Minimally invasive spine surgery in the nuevo hospital civil de guadalajara "dr. juan i. menchaca" / Cirurgia de coluna minimamente invasiva no nuevo hospital civil de guadalajara "dr. juan i. menchaca" / Cirugía de columna mínimamente invasiva en el nuevo hospital civilde guadalajara "dr. juan i. menchaca"

ABSTRACT Objective: To describe our experience on a case series treated with minimal invasive techniques in spine surgery, with short-term follow-up and identify complications. Methods: A prospective analysis was performed on 116 patients operated on by the same team from September 2015 to June 2016. Evaluating the short-term follow-up we registered the surgical time, bleeding, complications, hospital stay, pre- and postoperatively neurological status, as well as scales of disability and quality of life. Demographic and surgical procedure data were analyzed with SPSS version 20 program. Results: A total of 116 patients with a mean age of 49.7 + 15.7 (21-85 years) underwent surgery being 76 (65%) with lumbar conditions and 37 (32%) with cervical conditions. The most common procedures were tubular discectomies (31), tubular bilateral decompression (17), lumbar MI-TLIFs (7), and anterior cervical discectomy and fusion (35). The mean blood loss was 50.6 cc, the hospital stay was 1.7 day, pre- and postoperative pain VAS were 7.4 % and 2.3%, respectively, pre- and postoperative Oswestry (ODI) were 64.6% and 13.1%, respectively, pre- and postoperative SF-36 of 37.8% and 90.3%. There were no major complications, except for a surgical wound infection in diabetic patient and three incidental durotomies, one of these being a contained fistula, treated conservatively. Conclusions: The current tendency towards minimally invasive surgery has been justified on multiple studies in neoplastic and degenerative diseases, with the preservation of the structures that support the spine biomechanics. The benefits should not replace the primary objectives of surgery and its usefulness depends on the skills of the surgeon, pathology and the adequate selection of the techniques. We found that the tubular access allows developing techniques such as discectomy, corpectomy and fusion without limiting exposure, avoiding manipulation of adjacent structures, reducing complications and being feasible in a public hospital.

RESUMO Objetivo: Descrever nossa experiência em uma série de casos tratados por técnicas minimamente invasivas de cirurgia da coluna, o acompanhamento a curto prazo e identificar complicações. Métodos: Realizou-se análise prospectiva de 116 pacientes operados pela mesma equipe, de setembro de 2015 até junho de 2016. Avaliando o acompanhamento a curto prazo, foram registrados tempo cirúrgico, hemorragia, complicações, estadia hospitalar, estado neurológico pré e pós-operatório, além de escalas de incapacidade e qualidade de vida. Os dados demográficos e sobre o procedimento cirúrgico foram analisados com o programa SPSS versão 20. Resultados: Um total de 116 pacientes com média de idade de 49,7 + 15,7 (21 a 85 anos) foram operados, sendo 76 (65%) com afecção lombar e 37 (32%) com afecção cervical. Os procedimentos mais comuns foram discotomias tubulares (31), descompressão bilateral tubular (17), MI-TLIF (7) lombares; discotomia e artrodese anterior (35). O sangramento médio foi de 50,6 cm3, o tempo de hospitalização foi 1,7 dia, a escala EVA pré-cirúrgica foi 7,4 e a pós-cirúrgica 2,3, Oswestry (ODI) pré-cirúrgico de 64,6% e pós-cirúrgico de 13,1%, SF-36 pré-cirúrgico de 37,8% e pós-cirúrgico de 90,3%. Não houve grandes complicações, exceto uma infecção da ferida cirúrgica em paciente diabética e três durotomias incidentais um dos pacientes com fístula, uma delas contida, tratada de modo conservador. Conclusões: A tendência atual da cirurgia minimamente invasiva tem sido justificada em vários estudos sobre neoplasia e doenças degenerativas, preservando as estruturas da biomecânica da coluna vertebral. Os benefícios não devem substituir os objetivos primários e sua utilidade depende das habilidades do cirurgião, da patologia e do uso seletivo das técnicas. Constatamos que o acesso tubular permite desenvolver a técnica de discotomia, fusão e corpectomia sem limite de exposição, evitando manipulação de estruturas adjacentes, reduzindo as complicações e sendo viável em hospitais públicos.

