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1.
Br J Neurosurg ; 37(4): 848-852, 2023 Aug.
Article in English | MEDLINE | ID: mdl-31663376

ABSTRACT

Pleural effusions in children (PE) due to ventricle-peritoneal shunt (VPS) is very rare, with few cases reported. We present a new case of an infant with VPS who had a massive hydrothorax not associated with misplacement or migration of the distal catheter or with ascites. After the evacuation of the PE we managed the patient by adjusting the pressure of the adjustable valve (AV). Sequential thoracic ultrasounds showed a satisfactory outcome. We review the literature thoroughly and describe the possible pathophysiological mechanisms.


Subject(s)
Hydrothorax , Pleural Effusion , Humans , Child , Ventriculoperitoneal Shunt/adverse effects , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Pleural Effusion/surgery , Hydrothorax/diagnostic imaging , Hydrothorax/etiology , Hydrothorax/surgery , Catheters , Ultrasonography
2.
Rev Neurol ; 66(4): 113-120, 2018 Feb 16.
Article in Spanish | MEDLINE | ID: mdl-29435967

ABSTRACT

INTRODUCTION: In our setting, the ageing of the population has led to management of traumatic brain injury (TBI) in the later stages of life becoming an increasingly frequent problem. AIM: To evaluate the association between age and the functional and survival prognosis of patients who have undergone surgery due to TBI. PATIENTS AND METHODS: We performed a retrospective analysis of a series of 404 patients submitted to surgery between the years 2000 and 2015: 144 youngsters (12-44 years), 77 adults (45-64 years), 148 geriatric patients (65-79 years) and 26 'super geriatric' patients (> 80 years). We reviewed the demographic and nosological characteristics of the population, the survival and functional prognosis (Glasgow Outcome Scale, GOS) on discharge and at six months. RESULTS: Age presents a positive linear association with both intra-hospital mortality and the proportion of patients with an unfavourable prognosis (GOS 1-3) on hospital discharge and at six months (p < 0.001). Taking the population of youngsters as a reference, the relative risk for an unfavourable prognosis at six months was 1.5 (95% CI: 1.04-2.19) for adults; 2.37 (95% CI: 1.77-3.17) for the geriatric patients; and 3.5 (95% CI: 2.63-4.7) for the 'super geriatric' patients. These latter present a mortality rate while in hospital of 77.78% and a percentage of poor functional prognosis at six months of 94.44%. CONCLUSION: Increased age is a major negative determining factor in the prognosis of patients who undergo a craniotomy due to TBI. More precise knowledge of these outcomes and an adequate pre-operative discussion with the family will be an invaluable aid in the decision-making process.


TITLE: Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.Introduccion. En nuestro entorno, el envejecimiento poblacional ha convertido el manejo del traumatismo craneoencefalico (TCE) en etapas avanzadas de la vida en un problema de frecuencia creciente. Objetivo. Valorar la asociacion entre la edad y el pronostico vital y funcional de pacientes intervenidos por TCE. Pacientes y metodos. Analizamos retrospectivamente una serie de 404 pacientes intervenidos en nuestro centro entre los años 2000 y 2015: 144 jovenes (12-44 años), 77 adultos (45-64 años), 148 pacientes geriatricos (65-79 años) y 26 supergeriatricos (> 80 años). Revisamos las caracteristicas demograficas y nosologicas de la poblacion, y el pronostico vital y funcional (escala pronostica de Glasgow, GOS) en el momento del alta y a los seis meses. Resultados. La edad presenta asociacion lineal positiva tanto con la mortalidad intrahospitalaria como con la proporcion de pacientes con pronostico desfavorable (GOS 1-3) en el alta y a los seis meses (p < 0,001). Tomando como referencia la poblacion de jovenes, el riesgo relativo para pronostico desfavorable a los seis meses fue de 1,5 (IC 95%: 1,04-2,19) para los adultos, 2,37 (IC 95%: 1,77-3,17) para los geriatricos y 3,5 (IC 95%: 2,63-4,70) para los supergeriatricos. Estos ultimos presentan una mortalidad durante el ingreso del 77,78% y un porcentaje de mal pronostico funcional a los seis meses del 94,44%. Conclusion. El aumento de la edad es un factor determinante negativo mayor en el pronostico de pacientes sometidos a craneotomia por TCE. Un conocimiento preciso de estos resultados y una adecuada discusion preoperatoria con la familia resultaran de gran ayuda en el proceso de toma de decisiones.


