Anatomía de las osteotomías dorsolumbares en fotografías en 3D / Anatomy of thoracolumbar osteotomies in 3D photographs

Introducción y objetivo: Existe evidencia contundente que demuestra la relación entre el balance sagital y la calidad de vida de los pacientes adultos con deformidad espinal, de manera que la corrección y realineación en ese plano se ha transformado en un objetivo primario en el tratamiento quirúrgico de dichas afecciones. Las osteotomías dorsolumbares permiten liberar el raquis para realizar dicha realineación sin el uso de fuerza indebida. Sin embargo, son técnicas complejas y con alta tasa de complicaciones intra y post operatorias. Teniendo en cuenta que el conocimiento anatómico de dichos procedimientos es clave, el objetivo de esta revisión consiste en realizar una descripción de las osteotomías dorsolumbares mediante el uso de fotografías en 3D de un preparado cadavérico de raquis lumbar. Materiales y métodos: Se utilizó un preparado cadavérico formolizado de raquis lumbar. Se realizaron las osteotomías espinales lumbares según la clasificación de Schwab et al., en los segmentos L3 y L4. Se tomaron imágenes fotográficas en 3 dimensiones utilizando equipo Nikon D90, con lente 50 mm Af 1.8G, flash Nikon SB700, y una barra regulable para fotografía 3D. Las imágenes fotográficas obtenidas fueron procesadas con los siguientes softwares con técnica anaglífica: Anaglyph Maker versión 1.08 y StereoPhoto Maker versión 4.54. Resultados: Se realiza una descripción de las osteotomías según la clasificación en 6 grados anatómicos de Schwab y colaboradores. Conclusión: La utilización de la técnica fotográfica 3D permitió demostrar el tipo y magnitud de resección ósea necesaria en cada grado de osteotomía.

Introduction and objective: There is strong evidence that shows the relationship between the sagittal balance and the quality of life of adult patients with spinal deformity. According to that, the correction and realignment of the sagittal plane has become a primary objective in the surgical treatment of these conditions. The dorsolumbar osteotomies allow the spine to be released, in order to perform that realignment without the use of undue force. However, they are complex techniques, with a high rate of intra and post-operative complications. Taking into account that the anatomical knowledge of these procedures is fundamental, the objective of this review was to describe the dorsolumbar osteotomies using 3D photographs of a cadaveric preparation of the lumbar spine. Materials and methods: A cadaveric formolized lumbar spine preparation was used. Lumbar spinal osteotomies were performed according to the classification of Schwab et al. Three-dimensional photographic images were taken using Nikon D90 equipment, with a 50mm AF 1.8G lens, Nikon SB700 flash, and an adjustable bar for 3D photography. The photographic images obtained were processed with the following software with anaglyphic technique: Anaglyph Maker version 1.08 and StereoPhoto Maker version 4.54. Results: A description of the osteotomies was made, according to the 6 anatomic grades classification developed by Schwab et al. Conclusion: The use of the 3D photographic technique allowed to demonstrate the type and magnitude of bone resection needed in each degree of osteotomy.

Análisis morfométrico del atlas por tomografía computada para la colocación de tornillos trans-masas laterales / Morphometric analysis of the atlas by computed tomography for the placement of lateral transmass screws

