Degeneración tumoral en meningocele no intervenido. Descripción de dos casos / Tumoral degeneration occurring over a non-healing meningocele. Report of two cases

Asistir a pacientes que presentan un meningocele gigante y en edad adulta es una rareza clínica, debido en parte a que es una malformación disráfica con una incidencia baja y a que el índice de supervivencia de los recién nacidos con éstas patologías era menor en épocas anteriores, pese a la benignidad de la malformación. Aportamos a la literatura existente los casos de dos pacientes que nacieron con un disrafismo espinal abierto y que no fueron operados en su momento, llegando a la edad adulta con voluminosos sacos meningocutáneos que tuvieron que ser extirpados, por presentar en el caso de más edad, un absceso con fistulización sin salida de LCR que no mejoró con tratamiento tópico y antibiótico. En el otro caso por sospecha de malignización debido a crecimiento progresivo de la malformación durante el último año, endurecimiento de la piel y dolor. El estudio anatomopatológico de los sacos resecados demostró la existencia de una degeneración carcinomatosa. En nuestros casos y en los pocos casos encontrados en la bibliografía parece que la irritación crónica del LCR y la existencia de células multipotenciales en el saco meningocélico pueden favorecer la malignización de los tejidos que recubren el mismo. La posible malignización descrita en la escasa literatura existente, a la que aportamos nuestros dos casos, sugiere como tratamiento de elección la exéresis quirúrgica de estas lesiones congénitas lo más precozmente posible (AU)

A giant meningocelic sac has not been usually described in adult patients, due to the fact that it shows a low incidence and few newborn have survived to date though the malformation is benign. We report two cases of patients born with the described malformation and who were not operated at that time, so they reached adulthood with bigger sacs. They needed surgery to remove the sacs, for a different reason. The older one had a fistulous abcess but the LCR did not come out, and it did not improved by the application of topic and antibiotic treatment. The other patient showed a progressive growth of the malformation during the last year, skin hardening and pain. The histological study of the dried sacs proved the existence of a carcinomatous degeneration. In the patients we have treated, it seems that a chronic irritation of the LCR and the appearance of multipotent cells in the meningocele may favour the malignancy of the tissues surrounding the sac. This possible malignancy, already described in the bibliography, suggests a prompt elective surgical treatment of the patients with these congenital lesions as soon as possible (AU)

[Tumoral degeneration occurring over a non-healing meningocele. Report of two cases]. / Degeneración tumoral en meningocele no intervenido. Descripción de dos casos.

A giant meningocelic sac has not been usually described in adult patients, due to the fact that it shows a low incidence and few newborn have survived to date though the malformation is benign. We report two cases of patients born with the described malformation and who were not operated at that time, so they reached adulthood with bigger sacs. They needed surgery to remove the sacs, for a different reason. The older one had a fistulous abcess but the LCR did not come out, and it did not improved by the application of topic and antibiotic treatment. The other patient showed a progressive growth of the malformation during the last year, skin hardening and pain. The histological study of the dried sacs proved the existence of a carcinomatous degeneration. In the patients we have treated, it seems that a chronic irritation of the LCR and the appearance of multipotent cells in the meningocele may favour the malignancy of the tissues surrounding the sac. This possible malignancy, already described in the bibliography, suggests a prompt elective surgical treatment of the patients with these congenital lesions as soon as possible.

[The role of video-nystagmography in the diagnosis of acoustic neuroma]. / El papel de la videonistagmografía en el diagnóstico del neurinoma del acústico.

AIM: Schwannoma of the vestibular nerve represents 75% of all expansive processes affecting the pontocerebellosum angle. Hearing loss is the most frequent symptom at diagnosis (86%) with or without tinnitus, in the intracanalicular tumors. Vestibular symptoms are described in 60% of patients. MATERIAL AND METHOD: We study twenty cases of acoustic neuromas diagnosed between years 2000 and 2002 in both Otolaryngology and Neurosurgery Departments in our hospital. Videonystagmography (VNG) was performed in all of them. Videonystagmographic findings were analyzed statistically together with the tumoral size and hypoacusia level. DISCUSSION AND CONCLUSION: According to the medical literature reviewed for this paper, we conclude that caloric tests are the most frequently altered ones (77%), showing vestibular hyporreflexia or arreflexia.

