ABSTRACT
Objective. To report a case of segmental neurofibromatosis located in the fronto temporal orbitary region. Description. A 54 year-old patient with a right progressive exoftalmos due to a tumor inside the orbit. He was operated 18 years ago with an histopatology diagnosis of neurofibroma. He recovered well from the surgery, but 3 years ago the right exoftalmos reappeared. The MRI shows multiple subgaleal tumors located in the right fronto temporal area, inside and outside the orbit. Intervention. A right fronto orbitary craniotomy was performed with the resection of soft non encapsulated subgaleal lesions. Conclusion. Segmental neurofibromatosis is a rare affection wich is very difficult to deal with, because of the high incidence of recurrence of the neurofibromas. Despite this, in cases like this one a surgical treatment is highly recommended to prevent not only visual defects but also cosmetic alterations.
Subject(s)
Magnetic Resonance Spectroscopy , Neurofibromatosis 1ABSTRACT
Objetivo. Describir un caso de subluxación atlantoaxial anterior secundaria a una osteoartritis. Descripción. Un paciente masculino de 60 años de edad con una tetraparesia moderada, rápidamente progresiva, piramidalismo y trastornos sensitivos superficiales y profundos, de cuatro meses de evolución. Las radiografías de columna cervical frente y perfil muestraron una subluxación atlanto-axial anterior. La resonancia magnética mostró un tejido patológico periodontoideo con extensión a articulares y mielomalacia compresiva a nivel C1-C2 a expensas de elementos posteriores por la subluxación. Las radiografías del resto de la columna, manos, rodillas y hombros mostraron cambios degenerativos artrósicos. Se realiza una interconsulta con el servicio de reumatología que, luego del analizar los resultados serológicos, clínicos y radiológicos, arribó al diagnóstico de osteoartritis. Intervención. Consistió en un abordaje posterior, con apertura del foramen magno, laminectomía de C1 y osteosíntesis occipitocervical con la colocación de injertos óseos autólogos. Conclusión. La osteoartritis es una causa infrecuente de subluxación atlantoaxial anterior. Más allá de la patología causal, sabemos que el tratamiento quirúrgico es fundamental en los pacientes sintomáticos.
Objetive. To describe a new case of an anterior atlanto-axial suluxation caused by osteoarthritis. Dewscription. A 60-year-old male patient presented a 4 month history of progressive cuadriparesis, bipyramidalism and deep and superficial hipoestesia. The anterior and lateral radiographs showed an anterior C1-C2 subluxation and the magnetic resonance periodontoidal tissue mass that caused a compressive myelopathy. Intervention. Through a posterior approach, we openned theforamen magnum and performed a C1 laminectomy. After the decompression we performed an occipitocervical arthrodesis with an "Y" plate implant and autologous bone grafts. Conclusion. Osteoarthritis is an unusual cause of anterior atlantoaxial subluxation, that must be treated surgically in symptomatic patients.
Subject(s)
Osteoarthritis , Joint DislocationsABSTRACT
Objective: to present a case of an extradural arachnoid dorsal cyst in a 30 year-old woman. Description: a patient (30 years, female) who refers eight-months history of radicular pain and progressive right leg weakness, with exacerbations and remissions. On examination the patient had righ hemihypesthesia with T-10 sensitive level and right leg 4/5 palsy. Magnetic resonance imaging showed an extradural cystic lesion in T11-T12 hypointense in T1 and hyperintense en T2, without contrast enhancement. The cyst contained fluid tha demonstrated the same signal as cerebrospinal fluid. Intervention: After laminectomy of T-10 and T-11 the cystic lesion was exposed. The cyst was filled with CSF-fluid like. A surgical resection of the cyst wall was made. A small dural defect that allowed communication between the cyst and the subarachnoid space was revealed during the surgery, and a closure was made with a suture. Histopathological examination confirmed a cystic lesion with a single-cell lining of meningothelial cells, that contained no neural tissue neither ganglion cells. Conclusion: extradural arachnoid cysts showed characteristic images in the MRI in the preoperative stage. There was no need to use other invasive methods such as myelography or mielotomography to decide the indication for surgery or the surgical technique. Definitive diagnosis is based on the free comunication with the subarachnoidal space and the lack of neural tissue in the histopatological examination, which allowed us to distinguish between extradural arachnoid cysts and Tarlov cysts