Objetivos: Realizar un análisis morfométrico del atlas por tomografía computada, determinando los valores promedio, medianos, y de variabilidad de dicha vértebra para la correcta colocación de tornillos trans-masas laterales. Introducción: Existe una significativa variabilidad interpersonal en los aspectos morfológicos del atlas, y dada su proximidad a estructuras neurovasculares (arteria vertebral, médula cervical, raíz de C2), hacen mandatario un exhaustivo planeamiento prequirúrgico para la elección de la técnica de artrodesis, tipo de tornillos a utilizar, y su trayectoria. Material y métodos: Se realizó un estudio de diseño de tipo exploratorio, descriptivo, observacional, retrospectivo, transversal. Se revisaron 99 tomografías computadas de la columna cervical. Se midieron parámetros morfométicos y angulaciones desde un "punto de entrada" en la masa lateral de C1, que fueron llamados A, B, C, D, E, F, G y H. Las mediciones de los parámetros a estudiar fueron realizadas con el programa RadiAnt DICOM Viewer (64-bit) y posteriormente volcadas a una ficha de registro de datos. Discusión: La distribución según género fue de 34 varones y 65 mujeres. Se encontró una diferencia estadísticamente significativa no solo en lo referente al género (masculino vs femenino; parámetros A, B, C, D, F, G, H p-valor < 0,05) de los parámetros medidos, sino también según lateralidad (derecha vs izquierda; parámetros C, E, F, G p-valor < 0,05). La investigación propone además la generación de una base de datos con información morfométrica del atlas. Conclusión: Existe una diferencia estadísticamente significativa en las propiedades morfológicas del atlas, tanto en lo relativo al género (masculino vs femenino), como en la lateralidad (derecha vs izquierda). Es por ello que el presente estudio enfatiza en la importancia de la realización prequirúrgica de una tomografía computada de la columna cervical superior para garantizar una efectiva y segura instrumentación a éste nivel, según el largo, ancho y trayectoria de los tornillos a utilizar.

Objectives: To morphometrically analyze the atlas, using computed tomography, thereby defining mean, median and variability values of C1 for the correct placement of lateral mass screws. Introduction: Significant interpersonal variability exists among the various morphological characteristics of the atlas. Given the structure's close relationship to neurovascular structures like the vertebral arteries, cervical spinal cord, and cervical roots, exhaustive pre-surgical planning becomes mandatory. Such planning assists in the choice of arthrodesis technique, and the dimensions and trajectory of screws. Material and Methods: A retrospective, observational study was performed, for which the computed tomography (CT) scans of 99 cervical spines were reviewed. Morpho-metric parameters and angulations were measured from an "entry point" in the lateral mass at C1; these parameters were alphabetically labeled from A through H. The RadiAnt DICOM Viewer (64-bit) program was used to measure all parameters of interest, the values of which then were entered into a data collection file.Discussion: By gender, there were 34 men and 65 women. A statistically-significant difference was found between the two genders for all parameters except parameter E (all p-values < 0,05), and between the two sides (right vs. left) for parameters C, E, F, and G. Our results argue for the creation of a general database containing morphometric information on the atlas. Conclusion: Statistically-significant differences exist between men and women, and from right to left, among the morphometrical features of the atlas. This underscores the need for careful preoperative surgical planning, including the use of CT scanning to estimate optimum screw lengths and trajectories.

Espondilolistesis traumática L5-S1: presentación de 3 casos / Traumatic spondylolisthesis L5-S1: presentation of 3 cases

Objetivo: Reportar 3 casos de espondilolistesis traumáticas de L5-S1, una entidad infrecuente, con pocos casos publicados en la literatura. Material y métodos: Se revisaron las historias clínicas de 3 pacientes operados por espondilolistesis traumáticas L5-S1 en el período 2010-2015. Caso 1, varón de 30 años que sufrió una caída del caballo, anterolistesis grado II. Se realizó una artrodesis L4-S2 con realineación y soporte anterior con TLIF L5-S1. Caso 2, varón de 38 años que consultó por lumbalgia intensa luego de accidente automovilístico. Se diagnosticó una anterolistesis grado II con fractura de la base de ambas facetas ascendentes de S1. Se realizó artrodesis L5-S1 con liberación radicular y realineación. Caso 3, varón de 12 años derivado 20 días luego de un politraumatismo por el derrumbe de una pared. Se diagnosticó una espondilolistesis con dislocación facetaria bilateral. Se realizó una artrodesis L5-S1 con descompresión radicular bilateral. Todos los casos fueron estudiados en el preoperatorio con Rx, TC e IRM. El seguimiento promedio fue de 2.7 años. En los 3 casos se logró un buen control del dolor y de los síntomas neurológicos. La fusión se constató con radiografías simples en el control alejado. Conclusión: En todos los casos se logró un buen resultado clínico e imagenológico con una artrodesis sólida, realizada en un solo tiempo quirúrgico por abordaje posterior.

