Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge.

OBJECTIVE: This retrospective study aimed to evaluate the effective closure rate for spontaneous cerebrospinal fluid leaks with functional endoscopic sinus surgery and identify patient characteristics that may be associated with a need for additional therapy. METHOD: A retrospective analysis of patients with spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, intracranial pressure, clinical follow up, and complications were collected. RESULTS: Twenty-five patients had spontaneous cerebrospinal fluid leaks with evidence of idiopathic intracranial hypertension. The most common sites were the cribriform plate, followed by the ethmoid roof and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Post-operatively, all patients underwent lumbar drainage and acetazolamide therapy. CONCLUSION: Spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical or surgical means.

Gangliogliomas intracraneales. Revisión de una serie de 20 pacientes / Intracranial gangliogliomas. A review of a series of 20 patients

Introducción: El ganglioglioma es un tumor primario, de bajo grado, del sistema nervioso central constituido por una población celular mixta de elementos gliales y neuronales. Representan entre el 0,4 al 2% de todos los tumores intracraneales y afectan fundamentalmente a niños y adultos jóvenes. Métodos: Entre los años 1995 y 2008 hemos tratado en nuestro hospital 20 pacientes (12 adultos y 8 niños) con ganglioglioma intracraneal. Revisamos retrospectivamente el sexo, el síntoma de inicio y la edad, sintomatología y tiempo de evolución, exploración neurológica, localización del tumor, aspecto en la tomografía computarizada y resonancia magnética, el tratamiento quirúrgico y la evolución. Todos los pacientes fueron intervenidos quirúrgicamente y la extensión de la resección fue evaluada de la hoja operatoria y del seguimiento neurorradiológico. Resultados: La media de edad de los pacientes fue de 26,4 años (rango 1-75) y el ratio mujer/varón fue de 1.5:1. Excepto en un caso, todos los pacientes debutaron con crisis epilépticas, con una duración media antes del diagnóstico de 7,4 años (rango 1-29). Diecisiete tumores estaban localizados en el lóbulo temporal (9 derechos y 8 izquierdos). Se realizó extirpación macroscópicamente completa en 17 pacientes y subtotal en los 3 restantes. Se presentaron 4 recidivas que fueron tratadas mediante reintervención, añadiéndose radioterapia en uno de los casos. El tiempo medio de seguimiento fue de 8,5 años (rango 22 meses-14 años), la supervivencia libre de enfermedad a los 5 años fue del 85% y la supervivencia global del 95%. Conclusiones: Las crisis epilépticas, que constituyen el síntoma más frecuente mejoran de forma significativa tras la extirpación quirúrgica. El tratamiento quirúrgico es la primera opción terapéutica en este tipo de tumores, y ante la presencia de resecciones subtotales o recidivas tumorales la mejor indicación de tratamiento es la reintervención. La radioterapia debe reservarse únicamente para las formas malignas (AU)

Introduction: A ganglioglioma is a type of primary central nervous system low grade tumour composed of mixed populations of glial and neuroepithelial elements. They accounts for 0.4 to 2% of all intracranial tumours and appear more commonly in children and young adults. Seizures, which are the most important symptom in these tumours, improve significantly after surgical excision. Methods: Between 1995 and 2008, 20 patients with (12 adults and 8 children) with intracranial ganglioglioma were treated at our hospital. Clinical information obtained by chart review included sex, age at onset of symptoms, clinical history, results of neurological examination, tumour location, CT and MRI appearance, surgical results and follow-up. All patients underwent tumour resection and the extent of surgery was determined from the surgical reports and postoperative imaging studies. Results: The median age of patients was 26.4 years (range, 1-75 years), and the female to male ratio was 1.5:1. Except in one case, all patients had seizures with a median duration before diagnosis of 7.4 years (range 1-29). Seventeen tumours were located in the temporal lobe (9 right and 8 left). Macroscopically complete excision was performed in 17 patients and subtotal in the remaining 3. There were 4 cases of recurrence treated by surgery and radiotherapy being added in one case. The mean follow up was 8.5 years (range 22 months-14 years) and disease free survival at 5 years was 85% and an overall survival of 95%. Conclusions: The seizures, which are the most frequent symptoms, significantly improved after surgical removal. Surgery is the first choice of therapy in these tumours, and in the presence of subtotal resection or tumour recurrence the best indication for treatment is repeat surgery. Radiotherapy should be reserved only for malignant forms (AU)

[Chronic subgaleal hematoma in a child. Case report]. / Hematoma subgaleal crónico en un lactante. Presentación de un caso.