Subject(s)
Brain Injuries, Traumatic/mortality , Brain Injuries, Traumatic/surgery , Craniotomy , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Rate , Young Adult
3.
Neurocirugia (Astur) ; 21(4): 312-6, 2010 Aug.
Article in Spanish | MEDLINE | ID: mdl-20725700

ABSTRACT

Fluorescence-guided resection with 5-aminolevulinic acid (5-ALA) has demonstrated its usefulness in the resection of malignant cerebral gliomas. It also seems useful for the treatment of other types of cerebral and intramedullary neoplasms. We present the case of a patient with an intramedullary tumor in who fluorescence- guided resection was useful for intraoperative localization, definition of small tumor nodules and in order to achieve a complete resection of the tumor.


Subject(s)
Aminolevulinic Acid/metabolism , Brain Neoplasms , Glioma , Photosensitizing Agents/metabolism , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Female , Glioma/pathology , Glioma/surgery , Humans , Middle Aged , Neurosurgical Procedures/methods
4.
Neurocirugia (Astur) ; 21(3): 232-8; discussion 238-9, 2010 Jun.
Article in Spanish | MEDLINE | ID: mdl-20571727

ABSTRACT

Intramedullary schwannomas are benign tumors that arise from clusters of Schwann cells embedded in the medullary parenchyma. They are very rare and account for 0.3 to 1.5 % of all spinal schwannomas. It is not known for certain why this happens, and several theories have been put forward. They do not exhibit any characteristic clinical picture, being pain the most frequent symptom. Imaging is also not specific and the correct diagnosis is attained most of the times after pathological examination. The goal of treatment must be complete removal, which is curative. We are presenting two patients in whom an intramedullary tumor was removed. The true nature of the lesions was suspected during the operation, but only after pathological examination was confirmed. A review of the literature has been undertaken, with special attention to the theories about the origin of these uncommon tumors.


Subject(s)
Neurilemmoma/pathology , Spinal Cord Neoplasms/pathology , Adolescent , Adult , Female , Humans , Magnetic Resonance Imaging , Neurilemmoma/surgery , Spinal Cord Neoplasms/surgery
5.
Neurocirugia (Astur) ; 20(3): 272-7, 2009 Jun.
Article in Spanish | MEDLINE | ID: mdl-19575132

ABSTRACT

Dermoids cysts are embrionary benign lesions that comprise approximately 0.04-0.25% of all intracranial tumors. Occasionally they break and spread their content into subarachnoid space and/or lateral ventricles causing several acute or delayed symptoms. Debut of this type of tumor as acute stroke is poorly reflected in literature. We present a 26-year-old woman with a isolated mesencephalic infarct secondary to spontaneous rupture of a dermoid cyst. We discuss the possible pathophysiological mechanisms for this condition and review the literature.


Subject(s)
Brain Neoplasms , Dermoid Cyst , Mesencephalon/pathology , Stroke , Adult , Brain Neoplasms/complications , Brain Neoplasms/pathology , Dermoid Cyst/complications , Dermoid Cyst/pathology , Female , Humans , Rupture, Spontaneous , Stroke/etiology , Stroke/pathology
6.
Neurocir. - Soc. Luso-Esp. Neurocir ; 20(3): 272-277, mayo-jun. 2009. ilus, tab
Article in Spanish | IBECS | ID: ibc-60976

