Surgical Approach and Further Management of Intracranial Hemangioendothelioma With Double Location: A Case Report.

Hemangioendotheliomas are highly vascularized lesions, and their intracranial presentation is extremely rare. We present the case of a 65-year-old female patient who was evaluated for cranial deformity, headache, and left hemiplegia. Two bone lesions that were destroying and expanding the bone diploe with intracranial extension were identified in the fronto-temporal and parietal regions. Both lesions were multilobed and showed heterogeneous behavior. Mixed hemangioendotheliomas were identified after the successful resection of both tumors in two separate surgical procedures. The prognosis of this type of tumor with an intracranial location is not well-defined because there are too few reported cases.

Comparative Proteomic Study Shows the Expression of Hint-1 in Pituitary Adenomas.

Pituitary adenomas (PAs) can be unpredictable and aggressive tumors. No reliable markers of their biological behavior have been found. Here, a proteomic analysis was applied to identify proteins in the expression profile between invasive and non-invasive PAs to search for possible biomarkers. A histopathological and immunohistochemical (adenohypophyseal hormones, Ki-67, p53, CD34, VEGF, Flk1 antibodies) analysis was done; a proteomic map was evaluated in 64 out of 128 tumors. There were 107 (84%) invasive and 21 (16%) non-invasive PAs; 80.5% belonged to III and IV grades of the Hardy-Vezina classification. Invasive PAs (n = 56) showed 105 ± 43 spots; 86 ± 32 spots in non-invasive PAs (n = 8) were observed. The 13 most prominent spots were selected and 11 proteins related to neoplastic process in different types of tumors were identified. Hint1 (Histidine triad nucleotide-binding protein 1) high expression in invasive PA was found (11.8 ± 1.4, p = 0.005), especially at high index (>10; p = 0.0002). High Hint1 expression was found in invasive VEGF positive PA (13.8 ± 2.3, p = 0.005) and in Flk1 positive PA (14.04 ± 2.28, p = 0.006). Hint1 is related to human tumorigenesis by its interaction with signaling pathways and transcription factors. It could be related to invasive behavior in PAs. This is the first report on Hint expression in PAs. More analysis is needed to find out the possible role of Hint in these tumors.

Knowledge of skull base anatomy and surgical implications of human sacrifice among pre-Columbian Mesoamerican cultures.

Human sacrifice became a common cultural trait during the advanced phases of Mesoamerican civilizations. This phenomenon, influenced by complex religious beliefs, included several practices such as decapitation, cranial deformation, and the use of human cranial bones for skull mask manufacturing. Archaeological evidence suggests that all of these practices required specialized knowledge of skull base and upper cervical anatomy. The authors conducted a systematic search for information on skull base anatomical and surgical knowledge among Mesoamerican civilizations. A detailed exposition of these results is presented, along with some interesting information extracted from historical documents and pictorial codices to provide a better understanding of skull base surgical practices among these cultures. Paleoforensic evidence from the Great Temple of Tenochtitlan indicates that Aztec priests used a specialized decapitation technique, based on a deep anatomical knowledge. Trophy skulls were submitted through a stepwise technique for skull mask fabrication, based on skull base anatomical landmarks. Understanding pre-Columbian Mesoamerican religions can only be realized by considering them in their own time and according to their own perspective. Several contributions to medical practice might have arisen from anatomical knowledge emerging from human sacrifice and decapitation techniques.

Treatment of craniopharyngioma in adults: systematic analysis of a 25-year experience.

BACKGROUND AND AIMS: Craniopharyngioma is a rare and mostly benign epithelial tumor of the central nervous system, mostly affecting children. Considering that most of the published series of craniopharyngioma are based on pediatric populations, studies in adults gain importance based mainly on the reduced number of cases and the possible differences emerging from a mostly different histological type. We undertook this study to establish the pattern of presentation, morphological features and specific characteristics of craniopharyngioma in an adult Mexican population, as well as discussing the long-term outcome and how it may be influenced by surgical, anatomic and clinical factors. METHODS: A total of 153 adult patients (16 years or older) underwent transcranial and transsphenoidal surgery between January 1985 and December 2009, all with histological confirmation of craniopharyngioma. Hypothalamic involvement, surgical complications, rate of tumor resection and endocrinological outcome were evaluated. RESULTS: Seventy nine males (51.6%) and 74 females (48.4%) were included. Mean age at diagnosis was 32.4 years (range: 16-77 years). Mean initial tumor volume was 28.44 mL (range: 0.18-100.44 mL). Partial or complete hypothalamic involvement (Samii Grades III, IV and V) was found in 90.2%. The overall rate of new endocrinopathies was 37.25% after surgery (95% CI = 33.9-41.2). CONCLUSIONS: Gross total removal of craniopharyngiomas with large hypothalamic involvement was related to poor neuroendocrine outcome in adults. Partial removal should be indicated, associated with adjuvant therapy, in order to improve postoperative neuroendocrine status.

Biomechanics: its origin and evolution / Biomecánica: origen y evolución

En este trabajo la historia de una rama de la física la biomecánica este conocimiento tiene gran importancia para el estudio de la columna vertebral y sus enfermedades.

Spine biomechanics: basic review: anatomic and functional considerations / Columna biomecánica: revisión básica: consideraciones anatómicas y funcionales

Los problemas espinales ocurren a cualquier edad, ellos se presentan con mayor frecuencia secundarios a lesiones traumáticas y procesos degenerativos en desbalance. Analizar estas situaciones clínicas con propiedad puede ser muy difícil sin el conocimiento de la anatomía y propiedades funcionales de los elementos que forman la columna vertebral. Hemos tratado aquí de explicar de una manera sencilla esta compleja información aplicada a la biomecánica de la columna vertebral, es por eso que iniciamos con una explicación de la manera en que trabaja la espina y porque deben ser estudiados en un concepto biomecánico los músculos, tendones, ligamentos y cápsulas. La subdivisión de estructuras anatómicas de la espina en dos sistemas pasivos y un activo facilita la manera de estudiar y entender los movimientos de la columna vertebral siempre ayudados por un sistema de coordendas cartesianas.

Hematoma subdural posinstrumentación occipito-cervical / Subdural hematoma after occipito cervical fusion

La unión cráneo vertebral representa un reto diagnóstico y terapéutico para el clínico y cirujano debido a la complejidad anatómica de la región que a pesar de haber transcurrido casi 70 años de la descripción anátomopatológica realizada por el profesor Foerster, y del trabajo publicado por Chamberlain en donde se definieron las normas para el estudio radiográfico de la invaginación basilar, continua esta región despertando controversias diagnósticas y terapéuticas. Se presenta el caso de un masculino de 20 años de edad con diagnóstico de invaginación basilar, asimilación del atlas e inestabilidad atlantoodontoidea quien después de haber sido sometido a un abordaje occipito-cervical posterior con descompresión de fosa posterior y fijación cráneo cervical con placas y tornillos, desarrolla a las 2 semanas del posoperatorio un hematoma subdural occipital.