Osteocondroma de la columna cervical provocando tortícolis y hemiparesia / Cervical spine osteochondroma presenting with torticollis and hemiparesis

Los osteocondromas son tumores óseos benignos de lento crecimiento que se localizan habitualmente en los huesos largos. Aproximadamente el 1-4% de ellos se localizan en la columna vertebral. Los osteocondromas espinales solitarios pueden producir una gran variedad de síntomas, dependiendo de su localización y de su relación con las estructuras adyacentes. Recogemos el caso de una paciente de 74 años que fue ingresada en nuestro centro tras referir debilidad progresiva en el hemicuerpo izquierdo y dolor cervical. La exploración neurológica mostró hemiparesia izquierda leve y tortícolis izquierda. Los estudios de tomografía computarizada y resonancia magnética de la columna cervical demostraron una lesión expansiva afectando la articulación facetaria C3-C4 izquierda. Se realizó una hemilaminectomía C3 y C4, resección completa de la lesión y fijación cervical posterior instrumentada. El estudio anatomopatológico confirmó el diagnóstico de osteocondroma. Tras la intervención quirúrgica, los síntomas de la paciente mejoraron progresivamente sin secuelas neurológicas

Osteochondromas are slow-growing benign bone tumors that are located frequently in the long bones. Approximately 1-4% of them occur in the spine. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to associated structures. We report a case of a 74-year old woman who was admitted to our hospital with complaints of progressive left hemibody weakness and cervicalgia. Neurological examination disclosed mild left-sided hemiparesis and left torticollis. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansive lesion affecting the left C3-C4 facet joint. The patient underwent a posterior C3 and C4 hemilaminectomy, complete excision of the lesion and instrumented posterior cervical fixation. Histological examination confirmed the diagnosis of osteochondroma. After surgery her symptoms improved progressively with no neurological sequels

Pseudotumor retroodontoideo en un paciente con hiperostosis esquelética idiopática difusa / Retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis

El pseudotumor retroodontoideo es una lesión provocada por granulación inflamatoria o por hipertrofia de partes blandas asociado a inestabilidad atloaxoidea crónica. Sin embargo, cerca de un tercio de los casos recogidos en la literatura no demostraron claramente esta inestabilidad. Los autores exponen el caso de un hombre de 76 años, previamente diagnosticado de hiperostosis esquelética idiopática difusa, que presenta un cuadro de mielopatía severa progresiva. Las imágenes de resonancia magnética de la columna cervical mostraron una masa predural retroodontoidea con compresión marcada del cordón medular. Se realizó laminectomía del atlas y fusión occipitocervical. Tras la cirugía el paciente mejoró significativamente y se redujo el tamaño del pseudotumor

Retro-odontoid pseudotumors are lesions caused by inflammatory granulation or reactive soft tissue hypertrophy from chronic atlantoaxial subluxation. However, one-third of the cases reported in the medical literature did not show atlantoaxial instability clearly. The authors present the case of a 76-year-old man previously diagnosed with diffuse idiopathic skeletal hyperostosis who presented with severe progressive myelopathy. A magnetic resonance imaging of his cervical spine revealed a retro-odontoid predural mass, which caused a severe compression of the cervical spinal cord. The patient underwent a posterior laminectomy of the atlas and an occipitocervical fusion. After surgery, the pseudotumor was considerably smaller and the neurological symptoms improved

[Retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis]. / Pseudotumor retroodontoideo en un paciente con hiperostosis esquelética idiopática difusa.

Retro-odontoid pseudotumors are lesions caused by inflammatory granulation or reactive soft tissue hypertrophy from chronic atlantoaxial subluxation. However, one-third of the cases reported in the medical literature did not show atlantoaxial instability clearly. The authors present the case of a 76-year-old man previously diagnosed with diffuse idiopathic skeletal hyperostosis who presented with severe progressive myelopathy. A magnetic resonance imaging of his cervical spine revealed a retro-odontoid predural mass, which caused a severe compression of the cervical spinal cord. The patient underwent a posterior laminectomy of the atlas and an occipitocervical fusion. After surgery, the pseudotumor was considerably smaller and the neurological symptoms improved.

[Cervical spine osteochondroma presenting with torticollis and hemiparesis]. / Osteocondroma de la columna cervical provocando tortícolis y hemiparesia.

Osteochondromas are slow-growing benign bone tumors that are located frequently in the long bones. Approximately 1-4% of them occur in the spine. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to associated structures. We report a case of a 74-year old woman who was admitted to our hospital with complaints of progressive left hemibody weakness and cervicalgia. Neurological examination disclosed mild left-sided hemiparesis and left torticollis. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansive lesion affecting the left C3-C4 facet joint. The patient underwent a posterior C3 and C4 hemilaminectomy, complete excision of the lesion and instrumented posterior cervical fixation. Histological examination confirmed the diagnosis of osteochondroma. After surgery her symptoms improved progressively with no neurological sequels.

