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A first generation of Coflex implant for non-rigid stabilization of lumbar spine was presented by Samani (Study of a semi-rigid interspinous U fixation system. Spinal Surgery, Child Orthopaedics: 1707, 2000).We started to treat patients with this Coflex device in 2004 and since then more than 600 patients have been operated in our Neurosurgical Department. We are reporting 156 patients treated between December 2004 and 2006 with complete follow-up. The clinical trials of this and other implants provide evidence that this interspinous non-rigid stabilization is useful against low-back pain due to degenerative instability and without serious complications.
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Doenças Neurodegenerativas/cirurgia , Procedimentos Ortopédicos/métodos , Próteses e Implantes , Fusão Vertebral/métodos , Adulto , Fatores Etários , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
We present a combined experimental setup for spin- and angle-resolved direct and inverse photoemission in the vacuum ultraviolet energy range for measurements of the electronic structure below and above the Fermi level. Both techniques are installed in one ultrahigh-vacuum chamber and, as a consequence, allow quasisimultaneous measurements on one and the same sample preparation. The photoemission experiment consists of a gas discharge lamp and an electron energy analyzer equipped with a spin polarization detector based on spin-polarized low-energy electron diffraction. Our homemade inverse-photoemission spectrometer comprises a GaAs photocathode as spin-polarized electron source and Geiger-Muller counters for photon detection at a fixed energy of 9.9 eV. The total energy resolution of the experiment is better than 50 meV for photoemission and better than 200 meV for inverse photoemission. The performance of our combined direct and inverse-photoemission experiment with respect to angular and energy resolutions is exemplified by the Fermi-level crossing of the Cu(111) L-gap surface state. Spin-resolved measurements of Co films on Cu(001) are used to characterize the Sherman function of the spin polarization detector as well as the spin polarization of our electron source.
RESUMO
We present a spectrometer for inverse photoemission in the vacuum ultraviolet range with variable energy resolution between 400 and 165 meV full width at half maximum. The energy distribution of the electron beam used for excitation can be adjusted between 300 and 125 meV by the use of a toroidal 90 degrees electrostatic deflector combined with a slit aperture. The emitted photons are detected by Geiger-Muller counters filled with either acetone or iodine as counting gas. The optical bandpasses of the detectors can be tuned between 100 and 330 meV by varying the temperature of their entrance windows. The overall resolution of the spectrometer is determined by measuring the Fermi-level onset in inverse-photoemission data of polycrystalline gold. Furthermore, the resolution enhancement is demonstrated by spectra of image-potential-induced surface states at Cu(001).
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Espectrofotometria Ultravioleta/instrumentação , Desenho Assistido por Computador , Transferência de Energia , Desenho de Equipamento , Análise de Falha de Equipamento , Fótons , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espectrofotometria Ultravioleta/métodosRESUMO
Radiotherapy or irradiation of SNC AVM's or tumors also presents a high risk for provoking lesions in adjacent surrounding tissue. The objective of our study is to demonstrate radiotherapy induced alterations in a rat spinal cord model and evaluate the protective effect of Growth Hormone (GH) on rats exposed to high radiotherapy doses. The experimental study employed two groups of Wistar rats: Group A (control group):10 rats, which received 30 Gy at the spinal cord . Group B: 10 rats, these animals received 30 Gy and dose of 2mg/kg/day GH. Growth hormone administration was begun three days before radiotherapy and continued until two days after radiotherapy for a total of six days. At 14 days postradiotherapy, all the rats were sacrificed and the spinal cord extracted immediately. Hematoxyline-eosine histologic studies showed that control animals only exposed to radiotherapy had severe alterations with hemorrhage and vacuolisation of the entire irradiated segment while these alterations were much less severe in the GH-treated group. In conclusion, 30 Gy irradiation produced morphological changes including vascular endothelial oedema, necrosis, hemorrhage, and inflammatory exudates. A 2 mg/kg/day dose of GH protected the rat spinal cord against the noxious effects of the radiotherapy, decreasing the clinical, macro and microscopic damage in the treated animals.
