Subluxación atloaxoidea. “Os odontoideum”. Reducción y fijación posterior con alambres sublaminares en Cl anclados en tornillos pediculares de C2. Caso clínico / Atlanto axial dislocaton associated with os odontoideum. Reduction and fixation with sublaminar wires in CI and pedicle servew in C2. Case report

Se presenta un caso de subluxación atlo-axoidea asociada a “os odontoideum”, en un varón de 18 años con un antecedente traumático a los 2 años de edad, que padece una mielopatía crónica progresiva al borde de la supervivencia. Para la reducción y fijación de la luxación se han utilizado alambres sublaminares en Cl anclados a tornillos fijados en los pedículos de C2. Se comenta la técnica, no conociendo ningún precedente de la misma (AU)

This report describes a case of atlanto-axial disloca¬tion associated with os odontoideum. This 18-year-old male had a traumatic episode when he was 2 years old. As a result he suffered progressive chronic myelopathy on the verge of death. For the reduction and fixation of the atlanto-axial dislocation, sublaminar wires have been used anchored to Cl and to screws placed in the pedicles of C2. The authors present a surgical technique that has not been previously described (AU)

[Atlanto-axial dislocation associated with os odontoideum. Reduction and fixation with sublaminar wires in Cl and pedicle screws in C2. Case report]. / Subluxación atloaxoidea. "Os odontoideum." Reducción y fijación posterior con alambres sublaminares en C1 anclados en tornillos pediculares de C2. Caso clínico.

This report describes a case of atlanto-axial dislocation associated with os odontoideum. This 18-year-old male had a traumatic episode when he was 2 years old. As a result he suffered progressive chronic myelopathy on the verge of death. For the reduction and fixation of the atlanto-axial dislocation, sublaminar wires have been used anchored to C1 and to screws placed in the pedicles of C2. The authors present a surgical technique that has not been previously described.

[Hourglass retroperitoneal ganglioneuroma]. / Ganglioneuroma retroperitoneal en reloj de arena.

INTRODUCTION: Ganglioneuromas are neuroblastic tumours with a higher degree of histological differentiation and clinical benignity. They are well defined, encapsulated tumours that are made up of mature ganglionar cells. They are located mainly in the sympathetic ganglia of the mediastinum and the retroperitoneum. In this latter place they can be very large and even penetrate through the intervertebral foramen in the spinal canal in the shape of an hourglass and produce medullar compression. They are tumours that are produced in childhood or infancy. CASE REPORT: In the course of the diagnosis of an acute digestive haemorrhage in a 29 year old female patient, an abdominal computerised axial tomography (CAT) scan revealed, by chance, an abdominal retroperitoneal tumour that had introduced itself into the spinal canal in the shape of an hourglass. The patient had had lumbar pain that irradiated to the anterior side of the abdomen although up to that moment it was not considered very important. From the CAT scan and magnetic resonance imaging of the lumbar region a large, solid tumour was detected which protruded out in the shape of an hourglass from the vertebral canal at the point between L2 and L3. The patient was submitted to a surgical intervention in two stages and the tumour was removed. Because it was highly vascularised, hours before the intervention an arterial embolization of the tumour was performed in order to limit surgical bleeding. CONCLUSIONS: Due to the unspecific and late symptomatology of ganglioneuromas, we maintained the therapeutical criterion of carrying out a biopsy puncture, as well as a follow up and control if the histological study did not show up any kind of malignity. Because of the possibility of this kind of tumour becoming malign and the fact that there is little chance of guaranteeing a correct diagnosis by means of biopsy puncture, extirpation should be carried out as completely and early as possible

Ganglioneuroma retroperitoneal en reloj de arena / Hourglass retroperitoneal ganglioneuroma

Introducción. Los ganglioneuromas son los tumores neuroblásticos de mayor diferenciación histológica y benignidad clínica. Son tumores bien limitados, encapsulados, y formados por células ganglionares maduras. Se localizan principalmente en los ganglios simpáticos de mediastino y retroperitoneo. En este último lugar pueden alcanzar un gran tamaño, e incluso penetrar por el agujero de conjunción intervertebral en el canal espinal en forma de reloj de arena y producir compresión medular. Son tumores de la edad infantil y juvenil. Caso clínico. En el curso del diagnóstico de una hemorragia digestiva aguda, en una enferma de 29 años, se practicó una tomografía axial computarizada (TAC) abdominal, y se descubrió casualmente un tumor abdominal retroperitoneal que se introducía en el canal espinal en reloj de arena. Había tenido previamente un dolor lumbar irradiado en la cara anterior del abdomen, sin que hasta entonces se le diera ningún significado. Por la TAC y la resonancia magnética lumbares, se detectó un tumor sólido de grandes proporciones que emergía en forma de reloj de arena del canal vertebral por el agujero de conjunción entre L2 y L3. Se intervino quirúrgicamente en dos tiempos y se extirpó radicalmente. Por su gran vascularización, se practicó horas antes una embolización arterial del tumor para limitar la hemorragia quirúrgica. Conclusiones. Debido a la sintomatología inespecífica y tardía del ganglioneuroma, se ha mantenido el criterio terapéutico de realizar una punción biopsia así como un seguimiento y control si el estudio histológico no evidencia ninguna malignidad. Ante la posibilidad de malignización de estos tumores y la escasa garantía de una punción biopsia en el diagnóstico certero, se deberá realizar la extirpación lo más completa y precoz posible (AU)