ABSTRACT

Los quistes dermoides son lesiones benignas deorigen embrionario que representan del 0.04 a 0,25%de todos los tumores intracraneales. Estos quistesocasionalmente pueden romperse diseminándose elcontenido graso intraquístico al espacio subaracnoideoy/o los ventrículos laterales. En este caso puede provocardiversas manifestaciones clínicas de forma agudao retardada. El debut de este tipo de tumor con unictus agudo está escasamente reflejado en la literatura.Presentamos el caso de una mujer de 26 años con uninfarto mesencefálico aislado secundario a la rupturade un quiste dermoide. Discutimos el mecanismofisiopatológico supuesto y realizamos una revisión delos casos recogidos en la literatura (AU)


Dermoids cysts are embrionary benign lesions thatcomprise approximately 0.04-0.25% of all intracranialtumors. Occasionally they break and spread their contentinto subarachnoid space and/or lateral ventriclescausing several acute or delayed symptoms. Debut ofthis type of tumor as acute stroke is poorly reflected inliterature. We present a 26-year-old woman with a isolatedmesencephalic infarct secondary to spontaneousrupture of a dermoid cyst. We discuss the possiblepathophysiological mechanisms for this condition andreview the literature (AU)


Subject(s)
Humans , Female , Adult , Stroke/etiology , Dermoid Cyst/complications , Stroke/diagnosis , Dermoid Cyst/diagnosis , Stroke/drug therapy , Tomography, X-Ray Computed
7.
Neurocirugia (Astur) ; 19(5): 440-5, 2008 Oct.
Article in Spanish | MEDLINE | ID: mdl-18936861

ABSTRACT

Remote cerebellar hematoma, a cerebellar hematoma occurring after performing a surgical procedure in an anatomical distant area from the cerebellum, is a rare complication. It has been reported after supratentorial surgery and, less often, after spinal surgery with dural opening with important loss of cerebrospinal fluid. We report the occurrence of remote cerebellar hemorrhage after lumbar spinal fluid drainage in two patients with suspected normal pressure hydrocephalus. They were managed conservatively with good outcome. We review the pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage.


Subject(s)
Cerebral Hemorrhage/etiology , Decompression, Surgical/adverse effects , Drainage/adverse effects , Lumbosacral Region/surgery , Neurosurgical Procedures/adverse effects , Adult , Aged , Female , Humans , Hydrocephalus/pathology , Hydrocephalus/surgery , Male , Middle Aged
8.
Acta Neurochir (Wien) ; 149(12): 1229-36; discussion 1236-7, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17924056

ABSTRACT

Choroid plexus papillomas (CPP) are rare intracranial tumours with a favourable long-term outcome after surgical excision. Although they are histologically benign, local recurrences may occasionally occur, but leptomeningeal dissemination is exceptional. We report an unusual example of a fourth ventricle choroid plexus papilloma with diffuse leptomeningeal seeding. Neither the initial tumour nor the recurrence showed malignant histological features. Treatment with systemic and intrathecal chemotherapy was ineffective in this patient. We review the literature concerning leptomeningeal dissemination of benign choroid plexus papillomas.


Subject(s)
Cerebral Ventricle Neoplasms/surgery , Fourth Ventricle/surgery , Meningeal Neoplasms/secondary , Neoplasm Seeding , Papilloma, Choroid Plexus/surgery , Adult , Biomarkers, Tumor/analysis , Biopsy , Cerebral Ventricle Neoplasms/pathology , Disease Progression , Fatal Outcome , Female , Fourth Ventricle/pathology , Humans , Ki-67 Antigen/analysis , Laminectomy , Magnetic Resonance Imaging , Meningeal Neoplasms/pathology , Meningeal Neoplasms/surgery , Meninges/pathology , Papilloma, Choroid Plexus/pathology , Reoperation , S100 Proteins/analysis
9.
Neurocirugia (Astur) ; 16(1): 21-5; discussion 26, 2005 Feb.
Article in Spanish | MEDLINE | ID: mdl-15756407

ABSTRACT

Hemifacial spasm (HFS) is a clinical entity consisting of brief clonic jerking movements of the facial musculature, beginning in the orbicularis oculi with downward spreading to other facial muscles. Apart from vascular loop compression at the root exit zone of the facial nerve, other causes of HFS are rare. It is exceptional as a form of presentation of intracranial meningiomas We report three cases of patients with meningiomas who presented with HFS, either as an isolated sign or associated with symptoms of rise intracranial pressure or focal deficit. We review the literature and discuss the possible physiopathological mechanisms responsible for this association.


