Tumores avanzados de cabeza y cuello: resección total y reconstrucción con colgajos libres y pegamentos biológicos

Los pacientes con cáncer avanzado y recurrente de la piel de la cabeza y el cuello requieren agresivos y prolongados procedimientos, además de padecer una elevada morbilidad, para alcanzar márgenes seguros de curación oncológica. Se trataron once pacientes, 7 con carcinomas de células escamosas, 3 con carcinomas de células basales y 1 Schwanoma maligno, con una combinación de craniotomía, cirugía basal craneal y abordaje craneofacial para reconstruir extensos defectos utilizando colgajos libres musculares y cutáneos en una intervención. Grasa, músculo y 1 mm de una capa epidural de un adhesivo biológico (Bioglue) se usaron para sellar suturas durales y obliterar potenciales espacios muertos. No hubo reacciones adversas al adhesivo biológico y ningún paciente presentó otras complicaciones. De los once pacientes, 3 fallecieron por complicaciones médicas: embolismo pulmonar, mielodisplasia tardía e infarto del miocardio. Para el momento de nuestro seguimiento (9-58 meses) ningún paciente ha presentado recurrencias o metástasis distales

Patients with advanced and recurrent head and neck skin cancer need aggressive and prolonged reconstructive procedures, besides suffering high morbidity, to get safe margins of oncology healing. We treated eleven patients, 7 with squamous cell carcinomas, 3 with basal cell carcinomas and 1 malignant Schwanoma, by a combination of craniotomy, basal cranium, surgery and cra-niofacial boarding to reconstruct extensive defects using free muscular and skin flaps in one intervention. Fat, muscle and 1 mm ipidural biological adhesive layer (Bioglue) was used to seal dural sutures and obliterate potential dead spaces. There were no adverse reactions to the biological adhesive and no patients presented other complications. Out of the eleven patients 3 died due to medical complications: lung embolism, late mielodisplasia and myocardial infarction. After 9-58 months follow up none of the patients have presented with recurrent or distal metastasis

Leptomeningeal spinal spread of glioblastoma multiforme: report of two cases and review of the literature

Extracranial metastasis of glioblastoma multiforme (GMB) are extremely rare, developing clinically in less than 2 pert cent of case, but probably increasingas patients live longer. It has been reported from necropsic series that microscopic metastasis occur in approximately 6 pert cent and 60 pert cent of supratentorial and infratentorial glioblastomas respectively but patient usually die before they become symptomati. We report two patients with supratentorial glioblastoma multiforme who developed leptomeningeal seeding at the thoracolumbar region as part of their natural history. Clinical and radiographic features and the usefulness of magnetic resonance imaging and CSF fluid analysis is discussed as well as a brief review of the literature