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Hormônio do Crescimento/farmacologia , Fármacos Neuroprotetores/farmacologia , Medula Espinal , Animais , Radioterapia/efeitos adversos , Ratos , Ratos Wistar , Medula Espinal/efeitos dos fármacos , Medula Espinal/patologia , Medula Espinal/efeitos da radiaçãoRESUMO
PURPOSE: Epilepsies originated from the occipital, parietal and/or the posterior edge of the temporal lobe are grouped together into posterior cortex epilepsy (PCE). Our objective was firstly to describe electro-clinical and imaging findings in the presurgical evaluation of children with PCE, and secondly to identify potential factors associated with surgical and cognitive outcomes. METHOD: From the total of patients referred to the Epilepsy Monitoring Unit of 'Hospital Universitario Niño Jesús' from 2003 to 2016, 55 had drug-resistant PCE. Different variables obtained from the multimodal presurgical work-up were analyzed among patients achieving seizure freedom after surgery (ILAE class 1) and patients with persistent seizures. Categorical variables were compared with Fishers exact test and numeric variables with t-Student for independent samples, and multiple logistic regression were used to analyze predictive values. RESULTS: Median duration of epilepsy until surgery was 5 years [3-10 years]. Fifty patients showed lesions in the MRI, and 62.5% had concordant MRI-PET corregistration. 37 (67%) patients were operated (lesionectomy in 21 subjects, tailored resection based on intracranial studies in 16), and 23 (62,2%) reached ILAE class 1, with a mean follow-up period of 3.51 [1-12] years. A lower number of basal seizures and antiepileptic drugs, a well-defined lesion on the MRI, an epileptogenic zone (EZ) restricted to the posterior quadrant and the normalization of postsurgical EEGs were associated with seizure freedom (p<0.05). Additionally, 65% of patients had a long-term improvement of cognitive performances. CONCLUSIONS: Epilepsy surgery should be considered in children with drug-resistant PCE, especially in those with a restricted EZ.
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Córtex Cerebral/fisiopatologia , Cognição/fisiologia , Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento , Córtex Cerebral/diagnóstico por imagem , Criança , Pré-Escolar , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Eletroencefalografia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Imageamento por Ressonância Magnética , Masculino , Tomografia por Emissão de PósitronsRESUMO
INTRODUCTION: Syringomyelia is defined as a cavity containing cerebrospinal fluid inside the spinal cord. AIM: To describe the clinical characteristics of a series of patients with syringomyelia, as well as its diagnosis and treatment. PATIENTS AND METHODS: We conducted a retrospective descriptive study by reviewing the medical records at our centre. RESULTS: We reviewed 25 patients diagnosed with syringomyelia. In five cases, the diagnosis was reached casually, and eight of them presented a previous severe pathology (tumour, bone or vascular). Two patients began with hydrocephalus and clinical signs and symptoms of intracranial hypertension and just two of them reported headaches as the only symptom. Four presented progressive scoliosis, two of them as the initial complaint, and required surgery with arthrodesis and the use of a corset, respectively. A notable feature was the earliness of the diagnosis. Most of them only presented a slight loss of strength, with normal somatosensory potentials and electromyogram. Check-ups were carried out with magnetic resonance. Eight patients required a decompressive craniectomy with posterior C1-C2 laminectomy, with drainage of the syringomyelic cavity in four cases. Nine of them required a bypass valve and a ventriculostomy also had to be performed in two of them. CONCLUSIONS: The presence of syringomyelia is rare in paediatric patients, and is generally associated with malformations in the posterior fossa and a medical history of spinal dysrhaphism. Progressive scoliosis stands out as a possible isolated manifestation. A multidisciplinary approach with regular radiological check-ups and evaluation by paediatric neurology and neurosurgery services are mandatory for its follow-up.
TITLE: Siringomielias en pediatria: estudio retrospectivo de 25 casos.Introduccion. Se define siringomielia como una cavidad que contiene liquido cefalorraquideo dispuesta en el interior de la medula espinal. Objetivo. Describir las caracteristicas clinicas de una serie de pacientes con siringomielia, su diagnostico y tratamiento. Pacientes y metodos. Estudio descriptivo retrospectivo realizado mediante la revision de historias clinicas en nuestro centro. Resultados. Se revisaron 25 pacientes diagnosticados de siringomielia. En cinco el diagnostico fue casual y ocho presentaban una patologia grave previa (tumoral, osea o vascular). Dos pacientes comenzaron con hidrocefalia y clinica de hipertension intracraneal y unicamente dos destacaban cefalea como unico sintoma. Cuatro presentaron escoliosis progresiva, dos de ellos como queja inicial, y precisaron cirugia con artrodesis y uso de corse, respectivamente. Destaca la precocidad del diagnostico. La mayoria presentaba unicamente perdida de fuerza leve, con potenciales somatosensoriales y electromiograma normales. En todos se hicieron controles con resonancia magnetica. Ocho pacientes precisaron craniectomia descompresiva con laminectomia posterior C1-C2, con drenaje de la cavidad siringomielica en cuatro. Nueve requirieron valvula de derivacion y dos precisaron, ademas, ventriculostomia. Conclusiones. La presencia de siringomielia en pediatria es rara, y se asocia generalmente a malformaciones en la fosa posterior y antecedentes de disrafismo espinal. Destaca la escoliosis progresiva como posible manifestacion aislada. Un abordaje multidisciplinar con controles radiologicos seriados y la valoracion por servicios de neurologia y neurocirugia pediatricos son mandatorios para su seguimiento.
