Surgical Treatment of IV Ventricle Calcifying Pseudoneoplasm of the Neuraxis (CAPNON) Operative Nuances.

Calcifying pseudoneoplasm of the neuroaxis (CAPNON) is a rare, slow growing, and generally benign fibro osseous mass that can emerge throughout the entire central nervous system (CNS). When diagnosed, prompt surgical treatment can determine a good neurological outcome and possibly curative resolution. The objective of the present work is to present a step by step technical report with its video. We present a 37 year old female presented with occipital headache and cervical pain associated with dysphagia, nausea, and gait disturbances. Computed tomography (CT) scan showed a focal calcified lesion on the floor of the IV ventricle projecting toward the vermis with associated supratentorial hydrocephalus and transependymal edema. The telovelar approach was chosen for the procedure. The outcome was favorable, with no complications. Postoperative CT was performed, which revealed no residual lesion. A step by step report of a IV ventricle CAPNON that manifested with hydrocephalus is described.

Laminoplastia cervical con foraminotomía unilateral C4-C5: nota técnica y serie de casos / Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series

Objetivo La laminoplastia «open door» es una técnica ampliamente utilizada para el tratamiento de la mielopatía cervical multinivel. A pesar de presentar resultados funcionales y radiológicos satisfactorios a largo plazo, la parálisis de C5 postoperatoria continúa siendo una complicación severa e invalidante con una incidencia variable en la literatura. El objetivo del presente trabajo es describir e ilustrar la técnica quirúrgica paso a paso con el agregado de la foraminotomía unilateral C4-5, y evaluar los resultados obtenidos hasta el momento, haciendo especial énfasis en la parálisis de C5. Material y métodos Estudio retrospectivo de 20 pacientes intervenidos por mielopatía cervical mediante la técnica de laminoplastia cervical «extendida» con foraminotomía unilateral, para la cual se detallan los pasos. Resultados Entre enero de 2013 y abril de 2019 se trataron 20 pacientes con «laminoplastia cervical extendida». Un solo paciente agregó déficit de C5 postoperatorio (5%). El porcentaje de recuperación del Japanese Orthopaedic Association score (JOA modificado) postoperatorio fue del 54,5%, siendo similar a lo observado en otras series. Conclusión Se desarrolló e ilustró la técnica de laminoplastia cervical «extendida» con foraminotomía unilateral de C4-5 para la prevención de la parálisis de C5. Se analizaron los resultados, y se obtuvo una incidencia de parálisis de C5 coincidente con el menor porcentaje reportado en la literatura. Sería de utilidad un estudio prospectivo y aleatorizado para valorar el rol de la foraminotomía preventiva C4-5 unilateral (AU)

Objective The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. Material and methods Retrospective study of 20 patients operated on for cervical myelopathy using the “extended” laminoplasty technique, which is described step by step. Results Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. Conclusion The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy (AU)

Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series.

OBJECTIVE: The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. MATERIAL AND METHODS: Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step. RESULTS: Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. CONCLUSION: The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.

Resultados en el tratamiento de los hemangiopericitomas intracraneanos. Serie de casos / Results in the treatment of intracranial hemangiopericytomas. Case series

Objetivo Los hemangiopericitomas intracraneanos (HPC) son tumores de muy baja frecuencia, alta recidiva local y riesgo de metástasis extracraneal. El objetivo del siguiente trabajo es presentar los resultados en el tratamiento de los HPC en nuestra institución en los últimos 20 años y realizar una revisión de la literatura del tema. Material y métodos Se realizó un estudio retrospectivo que incluyó a los pacientes con diagnóstico de tumor fibroso solitario/hemangiopericitoma (TFS/HPC) intracraneanos intervenidos quirúrgicamente en el periodo 1997-2017. Se incluyeron pacientes con inmunomarcación positiva para STAT-6 y grado histológico II-III. Se recabaron datos demográficos, características tumorales, tratamiento y sobrevida de estos pacientes. Resultados Un total de 19 pacientes cumplieron los criterios de inclusión. La mediana de seguimiento fue de 96 meses (12-230). La mortalidad fue del 21% (n = 4). El 57,9% presentaron al menos una recidiva tumoral (n = 11) (con una recurrencia del 6, del 67 y del 90% a 1, 5 y 10 años, respectivamente). Cinco pacientes presentaron metástasis extracraneal. Tuvieron mayor sobrevida los pacientes con tumores < 6 cm (p < 0,05). Conclusiones Se presentó una serie de pacientes operados de TFS/HPC según los nuevos criterios de la OMS. El tamaño es un factor predictor de sobrevida. Actualmente no existen criterios validados de resección quirúrgica en esta patología. Una clasificación con orientación quirúrgica sería de utilidad en el futuro (AU)