Neonatal subgaleal hematomas are under-diagnosed collections of blood beneath the galea, often caused by certain obstetric procedures such as use of forceps or vacuum. They generally have low volume and often resolve spontaneously. Occasionally, they can achieve a large volume and may endanger the live of the affected newborns. Rarely, they become chronic and exceptionally they may require surgical treatment. We report the case of a child under one year of age who was referred to our department because of a subgaleal hematoma secondary to vacuum-assisted delivery that required surgical treatment.

[Pituitary apoplexy. A review]. / Apoplejía pituitaria. Revisión del tema.

Pituitary apoplexy constitutes a syndrome that is characterized by the ischemic infarction or hemorrhage into a pituitary tumour. Clinically the patient develops sudden headache, meningismus, visual disturbances, even blindness, and occasionally decrease in level of consciousness. To diagnose it is basic to perform a cerebral MRI. Treatment consists in urgent sellar decompression by transsphenoidal surgery and substitute therapy with steroids.

Apoplejía pituitaria. Revisión del tema / Pituitary apoplexy. A review

La apoplejía pituitaria es un síndrome caracterizadopor una necrosis o hemorragia en el seno deun tumor hipofisario. Clínicamente cursa con cefalearepentina, signos de irritación meníngea, alteracionesen la agudeza visual, incluso ceguera y en ocasiones disminucióndel nivel de conciencia. Para el diagnósticoes fundamental la realización de pruebas radiológicas,siendo la de elección la resonancia magnética. El tratamientoconsiste en la descompresión quirúrgica sellartransesfenoidal urgente y terapia sustitutiva con altasdosis de corticoides (AU)

Pituitary apoplexy constitutes a syndrome that ischaracterized by the ischemic infarction or hemorrhageinto a pituitary tumour. Clinically the patient developssudden headache, meningismus, visual disturbances,even blindness, and occasionally decrease in level ofconsciousness. To diagnose it is basic to perform a cerebralMRI. Treatment consists in urgent sellar decompressionby transsphenoidal surgery and substitutetherapy with steroids (AU)

[Intracranial gangliogliomas. A review of a series of 20 patients]. / Gangliogliomas intracraneales. Revisión de una serie de 20 pacientes.

INTRODUCTION: A ganglioglioma is a type of primary central nervous system low grade tumour composed of mixed populations of glial and neuroepithelial elements. They accounts for 0.4 to 2% of all intracranial tumours and appear more commonly in children and young adults. Seizures, which are the most important symptom in these tumours, improve significantly after surgical excision. METHODS: Between 1995 and 2008, 20 patients with (12 adults and 8 children) with intracranial ganglioglioma were treated at our hospital. Clinical information obtained by chart review included sex, age at onset of symptoms, clinical history, results of neurological examination, tumour location, CT and MRI appearance, surgical results and follow-up. All patients underwent tumour resection and the extent of surgery was determined from the surgical reports and postoperative imaging studies. RESULTS: The median age of patients was 26.4 years (range, 1-75 years), and the female to male ratio was 1.5:1. Except in one case, all patients had seizures with a median duration before diagnosis of 7.4 years (range 1-29). Seventeen tumours were located in the temporal lobe (9 right and 8 left). Macroscopically complete excision was performed in 17 patients and subtotal in the remaining 3. There were 4 cases of recurrence treated by surgery and radiotherapy being added in one case. The mean follow up was 8.5 years (range 22 months-14 years) and disease free survival at 5 years was 85% and an overall survival of 95%. CONCLUSIONS: The seizures, which are the most frequent symptoms, significantly improved after surgical removal. Surgery is the first choice of therapy in these tumours, and in the presence of subtotal resection or tumour recurrence the best indication for treatment is repeat surgery. Radiotherapy should be reserved only for malignant forms.