El papel de la videonistagmografía en el diagnóstico del neurinoma del acústico / The role of videonystagmography in the diagnosis of acoustic neuroma

Objetivo: El Schwannoma del nervio vestibular representa el 75 por ciento de los procesos expansivos del ángulo pontocerebeloso (APC). La hipoacusia con o sin tinnitus es el síntoma debut más frecuente (86 por ciento) en los tumores intrameatales. Los síntomas vestibulares se dan en el 60 por ciento de los pacientes. Material y método: Revisamos 20 casos de neurinomas diagnosticados entre los años 2000 y 2002 en los servicios de Otorrinolaringología y Neurocirugía de nuestro hospital a los que les hemos realizado videonistagmografía (VNG), y analizamos estadísticamente los hallazgos videonistagmográficos en relación con el tamaño tumoral y con el grado de hipoacusia. Discusión y conclusión: Revisamos la literatura médica al respecto y acordamos con ella en que la prueba calórica es la que con más frecuencia se altera (77 por ciento) en forma de hipo o arreflexia vestibular. (AU)

AIM: Schwannoma of the vestibular nerve represents 75% of all expansive processes affecting the pontocerebellosum angle. Hearing loss is the most frequent symptom at diagnosis (86%) with or without tinnitus, in the intracanalicular tumors. Vestibular symptoms are described in 60% of patients. MATERIAL AND METHOD: We study twenty cases of acoustic neuromas diagnosed between years 2000 and 2002 in both Otolaryngology and Neurosurgery Departments in our hospital. Videonystagmography (VNG) was performed in all of them. Videonystagmographic findings were analyzed statistically together with the tumoral size and hypoacusia level. DISCUSSION AND CONCLUSION: According to the medical literature reviewed for this paper, we conclude that caloric tests are the most frequently altered ones (77%), showing vestibular hyporreflexia or arreflexia (AU)

[Congenital cholesteatoma of the petrous process and mastoid: a report of two cases]. / Colesteatoma congénito de peñasco y mastoides. A propósito de dos casos.

Congenital cholesteatoma are unusual. They may arise in different sites of the temporal bone: petrous process, middle ear and mastoid. Primary cholesteatomas originate from embryonary ectodermal inclusions but the pathogenesis is not clear and many different hypotheses regarding its origin have been suggested. The clinical diagnosis is not easy if the tympanic membrane is normal, and computerized tomography and magnetic resonance imaging are useful. We report two cases of congenital cholesteatoma: One located in the petrous process and the other in the mastoid without affection of the tympanic cavity.

[Cerebral cavernous angiomas in pregnancy. Two cases and a review of literature]. / Angiomas cavernosos cerebrales en gestantes: estudio de dos casos y revisión de la literatura.

Whether pregnancy increases the risk of bleeding of cavernous angioma, as it does with other types of cerebral vascular malformation, is not known at present. We monitored the pregnancies of two patients with cerebral cavernous angiomas. One patient, whose long-standing epilepsy had until then been considered cryptogenic, with seizure occurring every 3 to 5 years, remained asymptomatic throughout her pregnancy which ended in spontaneous abortion. The parietal cavernous angioma was partially calcified and the tissue showed signs of earlier hemorrhage. The first symptom in the second patient was first-trimester hemorrhage from inside and around the angioma which was located in the optic chiasm. The lesion was fully excised in both patients. We review the literature and analyze the mechanisms that may be implicated in the clinical presentation during pregnancy of this type of cerebral vascular malformation.