Objective Intracranial hemangiopericytoma (HPC) is a rare central nervous system tumor characterized by its low incidence, high rate of local recurrence and risk of metastasis. The main objectives of this paper are two: to show the results in the treatment of HPC in our institution in the last 20 years and to make a review of the literature on this topic. Methods Retrospective review that includes patients diagnosed with intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) that have undergone surgery from 1997 to 2017. It includes patients that had nuclear expression of STAT-6 (detected by immunohistochemistry) and grade II/III histopathological diagnosis (defined by the World Health Organization in 2016). We collected demographic data, tumor characteristics, treatment and survival of these patients. Results A total of 19 patients fulfilled inclusion criteria. The median follow up was 96 months (12-230). The mortality rate was 21% (n = 4). 57.9% of patients presented at least one tumor recurrence (n = 11) (recurrences of 6%, 67% y 90% at 1, 5 and 10 years). Five patients presented extracranial metastasis. Patients with tumors < 6 cm had greater survival (P < .05). Conclusions A series of patients undergoing SFT/HPC were presented according to the new WHO criteria. Size is a predictor of survival. Currently there are no validated criteria for surgical resection in this pathology. A classification with surgical guidance would be useful (AU)

Results in the treatment of intracranial hemangiopericytomas. Case series. / Resultados en el tratamiento de los hemangiopericitomas intracraneanos. Serie de casos.

OBJECTIVE: Intracranial hemangiopericytoma (HPC) is a rare central nervous system tumor characterized by its low incidence, high rate of local recurrence and risk of metastasis. The main objectives of this paper are two: to show the results in the treatment of HPC in our institution in the last 20years and to make a review of the literature on this topic. METHODS: Retrospective review that includes patients diagnosed with intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) that have undergone surgery from 1997 to 2017. It includes patients that had nuclear expression of STAT-6 (detected by immunohistochemistry) and gradeII/III histopathological diagnosis (defined by the World Health Organization in 2016). We collected demographic data, tumor characteristics, treatment and survival of these patients. RESULTS: A total of 19 patients fulfilled inclusion criteria. The median follow up was 96 months (12-230). The mortality rate was 21% (n=4). 57.9% of patients presented at least one tumor recurrence (n=11) (recurrences of 6%, 67% y 90% at 1, 5 and 10years). Five patients presented extracranial metastasis. Patients with tumors <6cm had greater survival (P<.05). CONCLUSIONS: A series of patients undergoing SFT/HPC were presented according to the new WHO criteria. Size is a predictor of survival. Currently there are no validated criteria for surgical resection in this pathology. A classification with surgical guidance would be useful.

Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series. / Laminoplastia cervical con foraminotomía unilateral C4-C5: nota técnica y serie de casos.

OBJECTIVE: The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. MATERIAL AND METHODS: Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step. RESULTS: Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. CONCLUSION: The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.

Dolor poscraniectomía: comparación entre 2 incisiones para el abordaje retrosigmoideo. Estudio prospectivo aleatorizado / Postcraniectomy pain: comparison between 2 incisions for the retrosigmoid approach. Prospective randomized study

INTRODUCCIÓN: El abordaje suboccipital lateral es de práctica habitual en neurocirugía para exponer la región del ángulo pontocerebeloso. El dolor poscraniectomía (DPC) es una de las complicaciones más frecuentes que disminuyen la calidad de vida de los pacientes. OBJETIVO: Comparar el DPC en pacientes operados de neurinomas vestibulares por un abordaje suboccipital lateral mediante 2 incisiones distintas. MATERIAL Y MÉTODOS: Estudio de investigación prospectivo aleatorizado. Se realizó seguimiento de un grupo de pacientes operados por neurinomas vestibulares entre julio de 2017 y mayo de 2019 (n=40) por un mismo cirujano. Un grupo recibió la incisión lineal clásica (n=20) y otro grupo la incisión alternativa en «U» invertida o «Dandy modificada» (n=20). La intensidad del dolor fue evaluada mediante escala numérica. Se realizó un seguimiento mínimo de 3 meses. El impacto en la calidad de vida se objetivó mediante cuestionario SF-36 versión corta tanto pre- como posquirúrgico. RESULTADOS: La edad promedio fue 46,1 años. El índice global de DPC fue del 27,5% (n=11) de los pacientes. La incidencia de cefalea en el grupo que recibió la incisión clásica (A) fue del 20% (n=4), en el grupo B fue del 35% (n=7). CONCLUSIÓN: Encontramos un mayor índice de DPC en los pacientes que recibieron una incisión tipo «Dandy modificada». Estos son datos preliminares de un estudio que continúa y esperamos obtener datos más representativos en el futuro. Recomendamos el seguimiento interdisciplinario para el tratamiento integral del DPC