Hematoma subgaleal crónico en un lactante. Presentación de un caso / Chronic subgaleal hematoma in a child. Case report

Los hematomas subgaleales neonatales son colecciones sanguinolentas, localizadas entre la galea y el tejido conectivo epicraneal; con frecuencia son infradiagnosticados, y en la mayoría de las ocasiones guardan relación con determinados procedimientos obstétricos como el uso de fórceps o ventosa. En general tienen poco volumen y suelen solucionarse espontáneamente. Ocasionalmente pueden alcanzar gran tamaño y ponen en riesgo la vida del recién nacido; excepcionalmente tienden a la cronificación siendo necesario para su tratamiento emplear procedimientos quirúrgicos. Exponemos el caso de una paciente menor de un año de edad que presenta un hematoma subgaleal secundario a parto asistido con ventosa y que precisó tratamiento quirúrgico (AU)

Neonatal subgaleal hematomas are underdiagnosed collections of blood beneath the galea, often caused by certain obstetric procedures such as use of forceps or vacuum. They generally have low volume and often resolve spontaneously. Occasionally, they can achieve a large volume and may endanger the live of the affected newborns. Rarely, they become chronic and exceptionally they may require surgical treatment. We report the case of a child under one year of age who was referred to our department because of a subgaleal hematoma secondary to vacuumassisted delivery that required surgical treatment (AU)

[Filum terminale ependymomas. Analysis of a serie of 20 consecutive cases]. / Ependimomas del filum terminal. Análisis de 20 casos consecutivos.

OBJECTIVE: to analyze the clinical, radiological and surgical outcome of a series of filum terminale ependymomas. Patients and methods. This retrospective study involved 20 patients with 21 ependymomas of the filum terminale encountered during a 21 year period (1988- 2008). All patients were diagnosed using MRI and surgically treated. RESULTS: the male: female ratio was 1:1.5, and the mean age at diagnosis was 44.8 years (range 15-64). First symptom included radicular pain (12 cases) and lumbar pain in the other 8 cases, with average symptom duration of 8.7 years (range 0-6-32). All patients underwent open biopsy, seventeen tumours received gross-total resection and 4 received subtotal resection. Histologically, 20 tumours were myxopapillary ependymomas (grade I) and 1 case a grade II ependymoma. The mean follow-up period was 8 years (range 1-18 years). CONCLUSIONS: filum terminale ependimomas are slow growing tumours of the cauda equina with a high incidence in young adults. The most common presentation is with low back pain long time evolution. Although ependymomas of the filum terminale are thought to be benign, local recurrence is not uncommon.

Ependimomas del filum terminal. Análisis de 20 casos consecutivos / Filum terminale ependymomas. Analysis of a serie of 20 consecutive cases

Objetivos. Analizar las características clínicas,radiológicas y los resultados quirúrgicos de una serie de ependimomas del filum terminal. Pacientes y método. Se estudia retrospectivamente 20 pacientes con 21 ependimomas del filum terminal tratados durante un período de 21 años (1988-2008).Todos los pacientes fueron diagnosticados con resonancia magnética e intervenidos quirúrgicamente. Resultados. La relación varón-mujer fue de 1:1.5 yla media de edad al diagnóstico de 44.8 años (rango 15-64). El primer síntoma fue dolor radicular (12 casos) y lumbalgia en los 8 restantes, con una duración mediade la sintomatología antes del diagnostico de 8.7 años(rango 0.6-32). Todos los pacientes fueron intervenidos quirúrgicamente realizándose resección completa de 17 tumores y subtotal de 4. Histológicamente 20 tumoresfueron ependimomas mixopapilares (grado I ) y un caso grado II. El período de seguimiento fue de 8 años (rango1-18).Conclusiones. Los ependimomas del filum terminal, son tumores de crecimiento lento con una mayor incidencia en adultos jóvenes. La forma de presentación más habitual es con dolor lumbar con un largo tiempo de evolución. Aunque la mayoría son tumores de bajo grado histológico, tienen una especial tendencia a crecer y las recidivas locales no son raras (AU)

