Síndrome de Brown-Séquard progresivo secundario a hernia medular idiopática: correlación clinicorradiológica y quirúrgica / Progressive Brown-Séquard syndrome secondary to idiopathic spinal cord herniation: clinico-radiological and surgical correlations

INTRODUCCIÓN: La hernia medular idiopática es una patología infrecuente que cursa clínicamente con una mielopatía progresiva, la mayoría de las ocasiones en forma de síndrome de Brown-Séquard. Su base anatómica es un defecto dural por el que se incarcera progresivamente una porción del cordón medular anterior. La resonancia magnética y la mielotomografía demuestran un acodamiento medular en «tienda de campaña» hacia la cara anterior del estuche dural, a nivel dorsal medio fundamentalmente. Caso clínico. Varón de 37 años, diagnosticado de hernia medular idiopática e intervenido quirúrgicamente mediante una técnica propia; se demuestra su correlación neurorradiológica, anatomoquirúrgica y evolutiva. CONCLUSIÓN: El tratamiento debe ser individualizado, pues no existe una técnica quirúrgica universalmente establecida

INTRODUCTION: Idiopathic medullary herniation is an infrequent disease, which shows up in clinical form as a progressive mielopathy, most commonly known as the Brown-Séquard syndrome. Its anatomical base is a dural defect where a portion of anterior spinal cord gets progressively incarcerated. The MRI and myelo-CT scan show a bending of the spinal cord in the form of a «bell tent» towards the anterior dural sheath at the mid-dorsal portion mainly. CASE REPORT: A 37 year old male, who was diagnosed of idiopathic medullary herniation and surgically treated by our own developed technique, reporting its neuroradiological, anatomo-surgical and clinical correlation. CONCLUSION. Treatment should be individualized, as no standard surgical technique has been established up to the present

Trigeminal root massage in microsurgical treatment of trigeminal neuralgia patients without arterial compression: When, how and why / Masaje de la raíz trigeminal en el tratamiento quirúrgico de la neuralgia de trigémino sin contacto neurovascular arterial: cuándo, cómo y porqué

BACKGROUND: During the microsurgical exploration of trigeminal root in the pontocerebellar angle in patients with primary trigeminal neuralgia (TN) without an evident arterial compression, the surgeon is in an engaged situation because there are not well-established surgical strategies. The aim of this study is to describe in these cases the surgical maneuver we call "trigeminal root massage" (TRM). METHODS: 52 consecutive patients with primary trigeminal neuralgia who had undergone a microsurgical suboccipital retrosigmoid exploration of trigeminal root were reviewed. Among them we found 10 patients without an evident arterial compression after a thorough microsurgical exploration. In the great majority of these 10 cases, we noticed a venous contact to the trigeminal root along this cisternal trajectory, in most cases we have had to coagulate the compressive vein/s and then cut. All underwent a simple trigeminal root massage, without interposition of any material implant. RESULTS: All 10 patients experienced immediate pain disappearance and the postoperative course was uneventful except one case with a severe complication: cerebellar swelling, meningitis and hydrocephaly. The recurrence rate was 40%. Six patients achieved pain relief without specific medication with an average follow-up period of 5 years. There have been no mortalities nor any postoperative anesthesia dolorosa. CONCLUSIONS: The described maneuver provides an easy and simple alternative way in cases where during a microsurgical exploration of trigeminal root, where we don't find a clear arterial compression, with similar results than other possibilities such as partial sensory rhizotomy or more complicated and time consuming surgery as "nerve combing". Nevertheless, a 40% of pain recurrence after an average follow-up of 5 years means that is a good alternative, but not a definitive technique at the moment for permanent cure of trigeminal neuralgia without arterial compression