BACKGROUND: Suboccipital lateral approach is a common practice in neurosurgery to expose the region of the cerebellopontine angle. Postcraniectomy headache (PCH) is one of the most frequent complications that diminish the quality of life of patients. OBJECTIVE: To compare postcraniectomy pain in patients operated on for vestibular neurinomas by a suboccipital lateral approach by 2 different incisions. MATERIAL AND METHODS: Prospective randomized research study. Follow-up of patients operated for vestibular neurinomas between July 2017 and May 2019 (n=40) by the same surgeon. One group received the classical linear incision (n=20) and another group the alternative incision in an inverted "U" (modified Dandy) (n=20). Pain intensity was evaluated by numerical scale. A minimum follow-up of 3 months was carried out. The impact on quality of life was measured by the SF-36 questionnaire short version both before and after surgery. RESULTS: The average age was 46.1 years. The overall PCH index was 27.5% (n=11) of the patients. The incidence of pain in the group that received the classical incision (A) was 20% (n=4) and in group B was 35% (n=7). CONCLUSIONS: We found a higher rate of post-craniectomy headache in patients who underwent a "modified Dandy" incision. These are preliminary data of an undergoing study and we hope to obtain more representative information in the future. We recommend interdisciplinary follow up for the integral treatment of PCH

Postcraniectomy pain: comparison between 2 incisions for the retrosigmoid approach. Prospective randomized study. / Dolor poscraniectomía: comparación entre 2 incisiones para el abordaje retrosigmoideo. Estudio prospectivo aleatorizado.

BACKGROUND: Suboccipital lateral approach is a common practice in neurosurgery to expose the region of the cerebellopontine angle. Postcraniectomy headache (PCH) is one of the most frequent complications that diminish the quality of life of patients. OBJECTIVE: To compare postcraniectomy pain in patients operated on for vestibular neurinomas by a suboccipital lateral approach by 2 different incisions. MATERIAL AND METHODS: Prospective randomized research study. Follow-up of patients operated for vestibular neurinomas between July 2017 and May 2019 (n=40) by the same surgeon. One group received the classical linear incision (n=20) and another group the alternative incision in an inverted "U" (modified Dandy) (n=20). Pain intensity was evaluated by numerical scale. A minimum follow-up of 3 months was carried out. The impact on quality of life was measured by the SF-36 questionnaire short version both before and after surgery. RESULTS: The average age was 46.1 years. The overall PCH index was 27.5% (n=11) of the patients. The incidence of pain in the group that received the classical incision (A) was 20% (n=4) and in group B was 35% (n=7). CONCLUSIONS: We found a higher rate of post-craniectomy headache in patients who underwent a "modified Dandy" incision. These are preliminary data of an undergoing study and we hope to obtain more representative information in the future. We recommend interdisciplinary follow up for the integral treatment of PCH.

Asistencia Endoscópica en la Descompresión Microquirúrgica del Hemiespasmo Facial / Endoscopic Assistance in Microsurgical Decompression of Facial Hemiespasm

Introducción: El hemiespasmo facial primario (HFP) se produce por la hiperexcitabilidad del nervio facial y sus núcleos de origen como consecuencia de la compresión vascular. La cirugía de descompresión neurovascular se plantea como alternativa al tratamiento médico refractario. Objetivos: Presentar nuestra experiencia respecto a esta patología. Material y métodos: Se realizó una revisión retrospectiva de pacientes operados por HPF refractarios a tratamiento médico en nuestra institución en los últimos 5 años (periodo 2014-2019). Todos fueron intervenidos vía retrosigmoidea. Se evaluaron datos demográficos, evaluación prequirúrgica y evolución postoperatoria. Resultados: Se operaron 4 pacientes bajo técnica microquirúrgica asistido por endoscopía. Edad promedio 52 años (rango 41-61) con una relación femenino masculino 3:1. El 25% (n=1) presentaba paresia facial grado 2 (HB) en el prequirúrgico. No hubo cambios en cuanto al grado de paresia facial en el postoperatorio en ningún caso. Sólo un paciente registró caída leve en la audiometría postquirúrgica. El 75% (n=3) resolvieron el HFP. Conclusión: Si bien nuestra serie es acotada a un número reducido de pacientes, la cirugía descompresiva microvascular es efectiva como alternativa al tratamiento médico refractario del HFP.

