microdisección de fibras y demostración a través de tractografía / 3D microsurgical anatomy of the cortico-spinal tract and lemniscal pathway based on fiber microdissection and demonstration with tractography

Objetivo: Realizar un estudio anatómico de microdisección de fibras y radiológico mediante tractografía basada en tensor de difusión (DTT) para demostrar tridimensionalmente el tracto corticoespinal y el lemnisco medial. Material y métodos: Bajo visión microscópica y con el uso de instrumental microquirúrgico se disecaron y estudiaron 10 hemisferios cerebrales y 15 troncoencéfalos humanos a través de la técnica de microdisección de fibras. Se obtuvieron imágenes de resonancia magnética cerebrales de 15 sujetos sanos, empleando secuencias potenciadas en difusión para el trazado y reproducción mediante DTT del tracto corticoespinal y la vía del lemnisco. Resultados: Se demostraron y describieron anatómicamente el tracto corticoespinal y lemnisco medial en gran parte de sus trayectorias, identificando las relaciones entre sí y con otros haces de sustancia blanca y núcleos de sustancia gris cercanos, especialmente en el troncoencéfalo, con la correspondiente representación mediante DTT. Conclusiones: Mediante la técnica de microdisección se apreció la disposición, arquitectura y organización topográfica general del tracto corticoespinal y lemnisco medial. Este conocimiento ha aportado una perspectiva anatómica única y profunda que ha favorecido la representación y la correcta interpretación de las imágenes de DTT. Esta información debe ser trasladada a la práctica clínica para favorecer el análisis crítico y exhaustivo por parte del cirujano ante posibles lesiones localizadas en el interior del troncoencéfalo y, en consecuencia, mejorar la indicación y planificación quirúrgica, incluyendo la selección preoperatoria de estrategias óptimas y posibles zonas de abordajes a su interior, alcanzando una técnica microquirúrgica más segura y precisa

Objective: To demonstrate tridimensionally the anatomy of the cortico-spinal tract and the medial lemniscus, based on fiber microdissection and diffusion tensor tractography (DTT). Material and methods: Ten brain hemispheres and brain-stem human specimens were dissected and studied under the operating microscope with microsurgical instruments by applying the fiber microdissection technique. Brain magnetic resonance imaging was obtained from 15 healthy subjects using diffusion-weighted images, in order to reproduce the cortico-spinal tract and the lemniscal pathway on DTT images. Results: The main bundles of the cortico-spinal tract and medial lemniscus were demonstrated and delineated throughout most of their trajectories, noticing their gross anatomical relation to one another and with other white matter tracts and gray matter nuclei the surround them, specially in the brain-stem; together with their corresponding representation on DTT images. Conclusions: Using the fiber microdissection technique we were able to distinguish the disposition, architecture and general topography of the cortico-spinal tract and medial lemniscus. This knowledge has provided a unique and profound anatomical perspective, supporting the correct representation and interpretation of DTT images. This information should be incorporated in the clinical scenario in order to assist surgeons in the detailed and critic analysis of lesions located inside the brain-stem, and therefore, improve the surgical indications and planning, including the preoperative selection of optimal surgical strategies and possible corridors to enter the brainstem, to achieve safer and more precise microsurgical technique

3D microsurgical anatomy of the cortico-spinal tract and lemniscal pathway based on fiber microdissection and demonstration with tractography. / Anatomía microquirúrgica en 3D del tracto corticoespinal y de la vía del lemnisco basada en microdisección de fibras y demostración a través de tractografía.

OBJECTIVE: To demonstrate tridimensionally the anatomy of the cortico-spinal tract and the medial lemniscus, based on fiber microdissection and diffusion tensor tractography (DTT). MATERIAL AND METHODS: Ten brain hemispheres and brain-stem human specimens were dissected and studied under the operating microscope with microsurgical instruments by applying the fiber microdissection technique. Brain magnetic resonance imaging was obtained from 15 healthy subjects using diffusion-weighted images, in order to reproduce the cortico-spinal tract and the lemniscal pathway on DTT images. RESULTS: The main bundles of the cortico-spinal tract and medial lemniscus were demonstrated and delineated throughout most of their trajectories, noticing their gross anatomical relation to one another and with other white matter tracts and gray matter nuclei the surround them, specially in the brain-stem; together with their corresponding representation on DTT images. CONCLUSIONS: Using the fiber microdissection technique we were able to distinguish the disposition, architecture and general topography of the cortico-spinal tract and medial lemniscus. This knowledge has provided a unique and profound anatomical perspective, supporting the correct representation and interpretation of DTT images. This information should be incorporated in the clinical scenario in order to assist surgeons in the detailed and critic analysis of lesions located inside the brain-stem, and therefore, improve the surgical indications and planning, including the preoperative selection of optimal surgical strategies and possible corridors to enter the brainstem, to achieve safer and more precise microsurgical technique.