Objective: To report our surgical results treating three patients with traumatic L5-S1 spondylolisthesis, an infrequent lesion of which only a few isolated cases have been published. Materials and Methods: We reviewed the charts of three patients who underwent surgery from 2010-2015. Case 1 was a 30-year-old man who had fallen off a horse and in whom grade II lytic anterolisthesis was diagnosed, for which L4-S2 fusion with a L5-S1 TLIF was successfully performed. Case 2 was a 38-year-old man with severe low back pain after a car accident. Grade II anterolisthesis was diagnosed secondary to bilateral fractures of S1 facets, for which L5-S1 fusion was done. Case 3 was a 12-year-old child with low back and leg pain after a wall collapsed on top of him, who was diagnosed with anterolisthesis and bilateral facet dislocation. In this patient, L5-S1 fusion and realignment was performed. All patients were studied with full spine x-rays, CT scans and MRI. Average follow-up was 2.7 years. Pain was controlled and neurological deficits improved over the duration of long-term follow-up. X-rays revealed successful fusion in all cases.Conclusions: In our three cases, we achieved excellent clinical and radiological results with solid fusion, performed during a single surgical procedure.

Anatomía quirúrgica en 3D de las osteotomías vertebrales cervicales / 3D surgical anatomy of cervical vertebral osteotomies

Objetivo: realizar osteotomías cervicales en preparados cadavéricos, siguiendo la clasificación moderna de 7 grados según Ames y colaboradores, tomando fotos 3D para poner en evidencia la magnitud de resección ósea de cada uno de los subtipos. Material y Métodos: Se utilizaron dos preparados cadavéricos formolizados con inyección vascular, realizándose imágenes fotográficas en 3 dimensiones de los mismos. Las fotografías fueron tomadas con una camara Nikon D90, con lente 50 mm Af 1.8G, flash Nikon SB700, y una barra regulable para fotografía. Se realizó sobre las preparaciones cadavéricas la disección cervical con incisión en línea media posterior y abordaje por vía anterior segun Smith y Robinson. Se efectuó la exposición muscular y esquelitización ósea con exposición de láminas, apófisis espinosas, facetas articulares, ligamentos, discos, apófisis unciformes y cuerpos vertebrales. Mediante la utilización de un drill neumático de alta velocidad se realizaron 8 osteotomías, 4 por vía posterior y 4 por vía anterior. Resultados: Las osteotomías realizadas por vía anterior fueron la discectomía anterior completa (denominada osteotomía grado I anterior), la corpectomía parcial o total incluyendo discectomía superior e inferior (denominada osteotomía grado III), la resección completa de la unión uncovertebral o articulación de Luschka (denominada osteotomía grado IV) y la resección vertebral completa o espondilectomía (denominada osteotomía grado VII). Por vía posterior, se realizaron la facetectomía parcial (denominada osteotomía grado I posterior), la facetectomía total u osteotomía de Ponte (denominada osteotomía grado II), la osteotomía de apertura angular (denominada osteotomía grado V) y la osteotomía de cierre angular o de sustracción pedicular (denominada osteotomía grado VI). Las imágenes fotográficas obtenidas fueron procesadas con los siguientes softwares con técnica anaglífica: Anaglyph Maker versión 1.08 y StereoPhoto Maker versión 4.54...