Subject(s)
Hemifacial Spasm/etiology , Meningeal Neoplasms/complications , Meningioma/complications , Adult , Aged , Botulinum Toxins, Type A/therapeutic use , Brain/diagnostic imaging , Brain/pathology , Female , Hemifacial Spasm/diagnosis , Hemifacial Spasm/drug therapy , Humans , Magnetic Resonance Imaging , Male , Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/surgery , Meningioma/diagnosis , Meningioma/surgery , Neuromuscular Agents/therapeutic use , Severity of Illness Index , Tomography, X-Ray Computed
10.
Neurocirugia (Astur) ; 16(1): 50-3, 2005 Feb.
Article in Spanish | MEDLINE | ID: mdl-15756411

ABSTRACT

Cocaine abuse has been associated with a variety of intracranial haemorrhagic disorders, such as intracerebral, subdural or subarachnoidal haemorrhage. Frequently, these patients harbour underlying vascular malformations, like cerebral aneurysms or arteriovenous malformations (AVM). To the best of our knowledge only two cases of tumoral haemorrhage induced by cocaine abuse have been previously reported. We describe a new case of intracerebral haemorrhage after cocaine inhalation, in which both the preoperative imaging studies and the pathological examination showed a brain tumour as the origin of the haemorrhage. We think that cocaine abuse may be considered as a new precipitating factor in intratumoral haemorrhage.


Subject(s)
Astrocytoma/complications , Brain Neoplasms/complications , Cerebral Hemorrhage/etiology , Cocaine-Related Disorders/complications , Adult , Astrocytoma/diagnostic imaging , Astrocytoma/pathology , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Cerebral Hemorrhage/physiopathology , Disease Progression , Humans , Magnetic Resonance Imaging , Male , Neoplasm Staging , Tomography, X-Ray Computed
11.
Neurocir. - Soc. Luso-Esp. Neurocir ; 16(1): 21-26, feb. 2005. ilus
Article in Es | IBECS | ID: ibc-038293

ABSTRACT

El espasmo hemifacial (EH) constituye una entidad clínica caracterizada por contracciones tónico-clónicas de carácter involuntario de la musculatura inervada por el nervio facial. Como forma de presentación de meningiomas intracraneales es excepcional. Presentamos tres casos de pacientes con meningiomas cuya presentación clínica fue en forma de EH, bien de forma aislada o asociado a sintomatología de hipertensión intracraneal o déficit neurológico focal. Se revisa la literatura y se discuten los posibles mecanismos fisiopatológicos que puedan intervenir en esta asociación


Hemifacial spasm (HFS) is a clinical entity consisting of brief clonic jerking movements of the facial musculature, beginning in the orbicularis oculi with downward spreading to other facial muscles. Apart from vascular loop compression at the root exit zone of the facial nerve, other causes of HFS are rare. It is excepcional as a form of presentation of intracranial meningiomas We report three cases of patients with meningiomas who presented with HFS, either as an isolated sign or associated with symptoms of rise intracranial pressure or focal déficit. We review the literature and discuss the possible physiopathological mechanisms responsible for this association


Subject(s)
Male , Female , Aged , Humans , Hemifacial Spasm/etiology , Meningioma/complications , Meningeal Neoplasms/complications , Hemifacial Spasm/diagnosis , Meningioma/diagnosis , Meningioma/surgery , Magnetic Resonance Imaging , Botulinum Toxins, Type A/therapeutic use , Hemifacial Spasm/drug therapy , Neuromuscular Agents/therapeutic use , Tomography, X-Ray Computed , Severity of Illness Index , Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/surgery , Telencephalon/pathology , Telencephalon
13.
Neurocirugia (Astur) ; 13(6): 463-71; discussion 472, 2002 Dec.
Article in Spanish | MEDLINE | ID: mdl-12529775

