Diagnóstico diferencial en patología tumoral de la base de cráneo anterior / Differential diagnosis in tumor pathology of the anterior skull base

Objective. To describe a series of tumoral lesions of the anterior fossa that were treated at the Hospital de Clinicas during a determined lapse of time.Material and Methods. We evaluated the image archive and medical charts of all the patients operated on between January 2005 and May 2009 at the Neurosurgery Division of the Hospital de Clínicas. Results. From a total of 142 surgeries for expansive supratentorial lessions, 19 were for lessions of the anterior skull base (n=19) of which 7 were meningiomas (36%); four patients with gliomas (21%); one with GBM (5%); one with astrocitoma (5%); two with oligodendroglioma (10%); three patients presented tumors of the paranasal sinuses (15%); two had mucoceles (10%); one with squamous cell carcinoma (5%); three with orbital tumors; one with fibrous bone dysplasia (5%) and one with metastasis of a meduloblastoma of the posterior fossa (5%). Conclusion. The most frequent pathology found at this site is the meningioma, and secondly, gliomas. The third in frequency are the paranasal sinus tumors whose most malignant pathology is the squamous cell carcinoma. Our findings are statistically correspondent to other large series in literature.

Malformación de Chiari y siringomielia: experiencia 2000-2008 / Chiari malformation and syringomyelia: experience 2000-2008

Objetive: to describe the postoperative outcome of patients with Chiari malformation (CM) and/or syringomyelia (SM). Methods: the clinical records of patients with CM and SM, treated from 2000 to 2008, were retrospectively reviewed. Data about sex, age, previous history, admission symptoms, magnetic resonance imaging (MRI), treatment modalities, outcome (Odom´s sacale) and postoperative complications were collected. Results: we treated 17 patients (1 male, 16 women); mean age: 39 years old (10-66). The admission symptoms were: pain in 11 cases, cerebellum/brain stem in 4 cases and spinal cord in 14 cases. Diagnosis was made by MRI: CM type I with SM 9 cases, CM I without SM 6 cases, CM type II with SM 1 case and idiopathic SM 1 case. MC II had myelomeningocele and ventricular shunting surgery at 3 months old. In 15 cases we performed a suboccipital craniectomy with duraplasty and C1 posterior arch resection (n:12) or C1-C2 posterior arch resection (n:3). One case had surgery al another institution and 1 case was not operated because symptoms did not progressed. SM persisted in 4 of the operated cases; in 3 of them a syringopleural shunting (SPS) was performed. In the idiopathic SM a SPS was also performed, but it became obstructed 3 months later. Complications were: meningitis 1 case, CSF fistula 1 case and meningitis + CSF fistula 1 case. In CM outcome after 1 year was: excellent-good in 13 cases, fair in 1 case and poor in 2 cases. Conclusion: in patients with CM and/or SM, postoperative clinical outcome was excellent-good in 13/16 cases.