Traumatic epidural retroclival hematoma with odontoid fracture and cardiorespiratory arrest.

STUDY DESIGN: Case report. OBJECTIVES: To describe a case or traumatic retroclival hematoma with features not previously reported. SETTING: Single center. METHODS: Description of a case, in the context of relevant literature on the subject. RESULTS: Traumatic retroclival hematomas are a rare, typically pediatric, entity. Only four cases of epidural hematoma in adult patients have been reported. We describe an additional case, the first with a fatal course in the acute setting. It is also the first retroclival hematoma associated to an odontoid base fracture. CONCLUSION: Retroclival hematomas are a rare diagnosis, to be considered in pediatric patients with flexion-extension, high-energy injuries. Morphology is typically epidural. Brain stem and cranial nerve symptoms are typical. Treatment is usually conservative. Outcome is regarded as favorable, with partial recovery and neurologic sequelae. Adult cases are extremely rare. The case we describe adds new characteristics to the scarcity of cases.

Uncal decompression in gliomatosis cerebri.

Gliomatosis cerebri is defined as an infiltration, by an infiltrative glioma, of more than two cerebral lobes. Depending on response to treatment (chemotherapy and radiotherapy), clinical course may prolong over several months. Surgical excision has a very limited role in the management of this diagnosis. We present the case of a 48 year-old woman in whom a decompressive temporal lobectomy was performed in the context of a gliomatosis. Relief of intracranial hypertension allowed further treatment and a survival of 23 months. Relevant literature on the subject has been reviewed. There is the possibility of offering a decompressive lobectomy in selected cases of gliomatosis, allowing to undergo other treatment modalities.

[High cervical spine injuries: classification, therapeutic indications, and surgical approaches: 286 consecutive cases]. / Traumatismos de la columna cervical alta: clasificación tipológica, indicacionesterapéuticas y abordajes quirúrgicos (a propósito de 286 casos).

Around 60% of all cervical fractures occur in the high cervical segment (C0-C1-C2); 4-15% occurs in C1, and between 15-25% in the axis. Nowadays, with high resolution imaging, we can see both anatomic and functional aspects of the fractures, as well as understand the mechanisms of injury. This can also allow us to study the evolution of the soft tissue lesions and fractures. The classification of traumatic injuries in C0-C1-C2 is basic in order to understand the mechanism of injury and natural history of these lesions. This also allow us to choose the correct or most adequate form of treatment. In the cases where surgery is indicated we must: a) release of the cord or nerves, using standard techniques such as laminectomy, discectomy or corpectomy; b) align vertebral segments using traction, halo vest or surgery; c) estabilize the vertebral segments, using anterior, posterior or 360 degrees surgical approaches; d) stop the natural history of disease and e) allow maximal functional recovery. Although there are good classifications that typify the fractures in the C0-C1-C2 segments, there are not clear or standard treatments for them. This paper shows the personal experience of the author in the management of this type of fractures. The 286 patients with lesions in the high cervical segment C0-C1-C2 have been treated according to the classifications and recommendations already established in the literature. Selection of this cases and appropiate surgical approach is still a challenge for surgeons who deal with this problems.

Traumatismos de la columna cervical alta: Clasificación tipológica, indicaciones terapéuticas y abordajes quirúrgicos (a propósito de 286 casos) / High cervical spine injuries: classification, therapeutic indications, and surgical approaches: 286 consecutive cases