[Report of a case of pneumocephalus secondary to otologic surgery]. / Presentación de un caso de neumoencéfalo secundario a cirugía otológica.

Non-traumatic pneumocephalus of otic etiology, secondary to colesteatoma or the otologic surgery is extremely rare, and very few cases are described in the worldwide literature. The existence of air in the intracranial spaces/tracts is known as pneumocephalus. Symptoms are due to the increased intracranial pressure, therefore, a differential diagnosis should be made in order to rule out other expansive processes. Surgical treatment, with closure of the existing fistula, is conclusive. We present a case of tension pneumocephalus secondary to otologic surgery and review the literature existing on the topic.

[Cervical chordoma]. / Cordoma cervical.

Chordoma is an uncommon neoplasia with very aggressive behavior and very high local recurrence rate. It remains a difficult problem for the surgeon. A case of cervical chordoma in a 30 years old woman is reported. The patient had a retropharyngeal mass and changes in the quality of speech. A transoral approach was used to obtain complete removal. The biological, clinical and diagnostic characteristic of cervical chordomas are reviewed.

[Endoscopic treatment of intracranial lesions. Apropos of 8 cases]. / Traitement endoscopique des lésions intracrâniennes. A propos de 8 cas.

The authors describe their initial experience involving endoscopic techniques used in the treatment of eight patients with varied brain lesions. Two tumours and a colloid cyst of the third ventricle, two paraventricular symptomatic cysts, one arachnoid cyst, one chronic intracerebral hematoma and one case of free catheter extraction in the lateral ventricle. The common characteristics of all these lesions were their liquid character and/or intraventricular location. Rigid endoscopes were used, with 9 and 6 mm work channels and independent aspiration and irrigation systems. The optic elbow makes direct visualization and adaptation to the TV monitor possible. The endoscope was manually directed at the lesion through a 12 mm burr hole in five cases and by means of a stereotactic frame in three cases. Biopsies were obtained in six cases. In three cases a communication between the cyst and the ventricular system or adjacent cisterns was established and in two cases vaporization of the lesion using a CO2 laser was performed. Tolerance to the endoscopic procedures was good in all cases. In the authors' opinion, endoscopic techniques constitute a low risk method, midway between stereotactic techniques and the microsurgical approach, and are especially indicated in the treatment of cystic brain lesions or those situated in or near the ventricular system. Their most notable advantages are: providing direct visualization of the lesion without interference from the instruments in the operating field; non-repercussion of the spatial changes derived from the liquid outlet and possibility of lesion coagulation and manipulation. Their disadvantages, related to the use of very long instruments and from a reduced work channel, must be overcome by specialized training.

[Spontaneous regression of an aneurysmal bone cyst of the vertebrae after partial excision. Bibliographic review]. / Regresión espontánea de un quiste óseo aneurismático de localización vertebral tras su extirpación parcial. Revisión bibliográfica.

A case of a lumbar aneurysmal bone cyst is presented in a 5 year-9 month old girl. The characteristics of this tumor are described, specifically in the spinal area, with particular reference to the diagnostic and therapeutic difficulties referred, taking into account the existing bibliography. The partial resection has been curative, as it has been frequently written about in publication worldwide and which suggest that surgery does not have to be aggressive in unapproachable cases and that radiotherapy is unnecessary.

[Cerebral metastasis, idiopathic pneumoperitoneum and obstructive jaundice as clinical manifestations of carcinoma of the pancreas]. / Metástasis cerebral, neumoperitoneo idiopático e ictericia obstructiva, como manifestaciones clínicas de un carcinoma de páncreas.

A case of undifferentiated pancreatic carcinoma is described. The first symptoms were due to brain metastases and was then diagnosed as malignant glioma. The appearance of a sudden obstructive jaundice and pneumoperitoneum without any apparent cause led to the diagnosis of undifferentiated pancreatic carcinoma and peritoneal carcinomatosis, that was confirmed by the anatomicopathological study.