ABSTRACT
Introducción: los meningiomas del foramen óptico producen un rápido deterioro de la función visual aún cuando su tamaño es pequeño, por eso su diagnóstico y manejo difiere del resto de los meningiomas clinoideos. El propósito de este estudio es presentar la técnica y los resultados de nuestro manejo quirúrgico de meningiomas foraminales (MF). Pacientes y Métodos: se llevó a cabo una revisión de las historias clínicas de 47 pacientes con meningiomas primarios intraorbitarios. Se realizaron 52 cirugías en los pacientes con MF. Se empleó una craneotomía fronto-orbitaria, seguida de una descompresión extradural del canal óptico, resección del componente intraorbitario y exploración intradural del nervio óptico. Resultados: de los 12 pacientes con MF que presentaban la visión conservada, la agudeza visual fue preservada en 7 casos, mejoró en 2, y empeoró en 3. En 18 pacientes, el principal síntoma fue exoftalmos y en 35 pacientes ceguera unilateral. Ocurrieron 6 recurrencias, 2 a 10 años después de la resección quirúrgica. Cinco de ellos fueron reoperados. Se indicó radioterapia después de la recurrencia en 3 pacientes. Conclusión: el manejo de los MF continúa siendo controvertido y frecuentemente se propone un tratamiento conservador. Basados en nuestros hallazgos de frecuente extensión intracraneal, proponemos realizar una resección total o subtotal del tumor, preservando el nervio óptico en pacientes con visión prequirúrgica conservada.
Introduction: optic foramen meningiomas produce rapid deterioration of visual function even when its size is small, so its diagnosis and management differs from other clinoidal meningiomas. The purpose of this study is to present the technique and results of our surgical management of foraminal meningiomas (FM).Patients and Methods: a review of medical records of 47 patients harboring primary intraorbital meningiomas (PIM) was performed. In PIM patients fifty two operations were carried out. Fronto-orbital craniotomy was employed followed by extradural decompression of the optic canal, resection of the intraorbital component, and exploration of the optic nerve intradurally.Results: among 12 patients with PIM who had useful vision preoperatively the visual acuity was preserved in 7 cases, improved in 2, and worsened in 3 cases. In 18 patients exophthalmos was the main symptom and in 35 patients unilateral blindness. Six recurrences occurred 2 to 10 years after surgery. Five of them were reoperated on. We indicated radiotherapy after recurrence in 3 patients.Conclusion: the management of PIM remains controversial and conservative management is frequently proposed. Based on our frequent findings of intracranial extension, our approach has been to perform a total or subtotal removal of the tumor, sparing the optic nerve in patients with useful preoperative vision.
Subject(s)
Humans , Meningioma , Optic NerveABSTRACT
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
Objective: to compare the thecnical procedures used for reconstruction in different groups of traumatic brachial plexus lesions (TBPL): supra and infraclavicular. Methods: all cases of brachial plexus lesions operated between September 2002 and March 2004 were included. Each case was analyzed separately and included in one of the two groups. Results: a total of 12 lesions were included in this presentation. Out of these, 8 were supraclavicular lesions, wich required neurorraphy in 4 nerves or trunks, neurotization in 11, and neurolisis in one. There were 4 infraclavicular lesions: 4 required neurolisis, and 2 neurorraphy. Conclusion: Eachs group of TBPL required a different surgical reconstruction technique
Subject(s)
Brachial Plexus , Clavicle , Nerve Transfer , Brachial Plexus Neuropathies/surgery , Brachial Plexus Neuropathies/complicationsABSTRACT
Objective: to describe the incidence and the different etiologies of oculomotor palsy in neurosurgical patients. Methods: Hospital records from the last 3 years were retrospectively reviewed. Five formalin-fixed adults heads were examined using X6 to X40 magnification. A correlation between clinical findings, anatomical studies and MRI images was performed. Results: medical records from 382 patients operated on at our department were reviewed. Of these, 16 patients underwent complete oculomotor palsy before brain surgery. Two patients had a mesencephalic tumor, 6 patients underwent uncal herniation due to a fast-growing intracranial mass, one patient had a superior cerebellar artery aneurysm, 3 patients had a posterior communicating artery aneurysm, one patient had a cavernous sinus meningioma. An analysis of the clinical, anatomical and MRI/ angiography data of 5 cases are presented in this study. Conclusion: oculomotor palsy is a relatively common finding in neurosurgical practice. The fact that it can be caused by different etiologies should be considered in order to arrive to the appropiate diagnosis and treatment. Anatomical knowledge of third nerve is very important when dealing with oculomotor palsy
Subject(s)
Neurosurgical Procedures , Oculomotor Nerve , Oculomotor Nerve DiseasesABSTRACT
Objective: to report a case of glioblastoma multiforme (GBM) of the posterior fossa. Description: male, 53 years old, with a clinical presentation of dizziness and diplopia. MRI: posterior fossa tumor in the left cerebellar hemisphere, with an extension to the peduncle, brain stem and cerebellopontine angle. Intervention: a subtotal ressection was performed through a suboccipital craniotomy. Pathology informed GBM. After surgery the patient completed the treatment with radiotherapy (60Gy). The outcome was favorable. Conclusion: the preoperative diagnosis of a posterior fossa GBM is difficult because its a extremely rare localization, nevertheless it must be suspected