Objective: to perform cervical osteotomies in cadaveric specimens, following the new classification of Ames et al. 3D pictures were taken to show the amount of bone resection on each subtype. Material & methods: Using two formolized cadaveric specimens with vascular injection, we took 3D pictures of osteotomies following the Ames et al classification of cervical osteotomies. The pictures were taken with a Nikon D90 camera, with a 50 mm lens Af 1.8G, Nikon SB700 flash, and an adjustable titanium frame designed to take 3D pictures. Anterior cadaveric dissections were made based on the Smith & Robinson technique. We also performed a posterior approach to expose laminar surfaces, spinous processes, facets complexes, ligaments, discs, uncovertebral joints and vertebral bodies. With the aid of a pneumatic drill, 8 osteotomies (4 anterior and 4 posterior) were progressively made and pictured. Results: The anterior osteotomies were: discectomy, corpectomy, discectomy with uncovertebral resection and spondilectomy. Posterior osteotomies were: partial facetectomy, complete facetectomy (Ponte), open wedge osteotomy and closing wedge osteotomy (pedicle substraction). Pictures were processed and fused with Anaglyph Maker 1.08 and StereoPhoto Maker 4.54...

Síndrome agudo de cauda equina por extrusión discal: presentación de 5 casos / Acute cauda equina syndrome by disc extrusion: presentation of 5 cases

OBJETIVO: describir y analizar 5 casos de síndrome agudo de la cauda equina (SACE) por hernia de disco lumbar (HDL). MATERIAL Y MÉTODOS: se revisaron las historias clínicas de 5 casos (2 masc. - 3 fem. / 27 a 47 años de edad). Comenzaron en forma súbita: lumbalgia 1, ciática unilateral 3, ciática bilateral 1, paresia 3, hipoestesia 2, anestesia en silla de montar 4, alteración esfinteriana 3 e impotencia sexual 1. El tiempo entre el inicio y la consulta fue de 4 a 11 días. El diagnóstico se hizo con RM en 4 y TAC en 1. Tenían una HDL extruída (L4-L5 en 3 casos / L5-S1 en 2 casos). RESULTADOS: fueron operados dentro de las 24 hs. de la consulta; se realizó microdiscectomía, recalibrado en 4 y microdiscectomía, hemilaminectomía en 1. El seguimiento promedio fue de 22.2 meses (11 a 44). La recuperación no fue completa en 3 pacientes. Persistieron como secuelas: retención urinaria 2, incontinência urinaria 1, impotencia sexual 1, hipoestesia en silla de montar 1. CONCLUSIÓN: en los 5 casos de SACE por HDL obtuvimos buenos resultados postoperatorios tomando una conducta quirúrgica precoz mediante procedimientos poco invasivos

OBJECTIVE: to describe and analyze 5 patients with acute cauda equina syndrome (ACES) caused by a lumbar disc herniation (LDH). Description: we review 5 patients (2 males - 3 females) with an average age of 31.2 years old (between 27-47 years). All start with acute symptoms: low back pain 1, unilateral sciatica 3, bilateral sciatica 1, motor deficit 3, hipoestesia 2, saddle and/or genital sensory disturbance 4, bladder or bowel disturbance 3 and sexual dysfunction 1. Time between symptoms onset and emergency room visit was 4-11 days. Diagnostic was made with MRI 4 and TAC 1. Everyone has a voluminous LDH (L4-L5 3 cases/ L5-S1 2 cases). PROCEDURE: all surgical procedures were made before 24 hs of the visit doing microdiscectomy, fenestration 4 and microdiscectomy, hemilaminectomy 1. Average follow up was 22.2 months (11-44m). Recovery was incomplete in 3 patients, bladder disturbance persisted in 3 cases, sexual dysfunction 1, perianal anesthesia 1. CONCLUSION: in 5 cases of ACES caused by LDH we had good surgical results using emergency microdiscectomy with minimally invasive techniques

Radiculopatía por hematoma espontáneo del músculo psoas ilíaco / Radicular compromise caused by a spontaneous psoas hematoma

