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

Glioblastoma multiforme de fosa posterior. Presentacion de un caso / Posterior fosa multiform glioblastoma

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

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

Abordajes quirurgicos a la bifurcacion basilar estudio anatomico de las diferentes vias de acceso presentacion en 3D / Surgical approaches to the basilar bifurcation: anatomical study in 3D

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