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Siringomielia/diagnóstico , Siringomielia/patologia , Siringomielia/terapia , Criança , Cefaleia , Humanos , Hidrocefalia/etiologia , Laminectomia , Estudos RetrospectivosRESUMO
We present the case of a 69 year-old male without known antecedente who presented a clinical loss of distal force in his lower limbs during the last two months. Magnetic resonance imaging (MRI) showed an intramedullary spinal cord mass at the level of the medullaris cone. The patient was operated on; the histological diagnosis was clear cells carcinoma suggestive of metastasis from an unsuspected renal tumor that was later confirmed with an abdominal CT. When the patient's state is good, surgery can correct the neurological deficit produced by an intramedullary spinal cord lesion. The neurological state of our patient improved after the intervention, and 14 months after surgery, he has no neurological deficit in the lower limbs.
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Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/secundário , Neoplasias Renais/diagnóstico , Neoplasias da Medula Espinal/secundário , Idoso , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/patologia , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/cirurgiaRESUMO
Ankylosing spondylitis (AS) is an inflammatory disease involving the axial spine. Alterations in vertebral biomechanics leave the spine sensitive to traumas which, though minimal, may cause serious neurological lesions, particularly in long term AS patients with a completely ankylosed spine, who are more prone to suffer spine fractures. A 62-year-old man with a long-term AS suffered a minor trauma resulting in a cervical epidural hematoma from C2 to C7, leading to paraplegia. On the diagnosis of hematoma, he underwent C3-C7 left hemilaminectomies, to remove the hematoma. We could find no cause for the hematoma. The patient's condition improved, and he was eventually able to perform all his activities independently. Even though traumatic spinal epidural hematoma (SHE) of the ankylosed spine may occur in the absence of fracture, it is commonly associated with traumatic fracture or dislocation of the spine, particularly the cervical spine. In all the published series of SEH in AS, we could only find one more case of this pathology at the cervical spine without a fracture. Neurologic recovery can be successful if decompression is performed early. SHE must be considered after trauma to an ankylosed spine when there is neurological deterioration despite the absence of fracture. A good outcome depends on the early diagnosis and surgery.
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Vértebras Cervicais/patologia , Hematoma Epidural Espinal/complicações , Espondilite Anquilosante/complicações , Hematoma Epidural Espinal/patologia , Hematoma Epidural Espinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral , Espondilite Anquilosante/patologia , Tomografia Computadorizada por Raios XRESUMO
AIM: The objective of this experimental study was to assess the effectiveness of ADCON T/N in reducing perinerural adhesions when applied around a previously exposed and then anastomosed peripheral nerve in a rat model. METHODS: Sixteen adult 8-month-old male Wistar rats were used for this study. After the ulnar nerve was exposed bilaterally, the nerves were sectioned and anastomosised. ADCON T/N gel was applied around the nerve suture on 1 limb, while the contralateral limb was left untreated (sham operated control). Treatments were administered according to a randomised schedule revealed to the operator only after the perineural adhesions observed during the 2nd operation had been dissected and complete haemostasis achieved. In other group of 4 Wistar rats, the ulnar nerve was sectioned and the 2 ends connected with a 5 mm silastic tube that was placed bilaterally in each rat but on only one side, chosen randomly, was the nerve treated with ADCON TN and placed within the tube on that side. RESULTS: Three months after the 1st operation, the same nerves were exposed again in all animals under general anesthesia before microsurgical external neurolysis. The neurolysis sites in 16 rats were evaluated by blinded surgical dissection immediately before death. Parameters examined included: quality of wound healing, possible adverse effects, presence of residual implant material and perineural adhesions. Perineural adhesions around the ulnar nerve were visually scored using a 4-point qualitative scale (Mean 2.81 without gel, and 1.18 with ADCON T/N. p=0.017). There was no evidence of persistence of residual implant material in the ADCON T/N treated sites. No significant difference between the average density of myelinated axons was observed in either group. All ADCON T/N treated rats (4 animals) showed axonal growth through the tube connecting the 2 ends. CONCLUSION: ADCON-TN decreased fibrosis around the nerve anastomosis sites and did not impede growth between the severed ends of the axons. If reoperation becomes necessary, a reduction of fibrosis would facilitate access to the old site and decrease the risk of nerve lesions.