RESUMEN Objetivo: Describir nuestra experiencia en una serie de casos tratados mediante técnicas mínimamente invasivas en cirugía de columna, su seguimiento a corto plazo e identificar las complicaciones. Métodos: Se realizó un análisis prospectivo en 116 pacientes intervenidos por el mismo equipo desde septiembre de 2015 a junio de 2016. Evaluando el seguimiento a corto plazo, se registró tiempo quirúrgico, sangrado, complicaciones, estancia hospitalaria, estado neurológico pre y post operatorio además de escalas de discapacidad y calidad de vida. Los datos demográficos y del procedimiento quirúrgico fueron analizados con el programa SPSS versión 20. Resultados: Un total de 116 pacientes con edad promedio de 49,7 + 15,7 (21 a 85 años), fueron intervenidos siendo 76 (65%) patologías lumbares y 37 (32%) cervicales. Los procedimientos más comunes fueron discectomías tubulares (31), descompresión bilateral tubular (17), MI-TLIF (7) lumbares; discectomía y artrodesis anterior (35). El promedio de sangrado fue 50,6 cc, estancia hospitalaria 1,7 día, escala EVA prequirúrgica 7,4 y posquirúrgica 2,3, Oswestry (ODI) prequirúrgico 64,6% y posquirúrgico 13,1%, SF-36 prequirúrgico 37,8% y posquirúrgico 90,3%. No hubo complicaciones mayores, excepto una infección de herida quirúrgica en paciente diabética y 3 durotomías incidentales, una de estas con fístula contenida, de manejo conservador. Conclusiones: La tendencia actual de la cirugía mínimamente invasiva se ha justificado en múltiples estudios en patología tumoral y degenerativa, con la conservación de estructuras para biomecánica de la columna. Los beneficios no deben reemplazar los objetivos primarios y su utilidad depende de las habilidades del cirujano, la patología, y el uso selectivo de las técnicas. Encontramos que el acceso tubular permite desarrollar la técnica de discectomía, fusión y corpectomía sin limitar la exposición, evitando manipulación de estructuras adyacentes, disminuyendo complicaciones y siendo factible en un hospital público.

Diagnóstico simultáneo de pseudomeningocele, síndrome de médula anclada y fístula de líquido cefalorraquídeo: a propósito de un caso / Simultaneous diagnosis of pseudomeningocele, tethered cord syndrome and cerebrospinal fluid fistula: Report of a case

El caso clínico alude a una paciente con disrafismo sacro extenso, antecedentes de reparación de mielomeningocele en su infancia y signos y síntomas de síndrome de médula anclada. Se diagnosticó además pseudomeningocele y fístula de líquido cefalorraquídeo cutánea. El abordaje quirúrgico fue realizado con resultados alentadores en la evolución de la paciente. Se realizó además una revisión de la literatura, para fundamentar el tratamiento quirúrgico utilizado en este caso

The clinical case is presented on a patient with an extensive sacral dysraphism, a history of myelomeningocele surgical repair in her childhood, as well as tethered cord syndrome. The patient was also diagnosed with pseudomeningocele and a cerebrospinal fluid cutaneous fístula. A surgical approach was used, with encouraging results being obtained in the clinical outcome of the patient. A review of the literature was performed to support the surgical decision in this case

[Simultaneous diagnosis of pseudomeningocele, tethered cord syndrome and cerebrospinal fluid fistula: Report of a case]. / Diagnóstico simultáneo de pseudomeningocele, síndrome de médula anclada y fístula de líquido cefalorraquídeo: a propósito de un caso.

The clinical case is presented on a patient with an extensive sacral dysraphism, a history of myelomeningocele surgical repair in her childhood, as well as tethered cord syndrome. The patient was also diagnosed with pseudomeningocele and a cerebrospinal fluid cutaneous fístula. A surgical approach was used, with encouraging results being obtained in the clinical outcome of the patient. A review of the literature was performed to support the surgical decision in this case.