Objetive: to describe a patient with radicular pain secondary to a psoas muscle hematoma. Description: a 76 years old female, suffering from hypertension and medicated with anticoagulants after a triple coronary stent, complained of lumbar pain treated with analgesics and physiotherapy. The pain persisted and the condition worsened with the appearance of proximal crural paresia. An MRI showed an increased volume of the right psoas iliac muscle due to a hematoma. Intervention: anticoagulants were suspended and a neurological evaluation was done. The pain, paresia and hematoma receded. Conclusion: spontaneous hematoma of the psoas muscle is an infrequent cause of radicular syndrome although it should be taken into consideration in patients medicated with anticoagulants.

Metástasis de calota / Calvarial metastasis

Objective. To describe five cases of cranial vault metastasis. Materials and methods. Clinical records and images of five patients with cranial vault metastasis were reviewed at the “Hospital de Clinicas” and “Hospital Español” from Buenos Aires, between January 2009 to June 2010. Results. Case 1, 63 years old female, complains for headache with aleatory response to medical therapy; MRI: right occipital bone lession; Pathological Finding: breast carcinoma metastasis. Case 2, 70 years old female, complains for palpable lession of the scalp; MRI: right fronto-parietal intraxial lession and right parietal cranial vault lession; Pathological Finding: endometrial carcinoma metastasis (primary, diagnosed 4 months before). Case 3, 76 years old female, with palpable lession in the scalp; MRI: left parietal cranial vault lesion. Pathological Finding: kidney carcinoma metastasis (primary, diagnosed in 2008). Case 4, 50 years old female and Case 5, 78 years old male, both complains for bone pain; serological findings and marrow bone biopsy compatible with multiplemyeloma; screening of the long bones and cranial vault demonstrate evidence of bone infiltration. Conclusion. Metastasis at the cranial vault often presents with headache or pain upon inspection of a palpable scalp lession. Images of the CNS involves CT scan (delimitate lession and differentiates litic from blastic metastasis) and MRI (shows the degree of dural and brain infiltration). Prevalence of cranial vault metastasis is greater than brain metastasis, but this underdiagnosis is due that the first are frequently course without symptoms.

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.

Cuidados técnicos durante la artroplastia cervical: presentación de dos casos / Technical pitfalls during cervical arthoplasty: Report of two cases

Objective: to describe and analyze two cases of cervical arthroplasty with spinal misalignment. Description: Both, a 44 year old female (case 1) with a 9 months history of myeloradiculopathy and a 50 year old female (case 2) with a 2 year history of cervicobrachial pain had a C5-C6 posterolateral discal hernia diagnosed by magnetic resonance. As medical treatment failed, both patients were taken to surgery. Intervention: In both cases we performed a cervical arthroplasty using a 14mm Bryan cervical disc prosthesis. There were no intraoperative complications. Case 1 had a postoperative sagittal misalignment: and plate angle was -10° (preoperative +3°). This was caused by an inappropriate use of the manual stabilizer. Case 2 had a postoperative coronal misalignment: coronal angle was 18° (preoperative 0°). This was caused by the asymmetric anterior ostheophyte and end plate drilling. At the latest follow-up, 6 and 3 months respectively, case 1 still had muscular pain and case 2 was asymptomatic. Conclusion: In both cases misalignment problems could have been avoided with a proper surgical technique and were not inherent to the insertion technique.

