Hematoma epidural agudo cervical espontáneo de inicio atípico simulando cuadro ictal / Spontaneous acute epidural haematoma of the cervical spine with an atypical onset resembling ictal symptom

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Inhibition of endogenous phosphodiesterase 7 promotes oligodendrocyte precursor differentiation and survival.

During the development of the central nervous system (CNS), oligodendrocyte precursors (OPCs) are generated in specific sites within the neural tube and then migrate to colonize the entire CNS, where they differentiate into myelin-forming oligodendrocytes. Demyelinating diseases such as multiple sclerosis (MS) are characterized by the death of these cells. The CNS reacts to demyelination and by promoting spontaneous remyelination, an effect mediated by endogenous OPCs, cells that represent approximately 5-7 % of the cells in the adult brain. Numerous factors influence oligodendrogliogenesis and oligodendrocyte differentiation, including morphogens, growth factors, chemotropic molecules, extracellular matrix proteins, and intracellular cAMP levels. Here, we show that during development and in early adulthood, OPCs in the murine cerebral cortex contain phosphodiesterase-7 (PDE7) that metabolizes cAMP. We investigated the effects of different PDE7 inhibitors (the well-known BRL-50481 and two new ones, TC3.6 and VP1.15) on OPC proliferation, survival, and differentiation. While none of the PDE7 inhibitors analyzed altered OPC proliferation, TC3.6 and VP1.15 enhanced OPC survival and differentiation, processes in which ERK intracellular signaling played a key role. PDE7 expression was also observed in OPCs isolated from adult human brains and the differentiation of these OPCs into more mature oligodendroglial phenotypes was accelerated by treatment with both new PDE7 inhibitors. These findings reveal new roles for PDE7 in regulating OPC survival and differentiation during brain development and in adulthood, and they may further our understanding of myelination and facilitate the development of therapeutic remyelination strategies for the treatment of MS.

Hemangioma cavernoso intraóseo craneal / Cavernous haemangioma of the skull

Introducción. Los hemangiomas cavernosos sontumores benignos que excepcionalmente afectan loshuesos craneales. En ausencia de signos radiológicostípicos, frecuentemente son intervenidos bajo la sospechade otro tipo de neoplasia ósea, obteniéndose el diagnósticoúnicamente tras el procedimiento quirúrgico.Caso clínico. Presentamos el caso de una pacientede 52 años con una tumoración indolora del huesofrontal derecho, de lento crecimiento y característicasosteolíticas desde el punto de vista neurorradiológico.Para descartar un origen metastásico, se llevó a cabo unestudio oncológico sistémico, sin hallazgo de neoplasiaprimaria. Finalmente, la lesión fue extirpada en bloquemediante craniectomía, seguido de craneoplastia.El diagnóstico anatomo-patológico fue hemangiomacavernoso intraóseo.Conclusión. A pesar de su baja frecuencia, el diagnósticode hemangioma cavernoso intraóseo debe serconsiderado ante la presencia de una tumoración cranealde lento crecimiento y características osteolíticasen las pruebas de neuroimagen. El tratamiento deelección consiste en la resección completa de la lesiónmediante craniectomía, incluyendo márgenes de seguridadde hueso sano (AU)

Introduction. Cavernous haemangiomas are benigntumours that rarely affect the skull. A correct suspiciondiagnosis is seldom obtained when typical radiologicalsigns are lacking. In this way a definite diagnosis is onlyobtained after a surgical procedure in most cases.Case report. A 52-year-old female presented a painless,slow-growing tumoration in her right forehead.Skull CT showed an osteolytic lesion located within theright frontal bone. On suspicion of a metastatic originof the lesion, a sistemic research for a primary tumourwas performed without significative findings. Finally,en bloc resection of the lesion was performed followedby cranioplasty. Microscopically, the lesion proved to bea cavernous haemangioma of the frontal bone.Conclusion. Despite their low frequency, cavernoushaemangiomas must be included in the differentialdiagnosis of slow-growing osteolytic lesions locatedwithin the skull. The elective treatment of this tumoursincludes a complete resection by craniectomy, with safebony margins (AU)

Ausencia congénita en la región frontotemporal izquierda sin consecuencias neuropsicológicas: estudio de un caso / No disponible

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Vertebroplastia percutánea en el tratamiento del dolor debido a fractura del cuerpo vertebral / Percutaneous vertebroplasty in the management of pain caused by vertebral body fracture

Objetivo: Describir nuestra experiencia en la realización de vertebroplastias en el tratamiento agudo y crónico del dolor de origen raquídeo secundario a fractura del cuerpo vertebral de diferentes orígenes. Material y métodos: Treinta y siete procedimientos en 31 pacientes, la mayoría con fracturas osteoporóticas (25 casos). Vía transpedicular en 23 pacientes, posterolateral en 8 y anterior en 1. En todos los casos se utilizó inyección de cemento acrílico con visualización mediante escopia de alta resolución y control de la presión de inyección. Resultados: En todos los casos alivio significativo del dolor con disminución de los requerimientos de analgesia e incluso re t irada de los mismos. Ausencia de complicaciones significativas. Conclusión: La VP es una técnica percutánea mínimamente invasiva que se realiza con control radioscópico y que ha demostrado su eficacia en el tratamiento del dolor de origen vertebral secundario a fracturas del cuerpo vertebral, con morbilidad mínima y mejores resultados cuanto más precozmente se realice. (AU)

[Microvascular decompression of trigeminal neuralgia caused by vertebrobasilar dolichoectasia]. / Descompresión microvascular de la neuralgia del trigémino causado por dolicoectasia vertebrobasilar.