Subject(s)
Humans , Glioblastoma , Glioma , Infratentorial Neoplasms , RadiotherapyABSTRACT
Objective: to describe our surgical experience in suvacute and chronic subdural hematomas. Method: 176 patients with subacute or chronic subdural hematomas were operated between June 1998 and May 2003. Hospital records were used to ascertain data. We did a comparative analysis of the different types of surgical procedures performed. Results: the surgical procedure commonly performed was a burrhole craniostomy with subdural closed - system drainage (66 por ciento). This procedure was associated with a low rate of complications and reoperations, in comparison with the burr hole craniostomy or the craniostomy without subdural closed-system drainge. Global recurrence rate was 13 por ciento and 20,4 por ciento of the cases required reoperation. Clinical improvement rate was 72,3 por ciento. Conclusion: In our cases, burr hole craniostomy with closed-system drainge was the method of choice for the initial treatment in subacute and chronic subdural hematomas. Craniotomy should be reserved for those cases of recurrence or residual hematoma
Subject(s)
Drainage , Hematoma, Subdural, Chronic/surgery , Hematoma, Subdural, Chronic/diagnosis , Hematoma, Subdural, AcuteABSTRACT
Objective: To describe 2 cases of leptomeningeal carcinomatosis. Description: Case 1 (24 years old female) complained of right ciatica and wakness in the last 15 days, with urinary retention. MRI showed a conus medullaris lesion that enhanced with gadolinium. Case 2 (47 years old female) with a previous history of a high grade B-cell limphoma, complaneid of astenia, anorexia and radicular pain. Lately she developed neurological deterioration, VII nerve palsy, urinary retention and seizures. A cisternal puncture was positive for neoplastic cells. Intervention: In case 1 surgery was performed and pathology infrmed high grade glioma. After 30 days she developed a meningeal syndrome with bilateral VI and VII cranial nerves paresis and neurological deterioration. Lumbar puncture was positive for neoplastic cells. She died after 15 days. Case 2 received intrathecal chemotherapy. Conclusion: Patients with extraneural malignat tumors and high grade tumors of the nervous system that refer signs and symptoms of a meningeal dissemination, meningeal carcinomatosis must be suspected
Subject(s)
Carcinoma , Meningeal NeoplasmsABSTRACT
Objective: To describe a case of bilateral idiopathic orbital inflammatory pseudotumor with intracranial extension. Description: a 46 years old female patient complaneid of right eye blurred vision and amaurosis since the past 9 months. Examination revealed: right eye 7/10 visual acuity and exophthalmos; left eye amaurosis and optic atrophy: CT scan and MRI showed a bilateral intraorbital and intracanal lesions with left intracranial extension. Intervention: Through a left frontal approach the left intracranial extension eas removed and the optic nerve was decomprssed. Intraoperative biopsy revealed a linfoproliferative lesion. Surgery ended and definitive pathology was informed as an inflammatory pseudomotor. The patient received corticoids with a good response. Conclusion: The presence of bilateral intraorbital lesions with intracranial extension, should force us too think about inflammatory pseudotumors
Subject(s)
Humans , Adult , Female , Blindness , Magnetic Resonance Spectroscopy , Orbital Pseudotumor , TomographyABSTRACT
Objective: To describe a patient with a IX cranial nerve neurinoma of the cerebellopontine angle. Description: A 29 years old woman complained of headache and decreased hearing of the right ear during the last two years. MRI showed a lesion in the right cerebellopontine angle. Intervention: The patient was operated through a retrosigmoid approach. During surgery we realized that the lesion was related to the glossopharyngeal nerve. The tumor was totally resected, without postoperative morbidity. The pathologist informed schwanoma. Conclusion: The possibility of a glossopharyngeal schwannoma with auditive loss is possible
Subject(s)
Humans , Adult , Female , Brain Neoplasms , Glossopharyngeal Nerve , NeurilemmomaABSTRACT
Objective: This study was conducted to show the different ways to approach the basilar bifurcation. Methods: Four formalin-fixed adults heads were examined using X 6 to X 40 magnification. The vessels were filled with colored silicon. Results: The different approaches to the basilar bifurcation are: 1) subtemporal approach; 2)transylvian approach; 3) pretemporal approach; 4)transcavernous approach; 5)anterior transpetrosal approach and 6) trans third ventricle approach. Conclusion: The Knowledge of the different approaches to the basilar bifurcation is important in the management of the lesions in this region
Subject(s)
Basilar Artery , Intracranial Aneurysm , MicrosurgeryABSTRACT
Objective: This study was conducted to clarify the anatomy of the posterior cerebral artery P1 segment. Methods: Four formalin-fixed adults heads were examined using X6 to X40 magnification. The vessels were filled with colored silicon. Results: The branches arising from the P1 are: 1) the posterior thalamoperforating arteries; 2) the short and long circumflex branches; 3) the medial posterior choroidalartery; and 4)the meningeal branch of Davidoff and Schechter. Conclusion: the correct knowledge of the anatomy of the P1 segment of the posterior cerebral artery is very important in the treatment of lesions located in the interpeduncular cistern