Sarcoma de Ewing extraóseo / Extraosseous Ewing sarcoma

Introducción. La familia de sarcomas de Ewing incluye el sarcoma de Ewing óseo, el tumor neuroectodérmico primitivo, el sarcoma de Ewing extraóseo y el tumor de Askim (sarcoma de Ewing de la pared torácica). Los sitios más comunes de estos tumores son tórax y extremidades. Estos tumores malignos surgen del hueso o de tejidos blandos. Histológicamente, se caracterizan por alta celularidad de pequeño tamaño, redondas, azules y con tendencia a formar estructuras rosetoides. Caso clínico. Se presentó el caso de un adolescente de 14 años de edad que, tres meses previos a su ingreso, inició con cefalea fronto-parietal izquierda con irradiación hacia el globo ocular. Al examen neurológico se encontró proptosis y disminución de la agudeza visual, además de atrofia papilar. Se realizó una tomografía computarizada de cráneo, donde se identificó una lesión intraorbitaria izquierda y otra parietotemporal ipsilateral. Se realizó la exéresis tumoral, reportando positividad para marcadores de tumor neuroectodérmico primitivo, vimentina y CD99. Conclusiones. El sarcoma de Ewing es extremadamente raro a nivel de la órbita. Sin embargo, es prudente considerarlo como diagnóstico diferencial en lesiones de esta región, ya que el pronóstico depende de la precisión diagnóstica temprana.

Background. The Ewing sarcoma family includes Ewing bone sarcoma, primitive neuroectodermal tumor, extraosseous Ewing's sarcoma, and Askim tumor (Ewing sarcoma of the chest wall). The most common sites of these tumors are chest and limbs. These malignancies arise from bone or soft tissues. Histologically, it is characterized by high cellularity, small, round, blue and with a tendency to form rosette structures. Case report. We report the case of a 14-year-old patient whose evolution began 3 months before admission with left frontoparietal headache radiating to the eyeball. During neurological examination, proptosis and decreased visual acuity were found, as well as papillary atrophy. Cranial computed tomography identifed a left intraorbital injury and another ipsilateral parietotemporal. Tumor exeresis was performed, reporting positive for primitive neuroectodermal tumor markers, vimentin and CD 99. Conclusions. Ewing sarcoma is extremely rare at the orbital level: however, it is prudent to consider this tumor as a differential diagnosis in lesions of this region. Prognosis depends on early diagnostic accuracy.

Aneurismas del ápex carotideo en la edad pediátrica: Reporte de un caso / Carotid apex aneurysms in children: Case report

Introducción. Las malformaciones aneurismáticas del polígono de Willis comprenden un raro grupo de anomalías congénitas que se presentan en edades pediátricas. Son causa importante de morbimortalidad en este grupo de edad; en consecuencia, el manejo de estas lesiones es complejo y potencialmente letal, y puede plantear problemas para el paciente y su tratamiento. Caso clínico. Presentamos el caso de una niña de 10 años que inició de manera súbita con síncope neurogénico y crisis convulsivas tónico-clónicas generalizadas. Al llegar a urgencias, se le realizó una tomografía donde se identificó hemorragia subaracnoidea Fisher II. En la angiografía cerebral de 4 vasos se observó una lesión sacular del ápex carotideo, de aproximadamente 5.1 x 7.2 mm, con cuello visible y domo dirigido hacia la parte cefálica y hacia la parte frontal. Se le realizó craneotomía fronto-pterional derecha. Durante el transquirúrgico, se llevaron a cabo un ultrasonido pre-clipaje, que identificó la lesión aneurismática, y uno post-clipaje, para verificar la permeabilidad de las ramas distales al clipaje. Conclusiones. Las malformaciones aneurismáticas en la edad pediátrica son extremadamente raras. Por ello, métodos como la endoscopia y la sonografía transoperatoria y postoperatoria son de gran utilidad, ya que evidencian detalles que en ocasiones los estudios de imagen convencionales no revelan. Todo esto condiciona un procedimiento con menor riesgo de morbimortalidad para este tipo de pacientes.

