Quistes sinoviales lumbares: presentación de una serie de 10 casos y revisión de la literatura / Lumbar synovial cysts: presentation of a series of 10 cases and literature review

Introducción. Los quistes sinoviales lumbares son una causa infrecuente de dolor lumbar y radicular, aunque cada vez se describen con más frecuencia en la literatura. Objetivo. Analizar el tratamiento y resultados quirúrgicos de los quistes sinoviales lumbares intervenidos en nuestro centro en un período de 5 años. Material y métodos. Se realizó un estudio retrospectivo de pacientes tratados quirúrgicamente en nuestro servicio entre agosto de 2009 y septiembre de 2014, empleando la escala visual analógica para seguimiento clínico durante el año posterior a la cirugía. Resultados. Tras el tratamiento quirúrgico (exéresis del quiste con o sin artrodesis instrumentada con tornillos transpediculares), de 10 pacientes (5 mujeres y 5 varones) de edades comprendidas entre los 50 y 80 años (edad media 70,2 años), la evolución clínica fue satisfactoria en el 80% de ellos con resolución de su sintomatología. Conclusiones. Los quistes sinoviales lumbares deben ser considerados en el diagnóstico diferencial de pacientes con dolor lumbar y radicular. La mayoría de estos pacientes están en la 6.a década de la vida y presentan generalmente una espondilopatía degenerativa lumbar. En la actualidad, se recomienda la exéresis de los quistes sinoviales con artrodesis instrumentadas con tornillos transpediculares, ya que se considera que el aumento de movilidad podría ser una de las causas de su aparición; aunque todavía se necesitan más estudios al respecto, de ahí el interés de este trabajo (AU)

Introduction. Although they are freqqently described in the literature, lumbar synovial cysts are a relative uncommon cause of low back and radicular leg pain. Objective. To evaluate the treatment and surgical outcomes of the lumbar synovial cysts operated on in our hospital during a 5 year period. Material and methods. A retrospective study was conducted on patients surgically treated in our department from August 2009 to September 2014, using a visual analogue scale for the clinical follow-up in the first year after surgery. Results. After the surgical treatment (surgical removal of the synovial cyst with or without instrumented arthrodesis with transpedicular screws) of 10 patients (5 female and 5 male) with a mean age of 70.2 years (range 50-80), the clinical outcome was satisfactory in 80% of the patients, with the resolving of their symptoms. Conclusions. Lumbar synovial cysts have to be considered in the differential diagnosis in patients with low back and radicular leg pain. The majority of the patients are in their sixties and have lumbar degenerative spondylopathy. Nowadays, surgical resection of the lumbar synovial cysts and spinal fusion are the recommended treatment, because it is thought that the increased movement of the spine is one to the causes of the cyst formation. More studies are still needed, hence the relevance of this article (AU)

Lumbar synovial cysts: presentation of a series of 10 cases and literature review. / Quistes sinoviales lumbares: presentación de una serie de 10 casos y revisión de la literatura.

INTRODUCTION: Although they are freqqently described in the literature, lumbar synovial cysts are a relative uncommon cause of low back and radicular leg pain. OBJECTIVE: To evaluate the treatment and surgical outcomes of the lumbar synovial cysts operated on in our hospital during a 5 year period. MATERIAL AND METHODS: A retrospective study was conducted on patients surgically treated in our department from August 2009 to September 2014, using a visual analogue scale for the clinical follow-up in the first year after surgery. RESULTS: After the surgical treatment (surgical removal of the synovial cyst with or without instrumented arthrodesis with transpedicular screws) of 10 patients (5 female and 5 male) with a mean age of 70.2 years (range 50-80), the clinical outcome was satisfactory in 80% of the patients, with the resolving of their symptoms. CONCLUSIONS: Lumbar synovial cysts have to be considered in the differential diagnosis in patients with low back and radicular leg pain. The majority of the patients are in their sixties and have lumbar degenerative spondylopathy. Nowadays, surgical resection of the lumbar synovial cysts and spinal fusion are the recommended treatment, because it is thought that the increased movement of the spine is one to the causes of the cyst formation. More studies are still needed, hence the relevance of this article.

Congenital obstruction of the foramen of Monro causing unilateral hydrocephalus. A propos of a case / Oclusión congénita del foramen de Monro como causa de hidrocefalia unilateral. A propósito de un caso.