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Carboidratos/farmacologia , Procedimentos Neurocirúrgicos/efeitos adversos , Nervos Periféricos/efeitos dos fármacos , Polímeros/farmacologia , Complicações Pós-Operatórias/prevenção & controle , Neuropatias Ulnares/prevenção & controle , Animais , Axotomia , Carboidratos/uso terapêutico , Modelos Animais de Doenças , Fibrose/etiologia , Fibrose/prevenção & controle , Géis/farmacologia , Géis/uso terapêutico , Masculino , Regeneração Nervosa/efeitos dos fármacos , Regeneração Nervosa/fisiologia , Neuralgia/etiologia , Neuralgia/patologia , Traumatismos dos Nervos Periféricos , Nervos Periféricos/patologia , Nervos Periféricos/cirurgia , Polímeros/uso terapêutico , Complicações Pós-Operatórias/patologia , Ratos , Ratos Wistar , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Resultado do Tratamento , Nervo Ulnar/efeitos dos fármacos , Nervo Ulnar/patologia , Nervo Ulnar/cirurgia , Neuropatias Ulnares/patologia , Neuropatias Ulnares/cirurgiaRESUMO
INTRODUCTION: Ischemic symptomatology related to the presence of saccular brain aneurysms is infrequent, and this makes it difficult to reach a widespread agreement about the most suitable treatment. CASE REPORT: A 17-year-old male with symptoms of little stroke produced by distal embolisation of an aneurysm in the middle cerebral artery. The patient was treated by endovascular aneurysm exclusion. CONCLUSIONS: In patients with no other identifiable cause of ischemic attacks, the possible presence of a brain aneurysm must be taken into account. First choice treatment is the obliteration of the aneurysm using endovascular techniques. If the approach to the aneurysm (either endovascular or surgical) entails a high risk for the patient, another possibility is to use antiplatelet drugs.
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Isquemia Encefálica/etiologia , Aneurisma Intracraniano/complicações , Acidente Vascular Cerebral/etiologia , Adolescente , Humanos , MasculinoRESUMO
INTRODUCTION: Cavernous angiomas are angiographically occult vascular malformations that are present in 0.4% of people, and represent 5 13% of all cerebrovascular malformations. They can be alone or multiple, and sporadic or familial. The presence of multiple lesions is more frequent in familial cavernomatosis. OBJECTIVES: Improve our knowledge of the natural history of multiple cavernomatosis in order to improve our diagnostic and therapeutic management of this entity. PATIENTS AND METHODS: We have retrospectively reviewed 18 cases of multiple cerebral cavernomatosis; 4 of them belonged to the same family and 2 belonged to another family. Number, size, characteristics and evolution of the lesions, symptoms, treatment and clinical outcome have been analysed during a follow up period longer than 5 years. RESULTS: 31.5% of the cavernous angiomas reviewed by our department were multiple (at least three lesions). During the 5 year follow up period only four (4/18) patients underwent surgical treatment. 50% of patients suffered at least one hemorrhagic event with clinical impairment, and the most frequent manifestations were headache, focal deficit and seizures. The hemorrhagic rate per lesion per year was under 1%, for the more than 200 lesions and the low frequency of hemorrhagic events with clinical impairment in the time. CONCLUSIONS: Surgical treatment must be considered in patients with accessible lesions that have produced symptoms several or progressive symptoms. The non surgical patients should be followed with yearly MRI. When more than one first degree relative has a cavernous malformation or familial antecedent with cerebral hemorrhage or epilepsy, serial follow up monitoring consisting of physical examinations and MRI should be suggested to family members.