INTRODUCTION: Trigeminal neuralgia due to vertebrobasilar dolichoectasia is an acquired disease whose true incidence is not known. Microvascular decompression is the most effective technique both for symptomatic relief and for the conservation of nerve structure and function, in spite of the potential complications of all major surgery. In cases which are drug-resistant and have a life expectancy of over five years, microvascular decompression may be done using several techniques. CLINICAL CASES: We present three cases with drug-resistant trigeminal neuralgia. One patient had a history of previous cerebrovascular ischaemia, another had arterial and pulmonary hypertension. In all cases vertebrobasilar dolichoectasia was seen on magnetic resonance. Microvascular decompression of the trigeminal nerve was done, placing pieces of Teflon between the tentorium and the artery to displace it. Postoperatively the pain disappeared in two cases and was much relieved in the other, making good progress with no complications. CONCLUSIONS: Trigeminal neuralgia due to vertebrobasilar dolichoectasia is a progressive acquired disease. The imaging technique of choice is magnetic resonance. Cerebral angiography may be useful for confirmation. This new technique of microvascular decompression avoids excessive manipulation of the ectatic, arteriosclerotic basilar artery and also pulsatile compression, so that the risk of secondary effects is reduced and the efficacy of the decompression maintained. Further cases are needed to confirm the usefulness of this technique.

A new transfacial approach for lesions of the clivus and parapharyngeal space: the partial segmented Le Fort I osteotomy.

Tumors of the clival and parapharyngeal areas are a challenge because of their location. They used to be considered inaccessible because the aggressive approaches employed caused elevated levels of morbidity. This fact led to more conservative approaches that attempted to preserve the exposure of the lesion. These approaches were a combination of cranial and facial procedures, thus utilizing a combined effort between neurosurgeons and maxillofacial surgeons. We described our experience with a partial segmented Le Fort I osteotomy added to a transmandibular approach to expose a chordoma of the clivus and left parapharyngeal space. A three-dimensional imaging was used as a diagnostic tool and to plan the optimal surgical approach. The operative technique was described in this case study. Some important technical details of the approach are described. The global outcome was favorable.

[Giant fusiform aneurysm of the middle cerebral artery. Surgical treatment with multiple clipping: a case report]. / Aneurisma gigante fusiforme de la arteria cerebral media. Tratamiento quirúrgico con clipaje múltiple: presentación de un caso.

INTRODUCTION: Giant cerebral aneurysms (GCA) are defined by sizes above 2.5 cm. GCA clinically appear by the mass effect exerted on adjacent structures, and in other cases, by embolismal action of the mural thrombo or as a post rupture subarachnoid hemorrhage. THERAPEUTICAL OPTIONS INCLUDE: inducting mural thrombosis, inserting an intraneurysmatic balloon, setting a bypass and surgical clipping. The major characteristics of giant fusiform aneurysm (GFA), the lack of neck and the inclusion of main vessels, give surgical treatment a great complexity. CLINICAL CASE: 25 year old woman diagnosed of GFA of the middle cerebral artery, treated with direct surgical access with clipping and reconstruction of the vascular wall with fenestrated clips arranged in tandem. CONCLUSIONS: The lack of an accessible neck for clipping and exclusion of giant and fusiform intracranial aneurysms, forced practising bypass as a compulsory surgical alternative. Multiple clipping was a viable choice because of its simplicity and less surgical risk. This technique is not applicable to giant serpentine aneurysms as it is only feasible in cases of fusiform aneurysms with no intraluminal thrombosis. A satisfactory evolution of this case, keeping asintomatic after 18 months of the intervention guarantees its application in young patients with giant thrombosed aneurysms of low clinical repercussion.

[Memory disorders in epileptic patients. A study of pre-postsurgical follow-up]. / Alteraciones de memoria en pacientes epilépticos. Estudio de seguimiento pre-posquirúrgico.

In general terms, epileptic patients with temporal lobe epilepsy (TLE) show mnesic deficits. In the case of medically intractable epilepsy (around 20%) the neurosurgery intervention is a widely accepted treatment. The cognitive effects of surgery have been reported in last years; they emphasize the mnesic positive changes of contralateral area. In the same sense they have reported a negative change on mnesic modality in ipsilateral area. This paper present a study in which the mnesic deficits of twenty eight pharmaco resistant epileptic patients have been evaluated and followed up. These patients have been submittes to a surgical treatment at the Epilepsy Surgical Unit of the Hospital de La Princesa (Madrid). The assessment pre and postoperative tested six months apart. The most common cognitive deficit affect bimodally to mnesic functions: so in the verbal as in the visospatial modality. This deficit correlated with the years epilepsy. Meanwhile, the following up study indicates that a relevant numbers of these patients show an improvement in the function of the contralateral hemisphere with respect to the area surgically treated. This finding probably is the consequence of seizure free.

