[Painful tic convulsif: Case series and literature review]. / Tic convulsivo doloroso: serie de casos y revisión de la literatura.

BACKGROUND: The coexistence of hemifacial spasm and trigeminal neuralgia, a clinical entity known as painful tic convulsive, was first described in 1910. It is an uncommon condition that is worthy of interest in neurosurgical practice, because of its common pathophysiology mechanism: Neuro-vascular compression in most of the cases. OBJECTIVE: To present 2 cases of painful tic convulsive that received treatment at our institution, and to give a brief review of the existing literature related to this. The benefits of micro-surgical decompression and the most common medical therapy used (botulin toxin) are also presented. CLINICAL CASES: Two cases of typical painful tic convulsive are described, showing representative slices of magnetic resonance imaging corresponding to the aetiology of each case, as well as a description of the surgical technique employed in our institution. The immediate relief of symptomatology, and the clinical condition at one-year follow-up in each case is described. A brief review of the literature on this condition is presented. CONCLUSION: This very rare neurological entity represents less than 1% of rhizopathies and in a large proportion of cases it is caused by vascular compression, attributed to an aberrant dolichoectatic course of the vertebro-basilar complex. The standard modality of treatment is micro-vascular surgical decompression, which has shown greater effectiveness and control of symptoms in the long-term. However medical treatment, which includes percutaneous infiltration of botulinum toxin, has produced similar results at medium-term in the control of each individual clinical manifestation, but it must be considered as an alternative in the choice of treatment.

Mass Effect Due to Hypertrophic Pericranial Flap in the Reconstruction of Dural Defect.

OBJECTIVE: To present a case of symptomatic mass effect caused by engorgement of a vascularized pericranial flap in the repair of dural defect secondary to parasagittal meningioma surgical excision, in order to expose a potential complication from this reconstruction technique. CASE: A 62-year-old man with a left medial-third type 1 of Sindou's classification parasagittal meningioma underwent complete Simpson 1 surgical excision. For the reconstruction of the dural defect, a vascularized pericranial flap was sutured using water-sealed technique. On postsurgical day 2, the patient developed progressive neurologic impairment characterized by stupor. Magnetic resonance imaging stroke sequence revealed what appears to be an extradural collection not visualized on an immediate postsurgical computed tomographic scan. In surgical reexploration, we found an engorged pericranial flap causing direct compression to the parenchyma without the presence of additional hematoma in the surgical field. RESOLUTION: The pericranial flap needed to be excised, and the dural defect was repaired using synthetic material. No permanent neurologic deficit was documented at 6-month follow-up. CONCLUSION: We hypothesized that pericranial flap was strangulated because of final bone flap replacement so that venous outflow was compromised. This complication can be prevented if adequate drilling of the inner table at the edge of the craniotomy and at the outer table of the bone flap is performed just at the entry zone of pericranium flap pedicle to avoid a 90° angle of entry resulting in vascular congestion.