Background. Aneurysm malformations of the circle of Willis comprise a rare group of congenital anomalies that occur during the pediatric age and are a major cause of morbidity and mortality in this age group. Consequently, management of these lesions is complex and potentially lethal and may pose problems for the patient and affect their treatment. Case report. We report the case of a 10-year-old girl who had a sudden onset of neurogenic syncope and tonic-clonic seizures. After arriving at the emergency room, she underwent a CT scan, identifying a Fisher II subarachnoid hemorrhage. Four-vessel cerebral angiography identified apex saccular carotid injury ~5.1 x 7.2 mm with visible neck and dome partially cephalic and partially frontal. Right frontopterional craniotomy was performed and preclipping during trans-surgical ultrasound was performed, identifying the aneurysmal lesion and post-clipping to verify patency of the distal branches to clipping. Conclusions. Aneurysmal malformations in children are extremely rare. For this reason, methods such as endoscopy, trans- and postoperative ultrasound are very useful. These procedures sometimes reveal details that conventional imaging studies do not, determining use of a procedure with less risk of morbidity and mortality for these patients.

Ping pong fractures: treatment using a new medical device.

PURPOSE: The aim of this study was to assess the use of a new medical device to elevate depressed skull fractures (DSFs) in newborns and minor infants. METHODS: Nine patients (ranging from 1 day to 9 months of age) with simple DSF underwent skull elevation by a new elevator medical device. This medical device comprises two elements: a pediatric resuscitator (CPR mask) connected to a 50-ml syringe. Pediatric CPR face mask is placed on the depressed region and negative pressure is generated through syringe plunger elevation until fracture reduction is observed. RESULTS: Fracture reduction was confirmed in eight of nine patients by computed tomography scan without underlying brain damage and associated complications. Skull asymmetry was eliminated recovering normal shape. Up to now, there are no neurological concerns. Another treatment was chosen to be applied for one patient who did not respond to manipulation. CONCLUSION: The new device is a safe, affordable, and effective choice in the treatment of simple depressed skull fractures in newborns and minor infants.

[Amniotic band sequence and bilateral choanal atresia: a case report]. / Secuencia de bridas amnióticas y atresia bilateral de coanas: reporte de un caso.

Amniotic band sequence (ABS) is a group malformation that mainly affects limbs; clinically, constriction rings and lymphedema of the fingers, arms and legs, acrosyndactyly and pseudosyndactyly are observed; also there is congenital amputation of limbs due to distal swelling. Less frequently, craniofacial and trunk involvement are reported in some patients. Etiology is still unknown and most cases are isolated. In this report we present the case of a 45-day-old male with diagnosis of SBA and bilateral choanal atresia as attached finding, and review possible causes of SBA and associated alterations.

Secuencia de bridas amnióticas y atresia bilateral de coanas: reporte de un caso / Amniotic band sequence and bilateral choanal atresia: a case report

La secuencia de bridas amnióticas (SBA) es un grupo de malformaciones de tipo disruptivo que afecta principalmente las extremidades; clínicamente, se observan anillos de constricción y linfedema en dedos, brazos y piernas; pseudosindactilias y acrosindactilias; además, existe amputación congénita de las extremidades por tumefacción distal; en algunos pacientes se han comunicado, con menor frecuencia, alteraciones craneofaciales y del tronco. La etiología es aún desconocida y la mayoría de los casos son aislados. En este informe presentamos el caso de un paciente masculino, de 45 días de nacido, con diagnóstico de SBA y atresia bilateral de coanas como hallazgo adjunto; se revisan las posibles causas del SBA y las alteraciones asociadas.

Amniotic band sequence (ABS) is a group malformation that mainly affects limbs; clinically, constriction rings and lymphedema of the fngers, arms and legs, acrosyndactyly and pseudosyndactyly are observed; also there is congenital amputation of limbs due to distal swelling. Less frequently, craniofacial and trunk involvement are reported in some patients. Etiology is still unknow and most cases are isolated. In this report we present the case of a 45-day-old male with diagnosis of SBA and bilateral choanal atresia as attached fnding, and review possible causes of SBA and associated alterations.