Anatomía de los pedúnculos cerebelosos en 3D basada en microdisección de fibras y demostración a través de tractografía / 3D anatomy of cerebellar peduncles based on fibre microdissection and a demonstration with tractography

Objetivo: Realizar un estudio anatómico de microdisección de fibras y radiológico mediante tractografía basada en tensor de difusión (DTT) para demostrar tridimensionalmente los pedúnculos cerebelosos superiores, medios e inferiores. Material y métodos: Bajo visión microscópica y con el uso de instrumental microquirúrgico en el laboratorio, se disecaron 15 troncoencéfalos, 15 hemisferios cerebelosos y 5 hemisferios cerebrales humanos, entre julio de 2014 y julio de 2015. Se obtuvieron imágenes de resonancia magnética cerebrales realizas a 15 sujetos sanos entre julio y diciembre de 2015, empleando secuencias potenciadas en difusión para el trazado de los pedúnculos cerebelosos y su reproducción mediante DTT. Resultados: Se demostraron y describieron anatómicamente las principales fibras de los pedúnculos cerebelosos a lo largo de gran parte de su trayectoria en el cerebelo y troncoencéfalo, identificando las relaciones entre sí y con otros haces de sustancia blanca y núcleos de sustancia gris que los rodean, con la correspondiente representación mediante DTT. Conclusiones: Mediante la técnica de microdisección se apreció la disposición, arquitectura y organización topográfica general de los pedúnculos cerebelosos. Este conocimiento ha aportado una perspectiva anatómica única y profunda que ha favorecido la representación y correcta interpretación de las imágenes de DTT. Esta información debe ser trasladada a la práctica clínica para favorecer el análisis crítico y exhaustivo por parte del cirujano ante la presencia de lesiones que puedan localizarse cercanas a este grupo de haces en el cerebelo y/o troncoencéfalo, y, en consecuencia, mejorar la planificación quirúrgica y alcanzar una técnica microquirúrgica más segura y precisa

Objective: To perform an anatomical and radiological study, using fibre microdissection and diffusion tensor tractography (DTT), to demonstrate the three-dimensionality of the superior, middle and inferior cerebellar peduncles. Material and methods: A total of 15 brain-stem, 15 cerebellar hemispheres, and 5 brain hemispheres were dissected in the laboratory under the operating microscope with microsurgical instruments between July 2014 and July 2015. Brain magnetic resonance imaging was obtained from 15 healthy subjects between July and December of 2015, using diffusion-weighted images, in order to reproduce the cerebellar peduncles on DTT. Results: The main bundles of the cerebellar peduncles were demonstrated and delineated along most of their trajectory in the cerebellum and brain-stem, noticing their overall anatomical relationship to one another and with other white matter tracts and the grey matter nuclei the surround them, with their corresponding representations on DTT. Conclusions: The arrangement, architecture, and general topography of the cerebellar peduncles were able to be distinguished using the fibre microdissection technique. This knowledge has given a unique and profound anatomical perspective, supporting the correct representation and interpretation of DTT images. This information should be incorporated in the clinical scenario in order to assist surgeons in the detailed and critical analysis of lesions that may be located near these main bundles in the cerebellum and/or brain-stem, and therefore, improve the surgical planning and achieve a safer and more precise microsurgical technique

[3D anatomy of cerebellar peduncles based on fibre microdissection and a demonstration with tractography]. / Anatomía de los pedúnculos cerebelosos en 3D basada en microdisección de fibras y demostración a través de tractografía.

OBJECTIVE: To perform an anatomical and radiological study, using fibre microdissection and diffusion tensor tractography (DTT), to demonstrate the three-dimensionality of the superior, middle and inferior cerebellar peduncles. MATERIAL AND METHODS: A total of 15 brain-stem, 15 cerebellar hemispheres, and 5 brain hemispheres were dissected in the laboratory under the operating microscope with microsurgical instruments between July 2014 and July 2015. Brain magnetic resonance imaging was obtained from 15 healthy subjects between July and December of 2015, using diffusion-weighted images, in order to reproduce the cerebellar peduncles on DTT. RESULTS: The main bundles of the cerebellar peduncles were demonstrated and delineated along most of their trajectory in the cerebellum and brain-stem, noticing their overall anatomical relationship to one another and with other white matter tracts and the grey matter nuclei the surround them, with their corresponding representations on DTT. CONCLUSIONS: The arrangement, architecture, and general topography of the cerebellar peduncles were able to be distinguished using the fibre microdissection technique. This knowledge has given a unique and profound anatomical perspective, supporting the correct representation and interpretation of DTT images. This information should be incorporated in the clinical scenario in order to assist surgeons in the detailed and critical analysis of lesions that may be located near these main bundles in the cerebellum and/or brain-stem, and therefore, improve the surgical planning and achieve a safer and more precise microsurgical technique.