Objective. To analyze the clinical, radiological and surgical outcome of a series of filum terminale ependymomas. Patients and methods. This retrospective study involved 20 patients with 21 ependymomas of the filumterminale encountered during a 21 year period (1988-2008). All patients were diagnosed using MRI and surgicallytreated. Results. The male: female ratio was 1:1.5, and the mean age at diagnosis was 44.8 years (range 15-64).First symptom included radicular pain (12 cases) and lumbar pain in the other 8 cases, with average symptom duration of 8.7 years (range 0-6-32). All patients underwent open biopsy, seventeen tumours received gross-total resection and 4 received subtotal resection. Histologically, 20 tumours were myxopapillary ependymomas(grade I) and 1 case a grade II ependymoma.The mean follow-up period was 8 years (range 1-18years).Conclusions. Filum terminale ependimomas are slow growing tumours of the cauda equina with a highincidence in young adults. The most common presentation is with low back pain long time evolution. Although ependymomas of the filum terminale are thought to be benign, local recurrence is not uncommon (AU)

[Chronic subdural hematoma associated with arachnoid cyst. Report of 12 cases]. / Hematoma subdural crónico asociado a quiste aracnoideo. Presentación de 12 casos.

INTRODUCTION: We designed this study to investigate the clinical, neurological, and radiological outcome of patients with chronic subdural hematoma related to an intracranial arachnoid cysts. PATIENTS AND METHODS: Medical records of 12 cases of patients with arachnoids cyst complicated with chronic subdural hematoma were retrospectively reviewed. RESULTS: Between January 1984 and April 2008, 12 patients (0.9%) of 1.253 cases of chronic subdural hematoma surgically treated in our hospital had associated arachnoid cyst. Arachnoid cysts were located in the middle fossa (10 cases) and convexity (2 cases). The most frequent symptom was headache (6 cases), followed by seizures (3 cases). Eleven patients underwent burr hole and drainage; the oldest patient was treated conservatively. CONCLUSIONS: Patients with AC, especially when these are located in temporal fossa, appear to harbour a life-long risk of contracting subdural hematoma. Hematoma evacuation is adequate at first operation and if arachnoid cyst is symptomatic or preoperative symptoms persist, additional arachnoid cyst surgery should be considered.

Hematoma subdural crónico asociado a quiste aracnoideo. Presentación de 12 casos / Chronic subdural hematoma associated with arachnoid cyst. Report of 12 cases

Objetivos. Analizar las características clínicas,neurológicas y resultado neurorradiológico de una seriede pacientes con quiste aracnoideo asociado a un hematomasubdural crónico.Pacientes y método. Revisamos retrospectivamente12 casos de pacientes con quiste aracnoideo que presentaroncomo complicación un hematoma subduralcrónico.Resultados. Entre enero de 1984 y abril de 2008, 12pacientes (0.9%) de 1.253 casos con hematoma subduralcrónico presentaban un quiste aracnoideo intracraneal.La localización de los quistes fue en 10 casos en la fosatemporal y los otros dos en la convexidad. Los síntomasde presentación fueron cefalea en 6 pacientes (50%),seguidos por convulsiones (3 casos). En once pacientesse realizó agujero de trépano y drenaje del HSC, lapaciente de más edad fue tratada de forma conservadora.Únicamente se trataron 3 quistes aracnoideosmediante craneotomía y fenestración, con resolucióncompleta del quiste.Conclusiones. Los pacientes con quiste aracnoideo,sobre todo si esta localizado en la fosa temporal, tienenun mayor riesgo de sufrir un hematoma subduralcrónico. La primera opción terapéutica es el drenajedel hematoma subdural y si persiste la sintomatologíadeberá tratarse el quiste aracnoideo (AU)

