Fistula dural tipo adulta en un lactante: Reporte del caso y revisión de la bibliografía / Adult type dural A-V fistula in an infant: Report of a case and bibliographical review

Introduction. Dural arteriovenous malformations are rare in children. They constitute a group of entities with different origin, pathophysiology and prognosis. Case report. A 9 month old infant was brought to consultation because of cranial bruit in the left retroauricular area and opisthotonus crisis. CAT scan of the brain showed modest enlargement of ventricles and widening of the subarachnoid space. Cerebral angiography depicted an adult type dural arteriovenous fistula and thrombosis of the left transverse sinus. Angiographic cure was achieved by transarterial embolization of the fistula. The clinical condition of the patient improved significantly. Discussion. Dural arteriovenous fistulae (DAVS) constitute an heterogeneous group of disorders with an overall mortality of 38%. They have been classified by Lasjaunias in three categories: 1- Dural sinus malformations with DAVS, 2- Infantile type DAVS, and 3- Adult type DAVS. Clinical manifestations depend on the extent of the disorder and the magnitude of venous hypertension. Neonates may present with congestive heart failure (CHF). Infants and older children often show cranial bruits associated with macrocrania, seizures and developmental delay of variable severity. Conclussion. DAVS are unusual in the pediatric population. Early diagnosis and treatment are of major importance, in order to control venous hypertension and avoid the development of irreversible brain damage. Endovascular therapy has an important role in the acute treatment of CHF, and seems to be the best choice for treatment, either curative or palliative.

Tercer ventriculostomía endoscópica: mecanismos de fracaso y consideraciones sobre re fenestración o colocación de shunt / Endoscopic III ventriculostomy: Mechanisms of failure and considerations about refenestration of shuting

Objective: To evaluate retrospectively, a group of patients of our series, that had a failed ventriculostomy to try to determine the causes and the treatement offered to them. Material and method: 140 ETVs were performed in 132 patients; 120 of them are shunt free (90.90). Eight patients (5.71) showed closure of the ventriculostomy: in 4, it was presumed to be related to postoperative radiotherapy; 2 patients had an insufficient opening of the Lilliequist membrane and 2 showed ostoma closure of origin. In all of them a second ETV was performed, and the procedure was successful. Twelve patients (8.57) required shunt placement; 4, with a history of septated postmeningitis hydrocephalus, now only need a single ventricular catheter. Of the remaining, 3 presented with meningeal seeding from malignant tumors; 1 with racemous neurocysticerosis, 1 with multiple malformations and history meningitis; 2 with a previously unknown aresorptive component; 1 with history of post- shunt meningitis. Most patients with ETV failure developed CSF fistula. In all these cases, patency of the ostoma was confirmed during re-exploration, and consequently, a shunt was indicated. Discussion and conclusion: We consider ETV to be the standard treatment for obstructive hydrocephalus. With low morbidity in our series (4.68) and no mortality. Re-exploration and eventual re-fenestration are indicated in al cases of ETV failure, given the benefits of shunt independence.

Hernia medular espontanea: reporte de un caso. Revision de la literatura y teoria sobre las imagenes de IRM postoperatorias / Spontaneous spinal cord hernia. Case report, literature review and a theory about post operative MRI

Objective: to describe a new case of idiopathic spinal cord herniation. Description: a 34 year-old male patient had during the last 5 years a progressive Brown-Sequard syndrome. MRI showed ventral displacement of the spinal cord at T7-T8 and widening of the posterior subarachnoid space. Intervention: a laminectomy was performed with reduction of the herniated cord and closure of the dural defect with a graft. Postoperative outcome was uneventful and the patient improved neurologically. Control MRI showed hyperintense cord signals at the level of the previous herniated level. Conclusion: surgery with reduction of the hernia and dura closure provided symptomatic improvement. Postoperative MRI cord hyperintense signals may correspond to syringomyelia

Artritis Reumatoide con sub luxacion atlantoaxoidea: ¿es siempre necesaria la odontoidectomia? / Rheumatoid arthritis with atlantoaxial subluxation: is odontoidectomy always necessary?