[Cranio-orbital neurofibrosarcoma]. / Neurofibrosarcome cranio-orbitaire.

We present a type 1 neurofibromatosis case with sarcomatous degeneration of a cranio-orbital neurofibroma, its surgical evolution and the cytogenetics and cellular proliferative potential features (CMF, Ki-67 antibody).

[A comparative study of myelography and CAT in patients with lumbo-sciatica]. / Estudio comparativo de mielografía y de TAC en pacientes con lumbociática.

One hundred patients with acute lumbo sciatica symptoms probably due to disc hernia, have been studied. A CT scan and a myelography was performed in all patients. The clinical and radiologic (myelography and CT scan) findings have been evaluated in three categories based on their intensity and a correlation between these three parameters has been performed. Our results show a positivity of 94% in the clinical signs, 87% in the myelography findings and 88% in CT scan findings. The correlation results show that in very severe lumbo sciatica syndromes there is a greater positivity in the myelography than in CT scan findings and that there could be big radiologic changes without a clear clinical repercussion.

Utility of surgery in the treatment of epidural vertebral metastases.

Treatment of vertebral epidural metastases has been in the past and still remains the object of special attention in an attempt to improve the quality of life of these patients. To assess the effects of and indications for surgery, the clinical histories of 53 patients with this malignant disease who had undergone decompressive laminectomy have been reviewed retrospectively. The importance of the presence of complete or partial spinal cord compression in correlation with the presence of complete or partial myelographic block is dealt with. The results concerning pain, gait disturbances and sphincter disorders are studied with respect to the clinical and myelographic picture for the purpose of establishing the indications for decompressive laminectomy. Pain is not an indication for operative decompression, and complete paraplegia always never improves, thus being a contraindication. But in incomplete spinal cord involvement a decompression operation may be followed by an improvement of neurological deficit and quality of life.

[Paraganglioma of the cauda equina with gangliocyte differentiation]. / Paraganglioma de la cauda equina con diferenciación gangliocítica.

Clinicoradiologic and pathologic data of a patient with a paraganglioma of the cauda equina are described. The peculiar aspect of this rare case is the gangliocyte differentiation with mature ganglion cells scattered in the tumor. The histologic and ultrastructural features are similar to other described cases of this tumor, with Zellballen pattern and neurosecretory granules. The immunohistochemical studies are quite typical with positive staining with neuroendocrine markers (N.S.E., G.F.A.P.). An interpretation of these findings is made.

[Effects of high-frequency ventilation on the intracranial pressure and cerebral elastance in dogs]. / Efectos de la ventilación a alta frecuencia sobre la presión intracraneal y elastancia cerebral en perros.

We have evaluated the effects of the high frequency "jet" ventilation (HFJV) in 12 healthy dogs, under normal intracranial pressure (ICP) as well as under progressive Intracranial Hypertension (ICH). With a normal ICP, no significant differences were found in the mean ICP regarding the intermittent positive pressure ventilation (IPPV). However, during ICH the HFJV not only decreases the global cerebral elastance (CE), P/V curve with smaller slope, but also places the brain in an improved dynamic condition in the sense that, at an equal ICH level, the CE is lower, CE mean ICP relation having a significant difference (p less than 0.001).

[Non-reabsorptive communicating hydrocephalus: surgical results according to the diagnostic procedure]. / Hidrocefalia comunicante arreabsortiva: resultados quirúrgicos de acuerdo con el procedimiento diagnóstico.

Both ex-vacuo and non-reabsorptive hydrocephalus can present with a similar clinical triad of dementia, gait disturbances and incontinence. From a prognostic point of view, however, a great difference exists due to the possibility of surgical treatment with cerebrospinal fluid shunting in non-reabsorptive hydrocephalus. The difficulty lies in a correct preoperative diagnosis. In this study 37 patients aged from 60 to 72 with a clinical history suggestive of non-reabsorptive communicating hydrocephalus were evaluated; the diagnostic tests applied to them were: computerized axial tomography, infusion test with Nelson's technique and intracranial pressure monitoring. A clear correlation was observed between the clinical improvement obtained after a cerebrospinal fluid shunt had been placed and the presence of pathological computerized axial tomography (hydrocephalus without increased sulci with or without trans-ependymal edema) or the pathological infusion test (intracranial pressure increase over 2 mm Hg/min and no decrease back to the basal level once the infusion had ended). No correlation was observed between the different recordings obtained from the intracranial pressure monitoring and the surgical results. The clinical data which most easily revert are the gait disturbance, dementia and incontinence in this order and, more so, in patients with known etiology. Since non-reabsorptive hydrocephalus and ex-vacuo hydrocephalus may co-exist, mostly in elderly patients, it is important to further develop the dynamic studies of intracranial pressure with the aim of offering a more reliable surgical prognosis.