Introduction. We designed this study to investigatethe clinical, neurological, and radiological outcome ofpatients with chronic subdural hematoma related to anintracranial arachnoid cysts.Patients and methods. Medical records of 12 cases ofpatients with arachnoids cyst complicated with chronicsubdural hematoma were retrospectively reviewed.Results. Between January 1984 and April 2008,12 patients (0.9%) of 1.253 cases of chronic subduralhematoma surgically treated in our hospital had associatedarachnoid cyst. Arachnoid cysts were located inthe middle fossa (10 cases) and convexity (2 cases). Themost frequent symptom was headache (6 cases), followedby seizures (3 cases). Eleven patients underwentburr hole and drainage; the oldest patient was treatedconservatively.Conclusions. Patients with AC, especially whenthese are located in temporal fossa, appear to harboura life-long risk of contracting subdural hematoma.Hematoma evacuation is adequate at first operationand if arachnoid cyst is symptomatic or preoperativesymptoms persist, additional arachnoid cyst surgeryshould be considered (AU)

[Scedosporium apiospermum brain abscess. Report of one case with literature review]. / Absceso cerebral por Scedosporium apiospermum. Presentación de un caso con revisión de la literatura.

Scedosporium apiospermum is a fungus found in the soil and in contaminated water and commonly cause cutaneous infections and is a rare cause of central nervous system infection. Invasive infection is usually associated with immunosuppresion. The authors present a 73-year-old woman with chronic renal disease who presented with headache for 2 weeks. Computerized tomography scans revealed a ring-enhancing lesion in left temporal lobe. An urgent craniotomy was performed and the lesion was totally removed. The patient died 5 days later. Scedosporium apiospermum was isolated in the culture of the extirpated lesion. The authors review the previously reported cases of brain abscess for Scedosporium apiospermum.

Absceso cerebral por Scedosporium apiospermum. Presentación de un caso con revisión de la literatura / Scedosporium apiospermum brain abscess. Report of one case with literature review

Scedosporium apiospermum es un hongo que seencuentra en el suelo y en las aguas contaminadas, quehabitualmente ocasiona infecciones cutáneas y excepcionalmentepuede contaminar el sistema nervioso central.Sus infecciones se relacionan habitualmente consituaciones de inmunosupresión. Los autores presentanel caso de una mujer de 73 años con insuficiencia renalcrónica que se presentó con dolor de cabeza durante2 semanas y que en la tomografía computarizada seobservó una lesión en anillo en el lóbulo temporalizquierdo. Con el diagnostico de absceso cerebral sepracticó una craneotomía temporal y extirpación completade la lesión. La paciente falleció 5 días después dela intervención. En el cultivo del material evacuado seaisló Scedosporium apiospermum. Se realiza una revisiónde los casos publicados de absceso cerebral porScedosporium apiospermum (AU)

Scedosporium apiospermum is a fungus found in thesoil and in contaminated water and commonly causecutaneous infections and is a rare cause of central nervoussystem infection. Invasive infection is usually associatedwith immunosuppresion. The authors present a73-year-old woman with chronic renal disease who presentedwith headache for 2 weeks. Computerized tomographyscans revealed a ring-enhancing lesion in lefttemporal lobe. An urgent craniotomy was performedand the lesion was totally removed. The patient died 5days later. Scedosporium apiospermum was isolated inthe culture of the extirpated lesion.The authors review the previously reported cases ofbrain abscess for Scedosporium apiospermum (AU)

[Epidural haematoma due to an headrest in an adult]. / Hematoma epidural secundario al empleo de cabezal autoestático en un adulto.

A head fixation device with pins is commonly used for immobilization of the patients during neurosurgical procedures. Despite its appropriate management, it may be the cause of some serious complications such as skull perforation and intracranial injuries.We report the case of a 19-years-old young admitted for a endoscopic third ventriculostomy who developed an epidural haematoma due to the penetration of the skull by a pin.

Hematoma epidural secundario al empleo de cabezal autoestático en un adulto / Epidural haematoma due to an headrest in an adult

El cabezal autoestático es un instrumento utilizadohabitualmente en las intervenciones neuroquirúrgicas ya pesar de su utilización adecuada, puede ser el causantede algunas complicaciones graves como la perforacióncraneal y el desarrollo de hemorragias intracraneales.Presentamos el caso de un paciente varón de 19 añossometido a una ventriculocisternostomía endoscópicay que presentó un hematoma epidural secundario ala penetración intracraneal de uno de los pinchos delcabezal (AU)

A head fixation device with pins is commonly usedfor immobilization of the patients during neurosurgicalprocedures. Despite its appropiate management, maybe the cause of some serious complications such as skullperforation and intracranial injuries.We report thecase of a 19-years-old young admitted for a endoscopicthird ventriculostomy who developed an epidural haematomadue to the penetration of the skull by a pin (AU)

Meningiomas of the lateral ventricles. A review of 10 cases.