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Neoplasias Encefálicas , Hemangioma Cavernoso , Neoplasias Primárias Múltiplas , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Hemorragia Cerebral/etiologia , Criança , Pré-Escolar , Feminino , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/terapia , Estudos RetrospectivosRESUMO
OBJECTIVE: We examine a possible protective effect from growth hormone (GH) against radiation in cell cultures of rat embryon brain cortex. MATERIALS AND METHODS: Brain cortexes were removed from rat embryos of 17 days development and prepared for cell culture. The culture medium of half the plates was enriched with 500 ng/ml GH. All plates received a radiation dose of 3 Gy per plate and were again incubated for 24 hours. The TUNEL technique was employed to verify cell apoptosis in the irradiated plates and compare its level in plates with and without GH. CONCLUSIONS: We observed that irradiated cultures with GH had significantly less cell apoptosis than those without GH and concluded that this hormone excercised a protective effect on the cell cultures. The present study demonstrated the protective effect from GH in rat embryonary cells and suggests the need for future in vitro and in vivo studies using central nervous system cells.
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Encéfalo/citologia , Encéfalo/efeitos dos fármacos , Hormônio do Crescimento/farmacologia , Fármacos Neuroprotetores/farmacologia , Animais , Apoptose , Encéfalo/efeitos da radiação , Técnicas de Cultura de Células , Movimento Celular/fisiologia , Marcação In Situ das Extremidades Cortadas/instrumentação , Masculino , Ratos , Ratos WistarRESUMO
INTRODUCTION: The influence of surgery, radiotherapy and/or chemotherapy on the outcome on the results in patients with malignant gliomas is controversial. PATIENTS AND METHODS: We studied 44 patients (26, women; 18 men; age 38 72 years) diagnosed with grades III and IV astrocytoma who had been operated and then received adjuvant radiotherapy and either BCNU or temozolamyde chemotherapy. Survival time and adverse effects of the chemotherapy were analysed. CONCLUSION: Aggressive surgery associated with radiotherapy and temozolamyde chemotherapy prolonged survival in our patients with malignant astrocytomas.
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Astrocitoma/terapia , Neoplasias Encefálicas/terapia , Adulto , Idoso , Antineoplásicos/efeitos adversos , Astrocitoma/mortalidade , Neoplasias Encefálicas/mortalidade , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de SobrevidaRESUMO
Hyperflexion or teardrop fracture of low cervical vertebrae is characterised by ligament affectation of the entire intervertebral segment, the vertebral body, primarily its anteroinferior third and, frequently, spinal medullar affectation. This series presents the clinical symptoms, diagnosis, surgical approach, and post surgical evolution in 30 patients with tear drop fractures. Over the last 30 years, thirty patients with tear drop fractures at the low cervical spine (C3-C7) were admitted to our Neurosurgical Service. Diagnostic studies included simple radiographs, computerised axial tomography (CT), and magnetic resonance imaging (MRI), all of which evidenced the instability of the damaged segment due to osteoligamentous affectation, and a primarily vertebral body fracture. Patients' neurological status was according to the Frankel' scale adapted to the American Spinal Injury Association scale (ASIA). 11 patients were included in grade A, 5 in B, 3 in grade C, 2 in grade D and 9 grade E of neurological affectation. Surgery through an anterior approach was performed, an average of 5 days after placement of halo traction, which had been placed on admission to the hospital. Surgery consisted in vertebral corporectomy and placement of a plate and a graft from the iliac crest. The patients' neurological evolution was favourable in all cases with incomplete medullar lesions. There were 11 patients with complete lesions, or Frankel grade A affectation; two died due to other associated lesions and the other nine showed no neurological improvement after surgery. The degree of arthrodesis was good and only one patient required an a combined anterior-posterior approach. We conclude that teardrop fractures were associated with severe neurological affectation in more than 50% of our patients, and that these fractures provoke instability requiring arthrodesis, generally via an anterior approach.
