ABSTRACT
Introduction: Odontoid fractures correspond to 9-15% of cervical spine fractures. Atlas fracture is rare (3-13%)8. Case presentation: Male with Anderson and D´Alonzo Type II Odontoid fracture with unstable fragment treated with occipitocervical fixation with occipital plate, C2-C3 transfacet screws; Female with type E Jefferson fracture + anterolateral atloaxial dislocation, treated with occipitocervical fixation, C2-C3-C4 transfacet screws. Discussion: Anderson and D'Alonzo Type II fractures and Jefferson type E fractures are a surgical emergency due to instability and neurological deficit.
Introducción: Las fracturas odontoideas corresponden del 9-15% de las fracturas de la columna cervical. La fractura del atlas es poco común (3-13%)8. Presentación del caso: Masculino con fractura de Odontoides tipo II de Anderson y D´Alonzo con fragmento inestable tratado con fijación occipitocervical con placa occipital, tornillos transfacetarios C2-C3; Femenino con fractura de Jefferson tipo E+luxación atloaxoidea anterolateral, tratada con fijación occipitocervical, tornillos transfacetarios C2-C3-C4. Discusión: Fracturas tipo II de Anderson y D´Alonzo y fracturas de Jefferson tipo E son una urgencia quirúrgica debido a inestabilidad y déficit neurológico.
ABSTRACT
ANTECEDENTES: Los abordajes quirúrgicos de la región selar han sido un reto para los neurocirujanos. Con la introducción de la técnica endoscópica se ha minimizado el trauma quirúrgico, pero esta técnica no se encuentra exenta de complicaciones. OBJETIVO: Describir nuestra experiencia institucional en pacientes sometidos a resección de macroadenomas hipofisarios por vía microquirúrgica endonasal transesfenoidal asistida por endoscopia con énfasis en las complicaciones resultantes. MÉTODO: Revisamos los expedientes electrónicos de 17 pacientes sometidos a dicho procedimiento de manera consecutiva entre 2017 y 2018, y recabamos variables como edad, sexo, clasificación imagenológica, tiempo de diagnóstico al momento de la cirugía, complicaciones posoperatorias y recurrencia. RESULTADOS: La edad promedio de los pacientes fue de 45.23 años y el 70.59% eran mujeres. Radiológicamente predominó el grado 2 Knosp (47.05%). La complicación principal fue diabetes insípida transitoria (23.52%), seguida por la fístula de líquido cefalorraquídeo (11.76%). CONCLUSIONES: El manejo microquirúrgico asistido por endoscopia ha demostrado ser un recurso valioso para tratar macroadenomas hipofisarios, pero presenta grados variables de complicaciones, por lo cual se requiere la adquisición de habilidades para el uso del endoscopio, la planeación preoperatoria adecuada y el manejo conjunto multidisciplinario con el fin de evitarlas. BACKGROUND: Surgical approaches to the sellar region have been a challenge for the neurosurgeon. With the introduction of the endoscopic technique, surgical trauma has been minimized, however it is not free of complications. OBJECTIVE: To describe our institutional experience in patients undergoing resection of pituitary macroadenomas by endoscopic-assisted microsurgical approach, with emphasis on the resulting complications. METHOD: We reviewed the electronic files of 17 patients who underwent this procedure consecutively between 2017 and 2018, collecting variables such as age, sex, imaging classification, time of diagnosis at the time of surgery, postoperative complications and recurrence. RESULTS: The average age of the patients was 45.23 years, with 70.59% women. Radiologically, grade 2 Knosp predominated (47.05%). The main complication was transient diabetes insipidus (23.52%) followed by cerebrospinal fluid fistula (11.76%). CONCLUSIONS: The endoscopic-assisted microsurgical approach has proven to be a valuable resource for treating pituitary macroadenomas, however it presents variable degrees of complications, which requires the acquisition of skills for the use of the endoscope, adequate preoperative planning, and multidisciplinary joint management in order to avoid them.
Subject(s)
Postoperative Complications , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND: In December 2019, in Wuhan, a new virus emerged, causing severe acute respiratory syndrome (SARS) secondary to infection by a type of coronavirus, causing coronavirus disease (COVID-19). The pandemic caused by the new coronavirus has had implications in the central nervous system. COVID-19 is known to be characterized by coagulation activation and endothelial dysfunction, causing ischemic and hemorrhagic vascular syndromes. CASE DESCRIPTION: A 27-year-old male patient case with progressive decrease in visual acuity, associated with respiratory symptoms and intense headache. Multilobar infiltrate with a reticulonodular pattern is evident on chest CT scan. Brain CT scan with pituitary macroadenoma apoplexy was shown. SARS-Cov2 was confirmed, and respiratory support initiated. However, the patient died shortly afterward, secondary to pulmonary complications. CONCLUSION: The angiotensin-converting enzyme (ACE) II receptor is expressed in circumventricular organs and in cerebrovascular endothelial cells, which play a role in vascular autoregulation and cerebral blood flow. For this reason, is rational the hypothesize that brain ACE II could be involved in COVID-19 infection. Underlying mechanisms require further elucidation in the future.
ABSTRACT
BACKGROUND: Traumatic spinal cord injury (TSCI) is a devastating problem typically associated with multi-organ disorders. Studies regarding TSCI and their attendant comorbidities are scarce from developing countries. METHODS: The electronic files of 147 patients with TSCI (2017-2018) were reviewed; 78% of patients were males averaging 38 years of age. The following variables associated with the TSCI included age, sex, etiology of trauma, vertebral level, fracture classification, Frankel grade, treatment, complications, and mortality. RESULTS: Of interest, most cases involved thoracic injuries with attendant chest trauma resulting from falls from substantial heights. CONCLUSION: In Mexico, the majority of TSCI occur in young males (average age 38) who have sustained falls from significant heights resulting in thoracic fractures with a high frequency of chest injuries. By providing such information for developing countries, we may develop future strategies to TSCI in vulnerable populations.
ABSTRACT
BACKGROUND: Arachnoid cysts are dural diverticula with liquid content similar to cerebrospinal fluid, with 1% occurring in the spinal cord. They locate mainly in the dorsal region of the thoracic spine, and are unusual causes of spinal cord compression. CLINICAL CASE: The case is presented of a previously healthy 15-year-old boy, with a 20-month history of spastic paraparesis that started apparently after epidural block for ankle osteosynthesis. There was decreased sensitivity and strength of the pelvic limbs and gradually presented with anaesthesia from T12 to L4 dermatomes, L5 and S1 bilateral hypoaesthesia and 4+/5 bilateral strength, in the L2 root and 2+/5 in L3, L4, L5, S1, hyperreflexia, Babinski and clonus, but with no alteration in the sacral reflexes. In the magnetic resonance it was diagnosed as an extradural arachnoid cyst from T6 to T9. The patient underwent a T6 to T10 laminotomy, cyst resection, dural defect suture, and laminoplasty. One year after surgery, the patient had recovered sensitivity, improvement of muscle strength up to 4+/5 in L2 to S1, and normal reflexes. CONCLUSIONS: After the anaesthetic procedure, increased pressure and volume changes within the cyst could cause compression of the spinal cord, leading to symptoms. Despite being a long-term compression, the patient showed noticeable improvement.
