Demographics aspects of brain and spine metastatic melanoma. Retrospective analysis in a single third-level center.

Background: Melanoma metastases to the CNS rank third in frequency, just after lung and breast metastases. There is controversy regarding the factors predisposing to developing CNS metastases in patients with cutaneous melanoma and their survival with conventional treatments. Methods: We carried out a retrospective analysis in a third-level hospital in Mexico to determine epidemiological aspects of melanoma metastases to the central nervous system, factors related to its appearance, clinical presentation, and survival in three treatment groups: surgery, radiotherapy, and conservative management. Results: We found that the nodular variant has the most significant association with CNS metastases. In addition, the superficial spreading variant has the highest risk of presenting a more substantial number of lesions, up to seven for each case and predominantly in the infratentorial space. On the other hand, we found more remarkable survival in patients treated only with surgery than those treated with radiotherapy or conservatively. Conclusions: This study lays the foundations for future prospective survival analysis of the different current treatment modalities for metastatic melanoma in the brain and spine. It also highlights the clinical risk factors for metastatic brain and spine tumors of melanoma.

Dual Microscope Indocyanine Green Video Angiography and Endoscopic Review to Treat Intracranial Aneurysm: A Review of the Literature Regarding a Case.

The use of the indocyanine green video angiography (ICG-VA) both endoscope and microscope has become popular in recent decades thanks to the safety, efficacy, and added value that they have provided for cerebrovascular surgery. The dual use of these technologies is considered complementary and has helped cerebrovascular surgeons in decision-making, especially for aneurysm clipping surgery; however, its use has been described for both aneurysm surgery, resection of arteriovenous malformations, or even for bypass surgeries. We conducted a review of the literature with the MeSH terms "microscope indocyanine green video angiography (mICG-VA)," "endoscopic review," AND/OR "intracranial aneurysm." A total of 97 articles that included these terms were selected after a primary review to select a total of 26 articles for the final review. We also present a case to exemplify its use, in which we use both technological tools for the description of the aneurysm, as well as for decision-making at the time of clipping and for reclipping. Both tools, both the use of the endoscope and the mICG-VA, have helped decision-making in neurovascular surgery. A considerable clip replacement rate has been described with the use of these technologies, which has helped to reduce the complications associated with poor clipping. One of the main advantages of their usefulness is that they are tools for intraoperative use, which is why they have shown superiority compared to digital subtraction angiography, which takes longer to use and has a higher risk of complications associated with the contrast medium. On the other hand, a very low rate of complications has been described with the use of the endoscope and mICG-VA, which is why they are considered safe tools to use. In some cases, mention has been made of the use of one or the other technology; however, we consider that its dual use provides more information about the status of the clip, its anatomy, its relationship with other vascular structures, and the complete occlusion of the aneurysm. We consider that the use of both technologies is complementary, so in case of having them both should be used, since both the endoscope and the mICG-VA provide additional and useful information.

Case of anterolateral migration of herniated cervical disc fragment mimicking a spinal meningioma.

BACKGROUND: Before the introduction of high-resolution MR, few disc fragments were misdiagnosed as meningiomas. CASE DESCRIPTION: A 63-year-old female presented with a 6-month history of mild to moderate pain in the left arm, weakness 4/5 in the left arm C5-C6 distribution, and a loss of the left biceps reflex response. Although the MR study was read as showing a C5-C6 level probable spinal meningioma, this proved to be a sequestrated disc fragment at surgery. CONCLUSION: Rarely, cervical disc herniations may be misdiagnosed on MR studies as spinal meningiomas.

Histopathological Correlation (World Health Organization Classification) of Meningiomas and Their Anatomical Localization: A Multicenter Epidemiological Study in Mexico.

OBJECTIVE: To determine the epidemiology of the localization and histological type of meningiomas in the Mexican population and the distribution of the different histological patterns and their relationship to tumor localization and patient demographics. METHODS: A retrospective analysis was performed in 5 hospitals in Mexico from 2009 to 2019. For qualitative variables, mean values were compared using Pearson χ2 test for the correlation between location and histological pattern as well as the clinical presentation and the patient's sex. Student t test was performed for age and its correlation with location and histology. RESULTS: Analysis of 179 patients revealed significant differences in histopathological pattern, patient sex, and tumor location. No significant differences were found for age or clinical presentation in association with any specific histological pattern. CONCLUSIONS: There was a correlation between the histology of the 15 histopathological varieties of meningiomas and the predilection site of appearance as well as certain demographic aspects, such as sex. This study lays the foundation for future studies in Mexico on the differentiation and typing of meningiomas regardless of the histological grade to which they belong, as the exact behavior of these tumors, including grade I tumors, remains unknown to date.