INTRODUCCIÓN Y OBJETIVOS: Durante la exploración microquirúrgica de la raíz trigeminal en el ángulo pontocerebeloso en pacientes con neuralgia del trigémino (NT) primaria sin una evidente compresión arterial, el cirujano se encuentra en una situación comprometida, ya que no existe una estrategia quirúrgica establecida. El objetivo de este estudio es la de describir en esos casos una maniobra quirúrgica que llamamos «masaje de la raíz trigeminal» (MRT). MÉTODOS: Se revisan un total de 52 pacientes consecutivos con NT primaria a quienes se ha realizado una exploración de la raíz trigeminal por vía suboccipital retrosigmoidea. Entre ellos hemos encontrado 10 pacientes sin una evidente compresión arterial durante la exploración microquirúrgica. En 8 de los 10 casos ha existido un contacto venoso de la raíz trigeminal a lo largo de su trayectoria cisternal, procediendo a la coagulación y sección de la/s vena/s. En los 10 casos se ha procedido, finalmente, a un suave masaje de la raíz trigeminal sin interposición de ningún material. RESULTADOS: Los 10 pacientes experimentaron una inmediata desaparición de la neuralgia y el curso postoperatorio fue favorable excepto por un caso de complicación severa con edema cerebeloso, meningitis e hidrocefalia. La recidiva fue del 40%. Seis pacientes obtuvieron una desaparición completa de la neuralgia, sin medicación específica, en un seguimiento medio de 5 años. No ha habido mortalidad ni anestesia dolorosa postoperatoria. CONCLUSIONES: La maniobra quirúrgica descrita es una alternativa útil y sencilla en casos donde, durante la exploración microquirúrgica de la raíz trigeminal, no encontramos una clara compresión arterial, con resultados similares a otras posibilidades como la rizotomía parcial o más laboriosas como la llamada nerve combing. En cualquier caso, un 40% de recidiva dolorosa a los 5 años significa que, aunque es una buena alternativa, no es una técnica definitiva en la curación de todos los enfermos con NT sin conflicto arterial

Trigeminal root massage in microsurgical treatment of trigeminal neuralgia patients without arterial compression: When, how and why.

BACKGROUND: During the microsurgical exploration of trigeminal root in the pontocerebellar angle in patients with primary trigeminal neuralgia (TN) without an evident arterial compression, the surgeon is in an engaged situation because there are not well-established surgical strategies. The aim of this study is to describe in these cases the surgical maneuver we call "trigeminal root massage" (TRM). METHODS: 52 consecutive patients with primary trigeminal neuralgia who had undergone a microsurgical suboccipital retrosigmoid exploration of trigeminal root were reviewed. Among them we found 10 patients without an evident arterial compression after a thorough microsurgical exploration. In the great majority of these 10 cases, we noticed a venous contact to the trigeminal root along this cisternal trajectory, in most cases we have had to coagulate the compressive vein/s and then cut. All underwent a simple trigeminal root massage, without interposition of any material implant. RESULTS: All 10 patients experienced immediate pain disappearance and the postoperative course was uneventful except one case with a severe complication: cerebellar swelling, meningitis and hydrocephaly. The recurrence rate was 40%. Six patients achieved pain relief without specific medication with an average follow-up period of 5 years. There have been no mortalities nor any postoperative anesthesia dolorosa. CONCLUSIONS: The described maneuver provides an easy and simple alternative way in cases where during a microsurgical exploration of trigeminal root, where we don't find a clear arterial compression, with similar results than other possibilities such as partial sensory rhizotomy or more complicated and time consuming surgery as "nerve combing". Nevertheless, a 40% of pain recurrence after an average follow-up of 5 years means that is a good alternative, but not a definitive technique at the moment for permanent cure of trigeminal neuralgia without arterial compression.

PR-LncRNA signature regulates glioma cell activity through expression of SOX factors.