Fijación lumbar posterior empleando el sistema de imagen quirúrgica O-arm: experiencia inicial / Posterior lumbar fusion using the O-arm surgical imaging system: initial experience

Objetivo: La fijación con tornillos transpediculares en la columna lumbar es una técnica ampliamente aceptada para el tratamiento de patología traumática y degenerativa. Las complicaciones de la instrumentación espinal pueden ser graves. Sobrepasar caudal o medialmente la cortical del pedículo puede provocar lesiones nerviosas o durotomías incidentales. La cirugía guiada por imagen computarizada ha demostrado tasas más altas de precisión en la colocación de tornillos transpediculares comparada con la fluoroscopia convencional.El O-arm tiene la capacidad de obtener imágenes similares a la tomografía computarizada (TC) y realizar reconstrucciones multiplanares. En este estudio evaluamos una cohorte de pacientes en los que se realizó fijación lumbar posterior con tornillos transpediculares empleando el sistema de imagen quirúrgica O-arm. Métodos Se realizó un estudio retrospectivo de 40 casos consecutivos de fijación lumbar posterior empleando el O-arm. La población a estudio incluía 14 hombres y 26 mujeres. El rango de edad iba de 39 a 85 años, con una media de edad de 63,78 años. Veintiún pacientes presentaban estenosis del canal degenerativa (52,5%) y 19 espondilolistesis (47,5%). Se obtuvieron imágenes con TC intraoperatoria. Se recoge el (..) (AU)

Object: The use of transpedicular screw fixation has been widely accepted for the treatment of degenerative and traumatic pathology of the lumbar spine. Complications of spinal instrumentationcanbeserious.Screwmisplacementcanresultinunintendeddurotomy,nerveroot and/or cauda equina injury. In comparison to fluoroscopy-assisted screw placement, computer-assisted image guidance has been shown to achieve overall higher rates of accuracy. The O-arm is able to obtain computed tomography (CT)-type images with multiplanar reconstruction. In this study we evaluated a cohort of patients who underwent posterior lumbar fusion with pedicle screws utilizing the O-arm imaging system. Methods: A retrospective review of 40 consecutive patients who underwent posterior lumbar fusion surgery with O-arm utilization, was performed. The study population included (..) (AU)

Aneurisma de la arteria cerebral anterior que se presenta como masa del tercer ventrículo e hidrocefalia. A propósito de un caso / No disponible

Los aneurismas que se presentan como masas del tercer ventrículo son poco comunes, y en la mayor parte de los casos surgen del ápex de la arteria basilar. Presentamos el caso de un paciente varón de 67 años de edad que fue ingresado en el hospital con un cuadro de 4 semanas de evolución de inestabilidad de la marcha, incontinencia urinaria y pérdida progresiva de agudeza visual. La tomografía computarizada craneal mostraba una masa hiperdensa en el tercer ventrículo con dilatación triventricular. La resonancia magnética cerebral, la angiografía por resonancia magnética y la angiografía convencional identificaron esta lesión como un aneurisma parcialmente trombosado de la arteria cerebral anterior. Según nuestro conocimiento, este es el primer caso descrito de aneurisma de arteria cerebral anterior con estas características clínicas y radiológicas (AU)

[Anterior cerebral artery aneurism presenting as a third ventricular mass and hydrocephalus. Case report]. / Aneurisma de la arteria cerebral anterior que se presenta como masa del tercer ventrículo e hidrocefalia. A propósito de un caso.

Aneurysms which appear as third ventricular masses are uncommon; most are giant aneurysms arising from the basilar apex. We present the case of a 67-year-old male who was admitted to hospital with a 4-week history of gait instability, urinary incontinence and progressive visual loss. A cranial computed tomography scan revealed a hyperdense mass in the third ventricle with triventricular dilatation. Cerebral magnetic resonance imaging, magnetic resonance-angiography and conventional angiography identified this lesion as a partially thrombosed aneurysm of the anterior cerebral artery. To our knowledge, this is the first report of an anterior cerebral artery aneurysm with these clinical and radiological features.

[Posterior lumbar fusion using the O-arm surgical imaging system: initial experience]. / Fijación lumbar posterior empleando el sistema de imagen quirúrgica O-arm: experiencia inicial.

OBJECTIVES: The use of transpedicular screw fixation has been widely accepted for the treatment of degenerative and traumatic pathology of the lumbar spine. Complications of spinal instrumentation can be serious. Screw misplacement can result in unintended durotomy, nerve root and/or cauda equina injury. In comparison to fluoroscopy-assisted screw placement, computer-assisted image guidance has been shown to achieve overall higher rates of accuracy. The O-arm is able to obtain computed tomography (CT)-type images with multiplanar reconstruction. In this study we evaluated a cohort of patients who underwent posterior lumbar fusion with pedicle screws utilizing the O-arm imaging system. METHODS: A retrospective review of 40 consecutive patients who underwent posterior lumbar fusion surgery with O-arm utilization, was performed. The study population included 14 males and 26 females. Age range was 39-85 years with an average of 63.8 years. Twenty one patients had degenerative lumbar stenosis (52.5%) and 19 had spondylolisthesis (47.5%). Intraoperative CT-images were obtained. The mean time for surgery and screw placement was assessed. RESULTS: A total of 252 pedicle screws were sited using O-arm navigation system, with a mean of 6.3 screws per patient (range 4-10). On the basis of intraoperative CT, 3 screws were redirected, representing a 98.81% accuracy rate. The mean duration of surgery was 157.2 (90-240) minutes and the mean time for screw placement was 7.13 (3.08-15) minutes per screw. Three patients (7.5%) developed superficial wound infections which were treated conservatively. No patients required a return to the operating room because of screw malposition. CONCLUSION: The use of intraoperative O-arm imaging system with computer-assisted navigation significantly increases the surgical accuracy and safety of pedicle screw placement in lumbar fusion surgery.

Osteolipoma hipotalámico sintomático / Symptomatic hypothalamic osteolipoma

No disponible