ABSTRACT

Authors present a male patient with Spinal Extradural Lipomatosis, previously treated of a cerebral astrocytoma with surgery and radiotherapy, after which he received ACTH for a long period of time. Clinical manifestations were rachialgia, paraparesia with pain and dysestesias in both lower extremities. Diagnosis was carried out by Magnetic Resonance imaging. After a progressive withdrawal of the treatment with ACTH, the patient achieved a complete recovery and neuroimaging studies showed the dissappearance of the compression caused by the lipomatosis. We carry out a revision of the literature showing data we consider of interest derived from the wide series subjected to study.


Subject(s)
Adrenocorticotropic Hormone/adverse effects , Lipomatosis/chemically induced , Spinal Diseases/chemically induced , Adrenocorticotropic Hormone/therapeutic use , Astrocytoma/therapy , Brain Neoplasms/therapy , Combined Modality Therapy , Dura Mater , Humans , Lipomatosis/diagnosis , Magnetic Resonance Imaging , Male , Paraparesis/diagnosis , Spinal Diseases/diagnosis
15.
Cir Pediatr ; 11(2): 81-3, 1998 Apr.
Article in Spanish | MEDLINE | ID: mdl-9608149

ABSTRACT

Extranasal gliomas are very rare tumours, being difficult to diagnose preoperatively due to the unspecific nature of symptoms and, at times, of the test. A newborn baby, prenatally diagnosed with frontal tumour, which on exploration showed a mass at the root of the nose, red-violet in colour and which seemed to become tenser. Skull x-ray and brain ultra-sound were normal. Ultra-sound of the tumour area and TAC showed a mass with solid content, with possible intracraneal communication. Faced with this possibility, removal by neurosurgical procedures was performed with no communications with SNC being observed. Histological diagnosis: extra-nasal glioma. Tumours situated at the root of the nose can have normal skin covering whose aspect is similar to the tumour mentioned above. Test carried out may not show accurately whether the tumour communicates with SNC or not, which may lead to surgical errors. We recommend that these malformations be treated directly by surgical teams which include neurosurgical specialists.


Subject(s)
Facial Neoplasms/diagnosis , Facial Neoplasms/embryology , Glioma/diagnosis , Glioma/embryology , Diagnosis, Differential , Encephalocele/diagnosis , Facial Neoplasms/surgery , Female , Glioma/surgery , Humans , Infant, Newborn , Male , Pregnancy , Prenatal Diagnosis
20.
Acta Neurochir (Wien) ; 73(3-4): 165-77, 1984.
Article in English | MEDLINE | ID: mdl-6516917

ABSTRACT

The authors report visual results in a series of 42 patients with craniopharyngiomas. Visual abnormalities were present in 91% of the children and in 83% of the adults. Total removal was achieved in 16 patients with 3 postoperative deaths and subtotal removal in 26 patients with only one postoperative death. Of the 38 survivors, 63% improved, 26% remained the same and 10% worsened. When analyzing the influence of factors such as age, nature and location of the tumour, extent of removal, surgical approach, use of CT scan facilities and duration and degree of the deficit in the 31 survivors with preoperative visual impairment, it became apparent that only the duration and degree of preoperative visual deficit had a significant influence the outcome. The authors discuss also the suggestion that a conservative attitude may be associated with better visual results.


Subject(s)
Brain Neoplasms/complications , Craniopharyngioma/complications , Vision Disorders/etiology , Adolescent , Adult , Age Factors , Brain Neoplasms/surgery , Child , Child, Preschool , Craniopharyngioma/surgery , Diplopia/etiology , Female , Humans , Male , Optic Atrophy/etiology , Papilledema/etiology , Postoperative Period , Visual Fields
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