Isolated hydrocephalus of the lateral ventricle may result from unilateral occlusion of the foramen of Monro. The most common causes are tumours of the lateral ventricles or in the area of the third ventricle. Non-tumoural stenosis of the foramen is rare and can be due to inflammatory, vascular or congenital conditions. A full-term infant was prenatally diagnosed with unilateral hydrocephalus. After birth, progressive unilateral ventricular dilatation was confirmed in successive ultrasounds so surgery was indicated. The patient underwent endoscopic fenestration of the foramen of Monro and septostomy with good postoperative clinical evolution and reduction of ventricular size. Intraoperative findings demonstrated membranous obstruction of the right foramen of Monro. A successful treatment can be accomplished through a neuroendoscopic approach avoiding the use of ventricular shunts.

Oclusión congénita del foramen de Monro como causa de hidrocefalia unilateral. A propósito de un caso / Congenital obstruction of the foramen of Monro causing unilateral hydrocephalus. A propos of a case

La hidrocefalia aislada del ventrículo lateral puede ser provocada por la oclusión unilateral del foramen de Monro. Las causas más frecuentes son los tumores de los ventrículos laterales o en el área del tercer ventrículo. La estenosis no tumoral es poco frecuente y puede deberse a patologías inflamatorias, vasculares o congénitas. Se presenta el caso de un recién nacido a término diagnosticado prenatalmente de hidrocefalia unilateral. Tras el parto se confirmó en las sucesivas ecografías la dilatación ventricular unilateral motivo por el cual se indicó el tratamiento quirúrgico. El paciente fue sometido a la fenestración del foramen de Monro y septostomía por vía endoscópica, con buena evolución clínica y reducción del tamaño ventricular. Los hallazgos intraoperatorios demostraron la obstrucción por una membrana del foramen de Monro derecho. Se puede conseguir un tratamiento adecuado mediante neuroendoscopia, evitando implantar derivaciones ventriculares (AU)

Isolated hydrocephalus of the lateral ventricle may result from unilateral occlusion of the foramen of Monro. The most common causes are tumours of the lateral ventricles or in the area of the third ventricle. Non-tumoural stenosis of the foramen is rare and can be due to inflammatory, vascular or congenital conditions. A full-term infant was prenatally diagnosed with unilateral hydrocephalus. After birth, progressive unilateral ventricular dilatation was confirmed in successive ultrasounds so surgery was indicated. The patient underwent endoscopic fenestration of the foramen of Monro and septostomy with good postoperative clinical evolution and reduction of ventricular size. Intraoperative findings demonstrated membranous obstruction of the right foramen of Monro. A successful treatment can be accomplished through a neuroendoscopic approach avoiding the use of ventricular shunts (AU)

[Cabergoline-induced tension pneumocephalus in a patient with giant invasive prolactinoma. Case report]. / Neumoencéfalo a tensión causado por el tratamiento con cabergolina en un pacientecon prolactinoma invasivo gigante. A propósito de un caso.

Treatment of patients with prolactinomas consists primarily of dopamine agonists (DA). When these drugs reduce the size of invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. Pneumocephalus and cerebrospinal fluid leakage have been reported. A 56 year old male was admitted to the emergency unit with an intracranial hypertension syndrome. He had been treated for 2 weeks with cabergoline after an invasive prolactinoma was discovered. Brain CT showed frontal interhemispheric pneumocephalus on the previous tumor cavity, and bony defect on the sellar floor. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and subtotal tumor removal were performed. The literature is reviewed looking for possible pathophysiological mechanism, prevention and treatment.

Neumoencéfalo a tensión causado por el tratamiento con cabergolina en un paciente con prolactinoma invasivo gigante. A propósito de un caso / Cabergoline-induced tension pneumocephalus in a patient with giant invasive prolactinoma. Case report

El tratamiento de los pacientes con prolactinomas consiste principalmente en el uso de agonistas dopaminérgicos (AD). Cuando estos fármacos reducen el tamaño de prolactinomas invasivos, los espacios intra y extracraneal pueden llegar a comunicarse. El neumoencéfalo y la fístula de líquido cefalorraquídeo (LCR) han sido descritos. Un paciente varón de 56 años acude al servicio de urgencias con un síndrome de hipertensión intracraneal. Tras haber sido diagnosticado de un prolactinoma invasivo, había sido tratado con cabergolina durante 2 semanas. El TC craneal mostró neumoencéfalo frontal interhemisférico en la cavidad que ocupaba previamente el tumor, y un defecto óseo en el suelo de la silla turca. Se realizó evacuación del pneumoencéfalo, reparación de los defectos craneales y meníngeos y exéresis subtotal del tumor. Se revisa la literatura, los posibles mecanismos fisiopatológicos, modos de prevención y tratamiento (AU)