Long non-coding RNAs (LncRNAs) have emerged as a relevant class of genome regulators involved in a broad range of biological processes and with important roles in tumor initiation and malignant progression. We have previously identified a p53-regulated tumor suppressor signature of LncRNAs (PR-LncRNAs) in colorectal cancer. Our aim was to identify the expression and function of this signature in gliomas. We found that the expression of the four PR-LncRNAs tested was high in human low-grade glioma samples and diminished with increasing grade of disease, being the lowest in glioblastoma samples. Functional assays demonstrated that PR-LncRNA silencing increased glioma cell proliferation and oncosphere formation. Mechanistically, we found an inverse correlation between PR-LncRNA expression and SOX1, SOX2 and SOX9 stem cell factors in human glioma biopsies and in glioma cells in vitro. Moreover, knock-down of SOX activity abolished the effect of PR-LncRNA silencing in glioma cell activity. In conclusion, our results demonstrate that the expression and function of PR-LncRNAs are significantly altered in gliomagenesis and that their activity is mediated by SOX factors. These results may provide important insights into the mechanisms responsible for glioblastoma pathogenesis.

Targeting SOX2 as a Therapeutic Strategy in Glioblastoma.

Glioblastoma is the most common and malignant brain cancer in adults. Current therapy consisting of surgery followed by radiation and temozolomide has a moderate success rate and the tumor reappears. Among the features that a cancer cell must have to survive the therapeutic treatment and reconstitute the tumor is the ability of self-renewal. Therefore, it is vital to identify the molecular mechanisms that regulate this activity. Sex-determining region Y (SRY)-box 2 (SOX2) is a transcription factor whose activity has been associated with the maintenance of the undifferentiated state of cancer stem cells in several tissues, including the brain. Several groups have detected increased SOX2 levels in biopsies of glioblastoma patients, with the highest levels associated with poor outcome. Therefore, SOX2 silencing might be a novel therapeutic approach to combat cancer and particularly brain tumors. In this review, we will summarize the current knowledge about SOX2 in glioblastoma and recapitulate several strategies that have recently been described targeting SOX2 in this malignancy.

Síndrome de cola de caballo tras tratamiento quiropráctico / Cauda equina syndrome after chiropractic treatment

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Reagudización de asma tras tratamiento quirúrgico de síndrome de Cushing / Asthma relapse after surgical treatment of Cushing's syndrome

No disponible

Neurinoma de la cuerda del tímpano / Chorda tympani neuroma

No disponible

Bilateral congenital absence of the stapes superstructure in two siblings.

Middle ear ossicle malformations are an uncommon event. Among them, the congenital absence of the stapes is a very rare condition that is seldom described in the literature. We report the cases of two women, aged 19 and 22 , who presented with a long history of conductive deafness. An exploratory tympanotomy was performed and the absence of the stapes superstructure and an abnormal position of the facial nerve could be observed. A bone anchored hearing aid (BAHA) was implanted in both patients with good results. It is believed that stapes agenesis is related to an abnormal development of the facial nerve, which by the 5th to 6th week of gestation would interpose between the otic capsule and the stapes blastema, preventing these structures from contacting. A long history of nonprogressive hearing loss from birth or early childhood is the key to reach a diagnosis. Several treatment options have been described. The authors opted for a hearing aid due to the high risk of facial nerve lesion, with good functional results.

Primary bone non-Hodgkin lymphoma of the cervical spine: case report and review.

Primary bone lymphomas (PBL) account for approximately 3% of all malignant tumors and are commonly found in the femur or pelvis. Only 1.7% of the PBLs are found in the spine. We report the case of a 73-year-old male complaining of cervical pain with progressive loss of strength and frequent falls. The MRI showed invasion of the fourth cervical vertebra and an infiltrating prevertebral mass. A C4 corpectomy was performed. The pathology exam revealed a diffuse large B-cell lymphoma. Due to the previous condition of the patient only radiotherapy treatment was applied. PBL arising from the cervical spine is an exceptional event. The low incidence of this condition and its unspecific radiological features make the diagnosis challenging for the clinician. When neurological deficit appears, early surgery for decompression is indicated, followed by local radiotherapy and systemic chemotherapy.