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Vértebras Cervicais/lesões , Fraturas da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/etiologiaRESUMO
INTRODUCTION: Neurocysticercosis is the most frequent central nervous system parasitosis, although quite infrequent in our country. Its rising incidence can be explained by immigration from regions of the world where this disease is endemic. OBJECTIVE: This paper reviews treatment options for this condition. PATIENTS AND METHODS. Eight patients have been diagnosed with neurocysticercosis in the last three years in our hospital. Patient age, sex, origin, symptoms, CT and MR images, diagnostic tests, treatment and duration of medical treatment and clinical and neuroradiological evolution are examined. RESULTS: Patient age ranged from 25 to 33 years, all eight came from South America and the most frequent initial symptom was an epileptic crisis. Two patients had a single lesion, six had multiple lesions and all eight showed the lesion in the parenchyma. Only 50% showed a positive serum ELISA test for Taenia solium. Initial treatment was surgical in only one patient and the other seven received albendazol. In one of the latter the drug was ineffective and surgery was undertaken. A ten month follow up period has found a favorable evolution in all the patients, who are all also asymptomatic at the present time. DISCUSSION AND CONCLUSIONS: Neurocysticercosis is more common among immigrants than the local population in Spain. The initial treatment should be medical, with surgery as an option for non responders. We believe that duration of the medical treatment will depend on the patient and the clinico radiological evolution of his/her disease.
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Neurocisticercose/diagnóstico , Doença Aguda , Adolescente , Adulto , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Antígenos de Helmintos/líquido cefalorraquidiano , Antígenos de Helmintos/imunologia , Encéfalo/diagnóstico por imagem , Encéfalo/parasitologia , Encéfalo/patologia , Echinococcus/imunologia , Echinococcus/isolamento & purificação , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neurocisticercose/tratamento farmacológico , Neurocisticercose/parasitologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Tumours in the pineal region are located at a meeting point of several neurovascular structures that are difficult to reach surgically and for which the possibility of resection is limited; as a result the management of these lesions usually requires associated adjunctive treatment with radiotherapy and/or chemotherapy. PATIENTS AND METHODS: This study is a retrospective analysis of the epidemiological, clinical, neuroimaging and pathological characteristics of 23 patients with tumours in the pineal region who were treated between the years 1997 and 2010 in the Hospital Infantil Niño Jesús. The factors involved in the prognosis of this cohort following surgical or adjunctive treatment are also discussed. RESULTS: Subjects included in the study were 6 girls and 17 boys with ages ranging from 4 months to 18 years. It was found that the initial symptoms in 95% of the patients were signs of acute or subacute hydrocephalus, which required the placement of a ventriculoperitoneal shunt (82%). A histological sample of the tumour tissue was collected in all cases. Biopsy samples were taken in the case of five patients and 18 underwent surgery involving a craniotomy. Germinoma (eight cases) and mature teratoma (one case) were the tumours with the longest survival times; non-germinomatous tumours (three cases), those of the pineal parenchyma (four cases) and gliomas (five cases) presented the highest rates of recurrence and a poorer prognosis. CONCLUSIONS: The study of tumour markers can be used to guide the diagnosis of certain tumours of the pineal region. At present, the recommended procedure involves taking a histological sample of the tumour in order to establish an accurate diagnosis and a specific oncological treatment.
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Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Glândula Pineal/patologia , Adolescente , Biomarcadores Tumorais/análise , Biópsia , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Glândula Pineal/cirurgia , Prognóstico , Estudos RetrospectivosRESUMO
We evaluated treatment by posterior approach and its results for unilateral and bilateral facet dislocation of the lower cervical spine. Fracture reduction and ultimate stabilization of low cervical fractures located between C3 and C7 depend on the mechanism of the lesion and the resulting affectation of the osteoligamentary structures. The varied surgical approaches to fractures with unilateral or bilateral luxation include anterior, posterior, and combined. No surgery is performed if a conservative approach is used. Of the 71 low cervical fractures treated in our service in 10 years, 42 were facetary luxations (unilateral in 24 patients and bilateral in 18). Radiological studies included X-ray, CT and, in some cases, MRI. Once cervical fracture was diagnosed, halo traction was initiated and the decision to operate (34 cases) or continue conservative treatment (eight cases) was made a week after admittance. Surgery consisted of the posterior approach (27 bilateral clamps with bone graft, 5 wires with bone graft, and two posterior plates). Average patient follow-up was 7 (range 2-12) years. The patients' neurological status improved in 30 cases (71.42%) and was unchanged in 12 (28.57%). Three of eight patients initially treated conservatively developed radicular pain and instability and underwent surgery. Clamps were placed via a posterior approach in one case and the other two cases required a combined posterior and anterior approach. No instrumentation has required removal, although one patient developed a wall abscess. We found a posterior approach provides good stability for placing an arthrodesis in patients with a unilateral or bilateral cervical dislocation. In most of our cases we used clamps, and there was no worsening of any patient's neurological condition.