Treatment of patients with prolactinomas consists primarily of dopamine agonists (DA). When these drugs reduce the size of invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. Pneumocephalus and cerebrospinal fluid leakage have been reported. A 56 year old male was admitted to the emergency unit with an intracranial hypertension syndrome. He had been treated for 2 weeks with cabergoline after an invasive prolactinoma was discovered. Brain CT showed frontal interhemispheric pneumocephalus on the previous tumor cavity, and bony defect on the sellar floor. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and subtotal tumor removal were performed. The literature is reviewed looking for possible pathophysiological mechanism, prevention and treatment (AU)

[Mnemonic performance in patients following surgery to treat an aneurysm affecting the anterior circulation of the brain]. / Rendimientos mnésicos en pacientes intervenidos de un aneurisma de la circulación cerebral anterior.

INTRODUCTION: Patients submitted to surgery to treat a brain aneurysm, who have suffered a subarachnoid haemorrhage, sometimes present cognitive disorders that can affect their social, familial, academic or occupational relationships. Memory disorders are frequent, although other cognitive functions may also be affected. AIMS: The purpose of this research work was to study performance in logical verbal memory and visual-constructional memory in subjects following a surgical intervention (at least a year ago) to treat an aneurysm in the territory of the anterior circulation of the brain. We also wanted to analyse whether the location of the aneurysm in the brain had any effect on memory performance. PATIENTS AND METHODS: We examined a sample of 24 adult subjects of both sexes, with no previous history of cognitive or psychiatric disorders, who had undergone surgical treatment of brain aneurysms in the middle cerebral, anterior communicating and posterior communicating arteries. Neuropsychological tests were performed to assess the general cognitive status, as well as logical verbal and visual-constructional memory. RESULTS: 79% of the patients present a general cognitive status within the range of what could be considered to be normal. In logical verbal memory, 92% present performances within the limits of the expected range of values and 83% did the same in visual-constructional memory. Depending on the location of the aneurysm, significant differences were only found in the delayed evocation of logical verbal material. CONCLUSIONS: A year after the intervention, most of the patients present a pattern of normality in the general cognitive status, and in logical verbal and visual-constructional memory. Yet, in spite of the good neurological resolution, alterations to memory are still to be found, although less frequently. The anatomical location of the aneurysm in the brain affects performance in tasks involving delayed logical verbal memory.

Rendimientos mnésicos en pacientes intervenidos de un aneurisma de la circulación cerebral anterior / Mnemonic performance in patients following surgery to treat an aneurysm affecting the anterior circulation of the brain

Introducción. Los sujetos intervenidos de aneurisma cerebral, que han sufrido una hemorragia subaracnoidea, presentan en ocasiones trastornos cognitivos que pueden alterar sus relaciones sociales, familiares, académicas o laborales. Las alteraciones en la memoria son frecuentes, aunque también pueden afectarse otras funciones cognitivas. Objetivos. Estudiar los rendimientos en memoria verbal lógica y memoria visuoconstructiva en sujetos que se han intervenido (al menos hace un año) de aneurisma en el territorio de la circulación cerebral anterior. Analizar también si estos rendimientos en memoria varían en función de la localización cerebral del aneurisma. Pacientes y métodos. 24 sujetos adultos de risma. Doentes e métodos. 24 indivíduos adultos de ambos os sexos, sem antecedentes de perturbação cognitiva nem psiquiátrica prévia, submetidos a intervenção sobre aneurisma cerebral em: cerebral média, comunicante anterior e comunicante posterior. Efectuam-se testes neuropsicológicos para avaliar a situação cognitiva geral, memória verbal lógica e visuoconstrutiva. Resultados. 79 por ciento dos doentes apresentam uma situação cognitiva geral dentro do intervalo de normalidade. Na memória verbal lógica, 92 por ciento apresentam rendimentos dentro do esperado e 83 por ciento na memória visuoconstrutiva. Em função da localização do aneurisma, apenas existem diferenças significativas na evocação atrasada de um material verbal lógico. Conclusões. Um ano após a intervenção, a maioria dos doentes apresenta um padrão de normalidade na situação cognitiva geral, memoria verbal lógica e visuoconstrutiva; contudo, apesar da boa resolução neurológica, podemos encontrar alterações na memória, embora com menor frequência. A localização anatómica cerebral do aneurisma influi sobre os rendimentos em tarefas da memória verbal lógica atrasada (AU)