Introduction: Primary hemifacial spasm (PHS) is defined as the hyper excitability of the nerve due to the compression of the facial nerve or its nuclei, most commonly by a vascular structure. The surgical indication for microvascular decompression is resistance to pharmacological treatment or severe adverse effects. Objectives: To present our experience in the surgical treatment of this pathology with this novel technique. Materials and methods: We retrospectively reviewed all patients (n=4) with a diagnosis of PHS, who underwent endoscope-assisted microvascular decompression surgery in our institution during the last 5 years. In all the cases, we choose the retrosigmoid approach. We evaluated demographic data, preoperative evaluation, and post-operative evolution. Results: Endoscope-assisted microvascular decompression was the surgical technique in all the patients. The median age was 52 years, the female-male ratio of 3:1. Only one patient presented a grade 2 facial palsy (House-Brackmann scale) in the preoperative evaluation; there were no significant changes in the post-operative evaluation in any patient. Only one patient experienced worsening in the post-operative audiometric follow-up. The 75% (n=3) of the patients solved the HFP after the surgical treatment. Conclusion: By taking into account our experience in this small case series, we can support the concept that endoscope-assisted microvascular decompression is as effective as the open surgical treatment of the PHS.

[Placement of ventricle peritoneal shunt in the adult patient. A new protocol]. / Implante de shunt ventrículo peritoneal en el paciente adulto. Un nuevo protocol.

INTRODUCTION: Ventriculoperitoneal shunting is considered a relatively straightforward procedure, though it might ensure multiple complications. Our surgical team developed and implemented a new protocol since June 2016. The objective of this paper is to describe and illustrate the surgical technique step by step and to demonstrate that the use of the "new protocol" significantly reduces the complications associated with the procedure. METHODS: A retrospective descriptive study of 184 patients related with cerebrospinal fluid derivation systems from June 2014 to November 2017. One hundred and fourteen patients complied with the inclusion criteria. They were divided into two groups according to the protocol involved, previous (n = 59) and new (n = 55). The technique was described by photographic archive and surgical protocols. RESULTS: The technique consisting in seven phases was described. With the used of the new protocol the complications decreased significantly. After the new protocol, no ventriculoperitoneal shunt associated infections were observed. CONCLUSION: The technique for ventriculoperitoneal shunt consisting in seven phases was described thoroughly. This technique as well as a series of rules constitutes the new protocol. The implementation of the latter lessened the number of complications associated with the procedure. The "zero infection" rate is not a utopia.

Implante de shunt ventrículo peritoneal en el paciente adulto. Un nuevo protocolo / Peritoneal ventricular shunt implantation in the adult patient

Introducción: La colocación de un shunt ventrículo-peritoneal, a pesar de considerarse un procedimiento de baja complejidad, puede devenir en una serie de complicaciones. Nuestro equipo quirúrgico desarrolló e implementó a partir de junio de 2016 un nuevo protocolo. El objetivo del presente trabajo es: describir e ilustrar paso a paso la técnica quirúrgica utilizada y demostrar que el uso del "nuevo protocolo" disminuye significativamente las complicaciones asociadas al procedimiento. Material y métodos: Desde junio de 2014 a noviembre de 2017 se intervinieron 184 pacientes en relación a sistemas de derivación de LCR. Se realizó un estudio retrospectivo que incluyó los pacientes con colocación primaria de shunt ventrículo-peritoneal (n=114). El seguimiento promedio fue de 14,2 meses (rango 6-38). Para el análisis estadístico se dividió a la muestra en 2 grupos: "protocolo previo" (n=59) y "nuevo protocolo" (n=55). Para describir la técnica quirúrgica se utilizó el archivo fotográfico y los partes quirúrgicos. Resultados: Se describió la técnica quirúrgica en 7 fases. La cantidad de pacientes con alguna complicación fue significativamente menor luego de implementar el "nuevo protocolo" (20% versus 39% respectivamente; p=0,04). En el grupo "nuevo protocolo" no se registró infección alguna asociada a shunt. Conclusión: Se presentó e ilustró, de manera clara y detallada, la técnica de colocación de shunt ventrículo-peritoneal en 7 fases. Esta técnica, junto a una serie de normas, constituyen un "nuevo protocolo". La aplicación de éste disminuyó significativamente las complicaciones asociadas al procedimiento. La tasa de infección "cero" no es una utopía.

Introduction: Ventriculo-peritoneal shunting is considered a relatively straightforward procedure, though multiple complications might ensue. Our surgical team has developed and implemented a new protocol since June 2016. The objectives of this paper are to describe and illustrate the surgical technique we use step by step; and to demonstrate that using this "new protocol" significantly reduces the complications associated with the procedure. Methods: Ours was a retrospective, descriptive study of 184 patients with CSF-derived symptoms treated from June 2014 until November 2017. Of these 184, 114 met our inclusion criteria and were divided into two groups, based upon the treatment protocol followed: previous (n=59) or new (n=55). The new technique was detailed by photographic archives and surgical protocols. Results: A technique consisting of seven steps is described. With the new protocol, complications dropped, including no ventriculo-peritoneal shunt-associated infections post-operatively. Conclusions: A technique for ventriculo-peritoneal shunting, consisting of seven steps, is described thoroughly. This technique, combined with a series of rules, constitutes a new protocol. Protocol implementation reduced the number of procedure-related complications and resulted in a zero infection rate.