Bilateral traumatic facial paralysis. Case report

Aunque el déficit de origen traumático del séptimo par craneal es una entidad común en la práctica neuroquirúrgica, la parálisis facial bilateral asociada a fracturas temporales supone un episodio infrecuente. Describimos el caso de un paciente de 38 años que sufre un traumatismo craneoencefálico severo (Glasgow Coma Scale de 7). En la TC inicial se apreció una fractura de peñasco longitudinal derecha y transversal izquierda. El paciente ingresó en la unidad de cuidados intensivos y, tras la extubación, se comprobó la existencia de una diplejía facial bilateral. El déficit bilateral del séptimo par craneal posee una etiología distinta al déficit unilateral. En estos casos, la ausencia de asimetría facial puede dificultar el diagnóstico, por lo que la TC de alta resolución y el estudio electromiográfico son útiles para su detección (AU)

Although traumatic injury of the facial nerve is a relatively common condition in neurosurgical practice, bilateral lesions related to fracture of temporal bones are seldom seen. Were port the case of a 38-year-old patient admitted to Intensive Care Unit after severe head trauma requiring ventilatory support (Glasgow Coma Scale of 7 on admission). A computed tomography (CT) scan confirmed a longitudinal fracture of the right temporal bone and a transversal fracture of the left. After successful weaning from respirator, bilateral facial paralysis was observed. The possible aetiologies for facial diplegia differ from those of unilateral injury. Due to the lack of facial asymmetry, it can be easily missed in critically ill patients, and both the high-resolution CT scan and electromyography studies can be helpful for correct diagnosis (AU)

Bilateral traumatic facial paralysis. Case report.

Although traumatic injury of the facial nerve is a relatively common condition in neurosurgical practice, bilateral lesions related to fracture of temporal bones are seldom seen. We report the case of a 38-year-old patient admitted to Intensive Care Unit after severe head trauma requiring ventilatory support (Glasgow Coma Scale of 7 on admission). A computed tomography (CT) scan confirmed a longitudinal fracture of the right temporal bone and a transversal fracture of the left. After successful weaning from respirator, bilateral facial paralysis was observed. The possible aetiologies for facial diplegia differ from those of unilateral injury. Due to the lack of facial asymmetry, it can be easily missed in critically ill patients, and both the high resolution CT scan and electromyographic studies can be helpful for correct diagnosis.

Operative treatment for microcephaly secondary to craniosynostosis at the turn of the twentieth century.

INTRODUCTION: Microcephaly has been described throughout history, and physicians in the nineteenth and early twentieth centuries struggled to identify the etiology of this condition in order to better treat it. In 1908, Cushing wrote in Surgery of the Head, in Keen's Surgery Its Principles and Practice, that the use of craniotomies for the treatment of microcephaly was a futile practice, with limited post-operative improvement that did not justify the operative risks. METHODS: Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical files of the Johns Hopkins Hospital, from 1896 to 1912, were reviewed. A single case of operative treatment of microcephaly, performed 3 years after Cushing's published opinion on the procedure, was discovered and is described here. RESULTS: In 1911, a 3-year-old girl from Florida presented with complaints of an "inability to walk" and "backward development." The diagnosis of microcephaly, possibly secondary to craniosynostosis, was made. Cushing operated upon her twice, performing bilateral decompressive craniotomies in a two-stage operation, without excision of the synostosis. Post-operatively, he documented improvement in the child's condition and a resolution of some presenting symptoms. CONCLUSIONS: Although Cushing published his disapproval of the use of craniotomies in the treatment of microcephaly in 1908, a review of his early surgical files demonstrates that this opinion was based on cases published in the literature, rather than his own operative experience. In 1911, he performed bilateral craniotomies in a 3-year-old patient with microcephaly and documented post-operative improvement in the patient's general condition.