Introduction. Patients submitted to surgery to treat a brain aneurysm, who have suffered a subarachnoid haemorrhage, sometimes present cognitive disorders that can affect their social, familial, academic or occupational relationships. Memory disorders are frequent, although other cognitive functions may also be affected. Aims. The purpose of this research work was to study performance in logical verbal memory and visual-constructional memory in subjects following a surgical intervention (at least a year ago) to treat an aneurysm in the territory of the anterior circulation of the brain. We also wanted to analyse whether the location of the aneurysm in the brain had any effect on memory performance. Patients and methods. We examined a sample of 24 adult subjects of both sexes, with no previous history of cognitive or psychiatric disorders, who had undergone surgical treatment of brain aneurysms in the middle cerebral, anterior communicating and posterior communicating arteries. Neuropsychological tests were performed to assess the general cognitive status, as well as logical verbal and visual-constructional memory. Results. 79% of the patients present a general cognitive status within the range of what could be considered to be normal. In logical verbal memory, 92% present performances within the limits of the expected range of values and 83% did the same in visual-constructional memory. Depending on the location of the aneurysm, significant differences were only found in the delayed evocation of logical verbal material. Conclusions. A year after the intervention, most of the patients present a pattern of normality in the general cognitive status, and in logical verbal and visual-constructional memory. Yet, in spite of the good neurological resolution, alterations to memory are still to be found, although less frequently. The anatomical location of the aneurysm in the brain affects performance in tasks involving delayed logical verbal memory (AU)

[High jugular bulb and its relationship with acoustic neurinoma surgery]. / Golfo yugular prominente y su repercusión en la cirugía de los neurinomas del acústico.

The jugular bulb is formed by the junction of the sigmoid sinus, inferior petrous sinus and the jugular vein. It is housed in the jugular fossa of the petrous pyramid. Variations in its size, location and relationship to the internal acoustic canal (IAC) have been reported. When the jugular bulb is located medial and less than 2 mm from the posterior wall of the internal acoustic canal, it is named as high jugular bulb. If the surgeon is not aware of this variation, damage to this structure can result in profuse haemorrhage and air embolism. This anatomical change also makes difficult the access to the intracanalicular portion of acoustic neurinomas when these tumours are excised by a retrosigmoid approach. We present the case of a patient with an acoustic schwannoma in whom a preoperative axial cranial CT revealed a high jugular bulb. To control this venous structure, we opened the IAC in a longitudinal manner achieving a total excision of the lesion preserving the function of the facial nerve. We conclude that preoperative radiological investigations in acoustic schwannomas surgery should include cranial MR and TC, to rule out the presence of a high jugular bulb. Cranial axial CT including bony windows and slices of 1.5 mm thick, should be carried out to exclude a high jugular bulb.

Golfo yugular prominente y su repercusión en la cirugía de los neurinomas del acústico / High jugular bulb and its relationship with acoustic neurinoma surgery

El golfo de la yugular es una estructura venosa que se encuentra en la fosa yugular de la pirámide petrosa y que está formada por la confluencia de los senos sigmoideo, petroso inferior y de la vena yugular. Se han descrito variaciones en su tamaño, localización y relación con respecto al conducto auditivo interno (CAI). Cuando esta estructura venosa es medial y dista menos de 2 mm de la pared posterior del CAI, se le denomina golfo yugular alto o prominente. Esta variante anatómica representa una importante dificultad para el acceso quirúrgico a la porción intracanalicular de los neurinomas del acústico cuando son abordados por vía retrosigmoidea. Asimismo, si el cirujano no es consciente de esta anomalía, puede tener graves repercusiones quirúrgicas como hemorragia profusa o embolismo aéreo. Presentamos el caso de un paciente con un schwannoma del acústico en el que se diagnosticó un golfo yugular prominente mediante estudios preoperatorios de TC. Para controlar esta estructura venosa, se realizó una apertura longitudinal del CAI, llevándose a cabo una exéresis total del tumor y respetándose la función del nervio facial. Concluimos que los estudios radiológicos preoperatorios de la cirugía de los schwannomas del acústico deben incluir RM y TC craneal siendo necesarias, en esta última, ventanas óseas con cortes finos de 1.5 mm para poder identificar una posible presencia de un golfo yugular prominente (AU)