Reoperaciones en patología degenerativa cervical / Reoperations un degenerative cervical pathology

Objetivo. Analizar los resultados obtenidos en los casos de reoperaciones en patología degenerativa de la columna cervical. Método. Se revisaron restrospectivamente las historias clínicas de 14 casos (6 varones - 8 mujeres / edad media 55,70 años) de repoeraciones cervicales (10 derivados - 4 propios) por patología degenerativa entre los años 2000-2005. La primera cirugía fue: discectomía anterior con injerto autólogo (1 caso) y placa (3 casos), laminoplastía expansiva (5 casos), corpectomía anterior con injerto autólogo y placa (3 casos), laminectomía (1 caso) y microforaminotomía posterior (1 caso). El diagnóstico previo a la segunda cirugía fue: pseudoartrosis (1 caso) y luxación de placa (1 caso), compresión mecánica (10 casos), osteomielitis (1 caso) e inestabilidad (1 caso). Se decidió reoperarlos por estar sintomáticos. En el postoperatorio fueron evaluados con las escalas de Odom o Zeidman-Ducker a los 3 meses. Resultados. Las reoperaciones se realizaron entre 3 y 36 meses después de la primera cirugía: curetaje, injerto y placa (1 caso), recolocación (1 caso) y extracción de placa (1 caso), curetaje y laminectomía (1 caso), osteosíntesis posterior (1 caso), corpectomía (1 caso) y laminoplastía expansiva (8 casos). En 5/6 casos evaluados con la escala de Odom la evolución fue excelente y el 5/8 casos evaluados con la escala de Zeidman-Ducker su mielopatía mejoró 1 grado. Los que no mejoraron fue por la presencia de comorbilidades o daño medular permanente. Conclusión. En los casos de patología cervical degenerativa, la reoperación tuvo buenos resultados evolutivos en el 71 de los casos. Palabras clave: columna cervical, discectomía anterior, laminoplastía expansiva, reoperaciones.

Objective: To analize the outcome of cervical spine reoperations in cases with degenerative pathology. Method: We retrospectively reviewed the clinical records of 14 cases (6 males - 8 female / median age 55.70 years-old) of cervical spine reoperations (10 referrals - 4 of our own) with degenerative pathology during the years 2000-2005. The first surgery was: anterior discectomy with autologous graft (1 case) and plate (3 cases), expansive laminoplasty (5 cases), anterior corpectomy with autologous graft and plate (3 cases), laminectomy (1 case) and posterior microforaminotomy (1 case). The diagnosis previous to the second surgery was: pseudarthrosis (1 case) and plate luxation (1 case), mechanical compression (10 cases), osteomyelitis (1 case) and instability (1 case). they were reoperated beacause they were symptomatic. Postoperative outcome was evaluated according to Odom or Zeidman-Ducker scales at 3 months. Results: Reoperations were performed between 3 and 36 months after the first surgery: curetage, graft and plate (1 case), replating (1 case) and plate extraction (1 case), curetage and laminectomy (1 case), posterior fixation (1 case), corpectomy (1 case) and expansive laminoplasty (8 cases). In 5/6 cases, evaluated with the Odom scale the outcome was excellent and 5/8 cases evaluated with the Zeidman-Ducker scale mielopathy improved 1 grade. Those who did not improve had co-morbidities or permanent cerival myelopathy. Conclusions: In these cases presented with cervical degenerative pathology, reoperation has a good outcome in 71 of them. Key words: anterior descectomy - cervical spine - expansive laminoplasty - reoperations.

Meningiomas quisticos: presentacion de 3 casos / Cystic meningiomas: report of three cases

Objective: to describe 3 cases of intracranial cystic meningioma. Description: Case 1 (male, 24 years old), with headache, vomits, right homonymous hemianopsia and conductal disorder, in the last 2 months. MRI: left parieto - occipital cystic tumor. Case 2 (male, 56 years old) with generalized siezure, in the last month. MRI. left parietal cystic tumor. In the three cases, the suspected diagnose was glioma. Intervention: in the 3 cases a craniotomy was perfomed, with total (cases 2 and 3) or partial resection of the tumor (case 1). The cysts were intratumoral (case 2) and extratumoral (cases 1 and 3). Pathology informed meningioma. The outcome was favorable, with no complications. Conclusion: It is very difficult to make a diagnosis of cystic meningioma before surgery procedure and pathological analysis. During surgery they behave as solid meningiomas