Objective: to describe 3 cases of atlantoaxial irreductible subluxations (AIS) in rheumatoid arthritis (RA) and to determine the need of an odontoidectomy. Description: case 1 (60 years, female) had a chronic cervical myelopathy; case 2 (46 years, male) had and acute transitory postraumatic cervical myelopathy and case 3 had local cervical pain. Intervention: in case 1 we resected the anterior arc of C1, the pannus and the odontoid. The subluxation was reduced and a posterior occipitocervical fixation (POC) was performed. In case 2 the resection included the anterior arc of C1, the pannus and the odontoid partially because the dura was opened accidentally with the drill. In spite of it the subluxation was reduced and a POC was done. In case 3 the resection was limited to the anterior arc of the atlas and the pannus. The subluxation was reduced and a POC was performed. Conclusion: in cases of AIS with superior migration of the odontoid or retro - odontoid pannus, odontoidectomy must be performed but in cases with pre - odontoid pannus, odointoidectomy can be avoided

Rol de los corticoides en el trauma de craneo severo. Un interrogante no resuelto / Steroids rol in severe cranial trauma. A question nos answered

Objective: to evaluate the effectiveness of corticosteroids in the management of traumatic brain injury. Methods: trials concerning administration of corticosteroids to patients sustaining acute head injury were identified by means of electronic searches of MEDLINE. Articles related to pharmacology of corticosteroids, with special emphasis on potential neuroprotective activities were reviewed. Results: nineteen trials were identified, except for a few, no statistical difference in outcome or mortality between patients receiving corticosteroids or placebo. Nevertheless, a tendency was noticed towards a small number of deadths in the treated group. There was no statiscal difference between groups concerning gastrointestinal bleeding or other major complications. The analysis of the available literature on corticosteroids pharmacology provided a wide range of potentially beneficial effects through direct (receptor independent) and indirect actions, including among others, antiinflammatory, membrane stabilizing, anti oxidant and energetic metabolism protecting activities. Conclusion: corticosteroids given acutely to patients sustaining severe head injury resulted in a small but statiscally insignificant reduction in mortality. There was no significant difference between corticosteroid and control groups in mortality, nor in the rates of gastrointestinal bleeding or infection. Because of the relatively small number of patients previously enrolled in corticosteroids versus placebo trials, small reductions in mortality or deleterious effects associated with corticosteroid administration can not be excluded

Hernia medular espontanea: reporte de un caso. Revision de la literatura y teoria sobre las imagenes de IRM postoperatorias / Spontaneous spinal cord hernia. Case report, literature review and a theory about post operative MRI

Objective: to describe a new case of idiopathic spinal cord herniation. Description: a 34 year-old male patient had during the last 5 years a progressive Brown-Sequard syndrome. MRI showed ventral displacement of the spinal cord at T7-T8 and widening of the posterior subarachnoid space. Intervention: a laminectomy was performed with reduction of the herniated cord and closure of the dural defect with a graft. Postoperative outcome was uneventful and the patient improved neurologically. Control MRI showed hyperintense cord signals at the level of the previous herniated level. Conclusion: surgery with reduction of the hernia and dura closure provided symptomatic improvement. Postoperative MRI cord hyperintense signals may correspond to syringomyelia (AU)

Artritis Reumatoide con sub luxacion atlantoaxoidea: ¿es siempre necesaria la odontoidectomia? / Rheumatoid arthritis with atlantoaxial subluxation: is odontoidectomy always necessary?