RESUMO
La radioterapia empleada en el tratamiento de los tumores o malformaciones vasculares del SNC presenta riesgo de causar lesiones en los tejidos adyacentes. El objetivo de nuestro estudio es demostrar las alteraciones provocadas por la radioterapia en la medula espinal de ratas a altas dosis y el valorar el efecto protector de la hormona de crecimiento (GH). El estudio experimental fue realizado con dos grupos de ratas Wistar. Grupo A (grupo control): Constó de 10 ratas que se irradiaron con 30 Gy en la medula espinal. Grupo B: Fue un grupo de 10 ratas irradiadas con 30Gy a las que se administró 2mg/kg/día de GH tres días previos a la radioterapia, el día de la radioterapia, y dos días después. A los 14 días de la radioterapia fueron perfundidas mostrando el estudio histológico de la médula espinal de las ratas tratadas sólo con radioterapia de forma intensa, hemorragias y trombosis de capilares. Al grupo a las que se administró GH mostró una importante disminución de las lesiones. En resumen la radioterapia administrada en dosis de30 Gy causa cambios morfológicos como edema lesión del endotelio vascular, necrosis, hemorragias, exudado inflamatorio. La dosis de 2mg/kg/día ejerce un efecto protector en la medula espinal de ratas tras la administración de radioterapia disminuyendo el daño macro y microscópico en las ratas estudiadas
Radiotherapy or irradiation of SNC AVM's or tumors also presents a high risk for provoking lesions in adjacent surrounding tissue. The objective of our study is to demonstrate radiotherapy induced alterations in a rat spinal cord model and evaluate the protective effect of Growth Hormone(GH) on rats exposed to high radiotherapy doses. The experimental study employed two groups of Wistar rats: Group A (control group):10 rats, which received 30 Gy at the spinal cord . Group B: 10 rats, these animals received 30 Gy and dose of 2mg/kg/day GH. Growth hormone administration was begun three days before radiotherapy and continued until two days after radiotherapy for a total of six days. At 14 days postradio therapy, all the rats were sacrificed and the spinal cord extracted immediately. Hematoxy line-eosine histologic studies showed that control animals only exposed to radiotherapy had severe alterations with hemorrhage and vacuolisation of the entire irradiated segment while these alterations were much less severe in the GH-treated group. In conclusion, 30 Gy irradiation produced morphological changes including vascular endothelial oedema, necrosis, hemorrhage, and inflamantory exudates. A2 mg/kg/day dose of GH protected the rat spinal cord against the noxious effects of the radiotherapy, decreasing the clinical, macro and microscopic damage in the treated animals
Assuntos
Animais , Ratos , Hormônio do Crescimento/farmacologia , Fármacos Neuroprotetores/farmacologia , Medula Espinal , Medula Espinal/patologia , Medula Espinal , Medula Espinal/efeitos da radiação , Radioterapia/efeitos adversos , Ratos WistarRESUMO
Presentamos el caso de un varón de 69 años sin patología previa de interés que presentó clínica de pérdida de fuerza distal en miembros inferiores de dos meses de evolución. La resonancia magnética (RM) mostró la presencia de una masa intramedular a nivel del cono. El paciente fue intervenido practicándose resección de la tumoración, mostrando el estudio histológico la presencia de un carcinoma de células claras correspondiente a una sospecha de metástasis de un tumor renal, que posteriormente se confirmó con una tomografía axial computarizada (TAC) abdominal. Cuando el estado del paciente es bueno, la cirugía puede subsanar el déficit neurológico producido por la lesión intramedular. Nuestro paciente, tras la intervención, mejoró su estado neurológico; y actualmente, tras 14 meses, se mantiene sin déficit neurológico en miembros inferiores
We present the case of a 69 year-old male without known antecedente who presented a clinical loss of distal force in his lower limbs during the last two months. Magnetic resonance imaging (MRI) showed an intramedullary spinal cord mass at the level of the medullaris cone. The patient was operated on; the histological diagnosis was clear cells carcinoma suggestive of metastasis from an unsuspected renal tumor that was later confirmed with an abdominal CT. When the patient's state is good, surgery can correct the neurological deficit produced by an intramedullary spinal cord lesion. The neurological state of our patient improved after the intervention, and 14 months after surgery, he has no neurological deficit in the lower limbs