Sobre la columna cervical alta (C0-C1-C2) recae más del 60% de todas las lesiones traumáticas de la columna cervical; así, un 4-15% de todas las fracturas cervicales afectan al atlas y un 15-25% al axis. Hoy en día las técnicas de neuroimagen permiten ver las lesiones anatómicas y funcionales producidas en el accidente, comprender los mecanismos patomecánicos de estas lesiones, establecer una correlación clínico-radiológica y funcional de la patología producida, clasificar todas las lesiones, predecir su posible comportamiento y evolución y establecer pautas terapéuticas adecuadas. La clasificación de las lesiones traumáticas deC0-C1-C2 es imprescindible para tipificar la lesión y así definir los distintos tipos posibles de lesiones traumáticas producidas. En el contexto individual de cada paciente, cada tipo de lesión nos permite elegir el proceso terapéutico, médico o quirúrgico, más adecuado. De ello resulta una clara indicación terapéutica correcta para cada caso concreto. En los casos con indicación quirúrgica, la finalidad de la intervención será: a) liberar elementos radiculo-medulares atrapados mediante discectomías, corpectomías, laminectomías, evacuación de colecciones o ampliación de espacios; b) alinear segmentos vertebrales mediante tracción con compás, o con halo, manipulación o cirugía; c) estabilizar elementos vertebrales con técnicas quirúrgicas vía anterior, posterior o con dobles abordajes 360º surgery; d) detener la evolución clínico-radiológica y, e) permitir la máxima recuperación funcional. A pesar de que en los últimos años todas las posibles lesiones traumáticas del segmento occipitoatloaxoideo están correctamente clasificadas y tipificadas, las pautas de tratamiento no son uniformes ni todavía aceptadas o aplicadas de forma unánime. En este trabajo se presenta la experiencia del autor en el manejo de este tipo de lesiones traumáticas. Se analizan 286 lesiones del segmento C0-C1-C2 y se correlaciona su clasificación y tipología con las pautas de tratamiento establecidas. Poner orden en la selección de casos para una indicación terapéutica concreta, correcta y eficaz de la instrumentación cervical junto a una ejecución terapéutica meticulosa y precisa, es un reto actual delos cirujanos que tratamos a estos pacientes

Around 60% of all cervical fractures occur in the high cervical segment (C0-C1-C2); 4-15% occurs in C1, and between 15-25% in the axis. Nowadays, with high resolution imaging, we can see both anatomic and functional aspects of the fractures, as well as understand the mechanisms of injury. This can also allow us to study the evolution of the soft tissue lesions and fractures. The classification of traumatic injuries in C0-C1-C2 is basic in order to understand the mechanism of injury and natural history of these lesions. This also allow us to choose the correct or most adequate form of treatment. In the cases where surgery is indicated we must: a)release of the cord or nerves, using standard techniques such as laminectomy, discectomy or corpectomy; b) align vertebral segments using traction, halo vestor surgery; c) estabilize the vertebral segments, using anterior, posterior or 360° surgical approaches; d) stop the natural history of disease and e) allow maximal functional recovery. Although there are good classifications that typify the fractures in the C0-C1-C2 segments, there are not clear or standard treatments for them. This paper shows the personal experience of the author in the management of this type of fractures. The286 patients with lesions in the high cervical segment C0-C1-C2 have been treated according to the classifications and recommendations already established in the literature. Selection of this cases and appropiate surgical approach is still a challenge for surgeons who deal with this problems

[Upper cervical chondrosarcoma]. / Condrosarcoma cervical alto.

Spinal chondrosarcoma are extremely rare and slowly growing tumors. They have been reported in thoraco-lumbar spine and lower cervical spine. Our case, a female, has a tumor located in the axis with extension into C3 and then caudally to C4 as the disease progressed. We present a technical innovation in spinal stabilization and compare our result with previously reported cases.

Condrosarcoma cervical alto / Upper cervical chondrosarcoma

Los condrosarcomas espinales son tumores extremadamente raros y de crecimiento lento. Su principal localización es toraco-lumbar y cervical baja10. El caso que nosotros presentamos, una mujer, tiene un tumor localizado en la zona cervical alta C2 con extensión caudal a C3 y a lo largo de su evolución hasta C4 de predominio derecho. A pesar de haberse publicado con anterioridad1 aportamos nuevos aspectos de estabilidad cervical instrumentada y comparamos el resultado obtenido con las series publicadas

Spinal chodrosarcoma is extremely rare and slowly growing tumor. They have been reported in thoracolumbar spine and lower cervical spine10. Our case, a female, has a tumor located in the axis with extension into C3 and then caudally to C4 as the disease progressed. We present a technical innovation in spinal stabilization and compared our result with previously reported cases

Reducción de las masas periodontoideas tras artrodesis posterior, revisión a propósito de 2 casos no vinculados a artritis reumatoide / Reduction of periodontoid masses following posterior arthrodesis: two new cases not linked to rheumatioid arthritis review