BACKGROUND: Intraventricular meningiomas are rare tumours that represent about 2% of all intracranial meningiomas, and represent one of the most challenging problems in neurosurgery. They are located deep within the brain and often are sizable and highly vascular. We report on a series of 10 meningiomas of the lateral ventricles treated at our institution during the last 28 years. PATIENTS: Ten patients (6 women, 4 men; mean age 41.6 yrs) were admitted to our medical center between 1978-2005 with meningioma of the lateral ventricles. Headache was the first symptom in 8 cases and ocular signs were present in 5 patients. RESULTS: Seven tumours were located in the right ventricle (70%) ranging in size from 2-8 cm, with 7 tumours larger than 3 cm in diameter. Nine patients underwent surgery with total excision in 8 cases and subtotal in the other; the remaining patient only received radiosurgery. CONCLUSIONS: Total resection is the gold standard for treatment which was possible in all but one of the cases undergoing surgery.

Meningiomas of the lateral ventricles. A review of 10 cases

Background. Intraventricular meningiomas arerare tumours that represent about 2% of all intracranialmeningiomas, and represent one of the most challengingproblems in neurosurgery. They are locateddeep within the brain and often are sizable and highlyvascular. We report on a series of 10 meningiomas of thelateral ventricles treated at our institution during thelast 28 years.Patients. Ten patients (6 women, 4 men; mean age41.6 yrs) were admitted to our medical center between1978-2005 with meningioma of the lateral ventricles.Headache was the first symptom in 8 cases and ocularsigns were present in 5 patients.Results. Seven tumours were located in the rightventricle (70%) ranging in size from 2-8 cm, with 7tumours larger than 3 cm in diameter. Nine patientsunderwent surgery with total excision in 8 cases andsubtotal in the other; the remaining patient only receivedradiosurgery.Conclusions. Total resection is the gold standard fortreatment which was possible in all but one of the casesundergoing surgery (AU)

Introducción. Los meningiomas intraventricularesson neoplasias poco frecuentes que constituyen alrededordel 2% de todos los meningiomas intracraneales.Pacientes y métodos. Revisamos 10 pacientes (6mujeres, 4 varones; media de edad: 41.6 años) diagnosticados en nuestro servicio de neurocirugía entre 1978-2005 de meningioma de ventrículo lateral.Resultados. El síntoma de debut fue la cefalea en 8casos y en 5 pacientes existían alteraciones oculares.Siete tumores estaban localizados en el ventrículo derecho(70%) con un tamaño que oscilaba entre 2 y 8 cm.;7 tumores tenían más de 3 cm. de diámetro. Se intervinoquirúrgicamente a 9 pacientes consiguiéndose unaextirpación completa en 8 casos y subtotal en el otro;el paciente restante fue tratado mediante radiocirugíaestereotáctica.Conclusiones. La resección completa es el tratamientoidóneo en los meningiomas intracraneales, queexceptuando un caso fue posible en todos nuestrospacientes operados (AU)

Tumores craneales radioinducidos: serie clínica y revisión de la literatura / No disponible

No disponible

[Spontaneous resolution of an asymptomatic intracranial arachnoid cyst]. / Resolución espontánea de quiste aracnoideo intracraneal asintomático.

Arachnoid cysts are commonly considered to be benign, congenial, extraparenchymatous anomalies. Small cyst are common incidental findings in children and adults. The aetiology and natural history of arachnoid cysts are not fully understood. In most cases, the presence of the cysts is detected on CT-scans or MRI performed for other reasons. In the literature, there have been few documented cases of arachnoid cysts with spontaneous regression. We reports the case of a silvian arachnoid cyst, which disappeared spontaneously during the 13-year-follow-up period. We review the cases previously reported and the mechanisms underlying the resolution of the arachnoid cysts are discussed.