Objective: to describe 3 cases of atlantoaxial irreductible subluxations (AIS) in rheumatoid arthritis (RA) and to determine the need of an odontoidectomy. Description: case 1 (60 years, female) had a chronic cervical myelopathy; case 2 (46 years, male) had and acute transitory postraumatic cervical myelopathy and case 3 had local cervical pain. Intervention: in case 1 we resected the anterior arc of C1, the pannus and the odontoid. The subluxation was reduced and a posterior occipitocervical fixation (POC) was performed. In case 2 the resection included the anterior arc of C1, the pannus and the odontoid partially because the dura was opened accidentally with the drill. In spite of it the subluxation was reduced and a POC was done. In case 3 the resection was limited to the anterior arc of the atlas and the pannus. The subluxation was reduced and a POC was performed. Conclusion: in cases of AIS with superior migration of the odontoid or retro - odontoid pannus, odontoidectomy must be performed but in cases with pre - odontoid pannus, odointoidectomy can be avoided (AU)

Rol de los corticoides en el trauma de craneo severo. Un interrogante no resuelto / Steroids rol in severe cranial trauma. A question nos answered

Objective: to evaluate the effectiveness of corticosteroids in the management of traumatic brain injury. Methods: trials concerning administration of corticosteroids to patients sustaining acute head injury were identified by means of electronic searches of MEDLINE. Articles related to pharmacology of corticosteroids, with special emphasis on potential neuroprotective activities were reviewed. Results: nineteen trials were identified, except for a few, no statistical difference in outcome or mortality between patients receiving corticosteroids or placebo. Nevertheless, a tendency was noticed towards a small number of deadths in the treated group. There was no statiscal difference between groups concerning gastrointestinal bleeding or other major complications. The analysis of the available literature on corticosteroids pharmacology provided a wide range of potentially beneficial effects through direct (receptor independent) and indirect actions, including among others, antiinflammatory, membrane stabilizing, anti oxidant and energetic metabolism protecting activities. Conclusion: corticosteroids given acutely to patients sustaining severe head injury resulted in a small but statiscally insignificant reduction in mortality. There was no significant difference between corticosteroid and control groups in mortality, nor in the rates of gastrointestinal bleeding or infection. Because of the relatively small number of patients previously enrolled in corticosteroids versus placebo trials, small reductions in mortality or deleterious effects associated with corticosteroid administration can not be excluded (AU)

Granuloma eosinofilo solitario de vertice de orbita y senos paranasales en un adulto: comunicacion de un caso y revision de la literatura / Adult solitary eosinophilic granuloma of the orbital vertex and paranasal sinuses: case report and review

Objective: to report a rare localization of Langerhans cell histiocytosis and to define its differential diagnosis and therapeutic options. Description: a 32 year-old male with derecasing visual acuity, headache and epistaxis. MRI: parasellar lytic lesion extending to nasal cavities. Transnasal biopsy: proliferation of S100 positive cells and eosinophilic granulocytes. Intervention: radiation therapy was followed by reission. Conclusion: Langerhans cell histiocytosis can present as a unifocal (eosinophilic granuloma) or multifocal sidorder. Usually affects children. The skull base is rarely affected. Surgery with or without radiotherapy is the treatment of choice for solitary accessible lesions. Isolated radiotherapy and intralesional steroids are valid options. Systemic disease requires chemoterapy

Granuloma eosinofilo solitario de vertice de orbita y senos paranasales en un adulto: comunicacion de un caso y revision de la literatura / Adult solitary eosinophilic granuloma of the orbital vertex and paranasal sinuses: case report and review

Objective: to report a rare localization of Langerhans cell histiocytosis and to define its differential diagnosis and therapeutic options. Description: a 32 year-old male with derecasing visual acuity, headache and epistaxis. MRI: parasellar lytic lesion extending to nasal cavities. Transnasal biopsy: proliferation of S100 positive cells and eosinophilic granulocytes. Intervention: radiation therapy was followed by reission. Conclusion: Langerhans cell histiocytosis can present as a unifocal (eosinophilic granuloma) or multifocal sidorder. Usually affects children. The skull base is rarely affected. Surgery with or without radiotherapy is the treatment of choice for solitary accessible lesions. Isolated radiotherapy and intralesional steroids are valid options. Systemic disease requires chemoterapy (AU)