Hematoma subdural subagudo y cronico: tratamiento quirurgico en 176 pacientes. Nuestra experiencia / Subacute and chronic subdural hematomas: surgical treatment in 176 patients. Our experience

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

Carcinomatosis meningea. Comunicacion de dos casos / Meningeal carcinomatosis. Report 2 of cases

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

Pseudotumor inflamatorio idiopatico orbitario bilateral con extension intracraneana. Comunicacion de un caso / Bilateral idiopathic orbital inflammatory pseudotumor with intracranial extension. Case report

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

Neurinoma glosofaringeo: comunicacion de un caso / Glossopharyngeal neurinoma: case report

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

Aneurismas rotos tratados con tecnicas microquirurgicas: nuestra experiencia / Ruptured aneurysms treated with microsurgical techniques: our experience

Objective: to present our experience in ruptured aneurysms treated microsurgically. Method: medical records of 26 patients with SAH due to ruptured aneurysms that were operated between June 2001 and June 2003 were analyzed. Results: 25 aneurysms were microsurgically clipped and one was packed. Global Glasgow Outcome Scale (GOS ) was: GOS 5-4: 14/26 patients; GOS 3:3/26 patients; GOS 1-2: 8/26 patients. Conclusion: the best treatment for ruptured aneurysms is early surgery. As in many others series we find a relationship between clinical presentation and outcome

Anatomia microquirurgica del segmento P1 de la arteria cerebral posterior / Microsurgical anatomy of the P1 posterior cerebral artery segment

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

Reparos anatomicos superficiales de los senos transverso y sigmoideo. Importancia en la planificacion de un abordaje / Superficial anatomyc repairments of transversal and sigmoid sinus. The importance in planification of the approach

Se realizo un estudio anatomico con el fin de determinar la manera mas confiable de conocer la localizacion de los senos transverso y sigmoideo a traves de reparos anatomicos superficiales. Para desarrollar el trabajo se utilizaron 20 craneos secos. Se dividio el complejo seno transverso - seno sigmoideo en 3 porciones: seno transverso, andgulo de union y seno sigmoideo. Se realizaron mediciones entre los reparos anatomicos elegidos y los 3 sectores del complejo seno transverso - seno sigmoideo. Se observo que:a) la linea arco cigomatico-inion es un buen reparo para localizar el seno transverso; b) la punta de la apofisis mastoides es el reparo oseo mas confiable para localizar el angulo de union c)la linea que va desde la union de la sutura escamosa con la sutura pairetomastoidea a la punta de la apofisis mastoides es confiable para localizar el seno sigmoideo

Estudio prospectivo sobre el riesgo de infeccion en distintos tipos de cortes de cabello en neurocirugia / Prospective study on infection risk in different types of haircuts in neurosurgery

El peinado, corte y rasurado del cabello en neurocirugias programadas y el estudio del riesgo relativo de infeccion son el objetivo de este estudio. Se analizan 105 procedimientos divididos en cuatro grupos de rasurado del cabello: sin cortar, corte con tijera, corte con maquina y corte con bisturi, en un protocolo que incluia tres lavados previos a la cirugai con jabon antiseptico. La tasa global de infecciones fue del 7.61 por ciento (8 casos) de los cuales 5 fueron meningitis y 3 infecciones de colgajo. Se hallo una mayor incidencia de meningitis en los pacientes rasudaros con bisturi (17.24 por ciento) y un riesgo incrementado de infeccion de colgajo en los pacientes con el cabello sin cortar (8.33 por ciento). Se observo menor incidencia de ifecciones en los casos en los que el cabellos se corto con maquina (3.57)o tijera en una linea de 1cm de ancho a lo largo de la incision (0 por ciento). En conclusion, se sugiere que el rasurado previo con bisturi deberia ser abandonado como rutina antes de la cirugia, en favor del corte con tijera o maquina en la zona de incision