La aparición de un “pannus” inflamatorio periodontoideo en pacientes afectos de artritis reumatoide, es sobradamente conocida. Menos frecuente es la existencia de masas periodontoideas, de aspectos similar al “pannus”, pero no vinculadas con la inflamación reumática. La cirugía transoral asociada a artrodesis posterior se consideró durante mucho tiempo como un a e las formas más eficaces para resolver el “pannus” en aquellos casos que se presentaban con deterioro neurológico secundario a esta masa de partes blandas. Presentamos dos casos de desaparición de una lesión proliferativa alrededor de la apófisis odontoides mediante una artodesis posterior occipito-cervical. Se trataron dos mujeres de 67 y 60 años respectivamente, con clínica de dolor y deterioro neurológico progresivo. Existían antecedentes de una posible fractura antigua de odontoides en un caso y de una artrodesis cervical anterior amplia por espondiloartrosis en el otro. Ambos pacientes mejoraron neurológicamente después de una artrodesis por vía posteiror (AU)

Inflamatory periodontoid pannus is quite common in patients with rheumatoid arthritis. However, the occurrence of a pannus-like periodontoid mass that is unassociated with rheumatic inflammation is less frequent. Transoral surgery associated with a posteori stabilization has long been considered one of the most efficient methods to resolve the problem of instability in patients presenting neurological deficits secondary to the pannus. We present two cases of non rheumatic etiology, in which an occipito – cervical arthrodesis was used to resolve the proliferative lesion around the odontoid apophysis. Two women (67 and 60 years old respectively) presented symptoms of pain and neurological deterioration with an antecedent of possible past odontoid fracture in one case, and previous large anterior cervical arthrodesis to correct spondylarthrosis in the other case. Both patient´s neurological condition imporved after placement of an arthrodesis through a posterior approach (AU)

[Reduction of periodontoid masses following posterior arthrodesis: review of two new cases not linked to rheumatoid arthritis]. / Reducción de las masas periodontoideas tras artrodesis posterior: revisión a propósito de 2 casos no vinculados a artritis reumatoide.

Inflamatory periodontoid pannus is quite common in patients with rheumatoid arthritis. However, the occurrence of a pannus-like periodontoid mass that is unassociated with rheumatic inflammation is less frequent. Transoral surgery associated with a posterior stabilization has long been considered one of the most efficient methods to resolve the problem of instability in patients presenting neurological deficits secondary to the pannus. We present two cases of non rheumatic etiology, in which an occipito-cervical arthrodesis was used to resolve the proliferative lesion around the odontoid apophysis. Two women (67 and 60 years old respectively) presented symptoms of pain and neurological deterioration with an antecedent of possible past odontoid fracture in one case, and a previous large anterior cervical arthrodesis to correct spondylarthrosis in the other case. Both patient's neurological condition improved after placement of an arthrodesis through a posterior approach.

Benign osteoblastoma of the parietal bone: case report.

A case of benign osteoblastoma of the parietal bone is presented. Attention is drawn first to the rarity of this tumor and second to the fact that the radiological and histopathological features of the tumor reported here lead us to suspect the presence of regressive features in its evolution.

Failure of autologous fat grafts to prevent postoperative epidural fibrosis in surgery of the lumbar spine.

In three cases of lumbar disc herniation, autologous fat grafts were inserted over the dura mater and the exposed nerve roots during surgery with the aim of preventing postoperative epidural fibrosis. A second operation had to be performed in two of these cases as a result of the radiographic appearance of excessive scar formation in the epidural and adjacent regions of the nerve root giving rise to symptoms. In the third patient, myelographic studies revealed the development of this type of hypertrophic scarring; however, the patient refused a further operation. The hypertrophic epidural scarring occurred in these three cases despite the presence of autologous fat grafts. Histopathological examination of the fat removed from the two patients who were operated on a second time showed a fibrotic infiltration into the fat graft.

[Acute subdural hematoma caused by rupture of a peripheral aneurysm of the sylvian artery]. / Hématome sous-dural aigu par rupture d'un anévrysme périphérique de l'artère sylvienne.

A patient who suffered acute subdural hematoma secondary to rupture of intracranial aneurysm is reported. Cerebral angiography showed a subdural collection on the left hemisphere and a distal middle cerebral artery aneurysm. There was no history of head trauma, endocarditis or systemic infection, and physical examination was normal. Congenital etiology is presupposed. From our review of the literature this is a rare association. The author emphasizes on the continuing role of angiography to evaluate spontaneous subdural hematomas.