Minimally invasive management for a giant lumbar intervertebral disc herniation: A case report, and literature review.

INTRODUCTION AND IMPORTANCE: Low back pain and lower limb radiculopathy are some of the most common diagnoses in our neurosurgery department. Giant lumbar intervertebral disc herniation, are not a common find in our daily practice. Management for this kind of pathology is controversial. The quest for the best surgical approach is still a matter of debate. This case report intends to demonstrate the advantages of minimally invasive procedures. CASE PRESENTATION: 40-year-old female, diagnosed with giant lumbar L5-S1 disc herniation with localized lower back electric-type pain, 5/10 intensity in the visual analog scale (VAS) and an Oswestry Disability Index (ODI) score of 76 points, underwent minimally invasive surgery (MIS) with tubular retractor system. 6-month post-op, the patient referred no pain, and an ODI score of 4 points was obtained. CLINICAL DISCUSSION: There is no clear classification, regarding the lumbar intervertebral disc herniated content. We didn't find any clear indications or contraindications regarding the relationship of the size of herniated disc content and surgical approach (MIS vs Open). We perform on average 175 spine cases per year and educational commitment with spine pathology is demonstrated with our spine fellowship since 3 years ago. CONCLUSION: We believe giant extruded regardless of migration, single-level intervertebral disc herniation, could be effectively and safely treated by MIS.

Intracranial hypertension syndrome secondary to internal jugular vein thrombosis due to miliary cervical tuberculosis: A case report.

BACKGROUND: Thrombosis of the internal jugular vein (IJV) is extremely rare, being central catheterization the most common cause. We present a case of a patient with an unusual appearance of neurological symptoms as a consequence of thrombosis of the IJV secondary to miliary tuberculosis. CASE DESCRIPTION: A 30-year-old woman with disseminated tuberculosis, with multiple lymphadenopathy, axillary, cervical, mesenteric, retroperitoneal, and inguinal, presented with clinical evidence of intracranial hypertension. A diagnostic cerebral angiography was performed, which revealed an occluded left internal jugular and venous stasis in the entire cerebral venous system. The patient was treated with low-molecular-weight heparin, with which she had an adequate evolution. CONCLUSION: Tuberculosis is capable of generating a state of hypercoagulability, in addition to a mechanical compression effect due to cervical lymphadenopathy. We report an unusual clinical presentation, with intracranial involvement due to IJV thrombosis secondary to miliary tuberculosis. So far, there are no cases with a similar presentation described above.

360-surgery for a giant cervical chordoma with involvement of the right vertebral artery.

BACKGROUND: Chordomas are malignant tumors that arise from the remnants of the notochord. Complete en bloc radical resection with postoperative radiation therapy is currently considered the gold standard. Here, we performed a 360-staged approach to manage a C3-C4 chordoma that involved the right vertebral artery. CASE DESCRIPTION: A 40-year-old woman presented with a C3-C4 chordoma that invaded the right vertebral artery. She responded well to a circumferential approach including resection and stabilization. CONCLUSION: A 40-year-old woman with a C3-C4 spinal chordoma was optimally managed with a combined anterior/posterior surgical approach including decompression/fusion.

Ventriculopleural shunt dysfunction as the first sign of a hidden aneurysmal Subarachnoid Hemorrhage: A case report.

INTRODUCTION: Subarachnoid Hemorrhage (SAH) is caused by an aneurysmatic origin in 80% of cases. In the adult population, the risk of shunt dysfunction is about 16% in the first year, with proximal mechanical obstruction being the most frequent cause. CASE REPORT: An 81-year-old man with a history of shunt system placement presented among clinical data of shunt dysfunction. The brain Computed Tomography (CT) showed dilation of the ventricular system, with no other associated injury. The cause of the dysfunction was a SAH determined by a lumbar puncture (LP) study. We performed an angiography reporting 3 aneurysms. DISCUSSION: The risk of shunt dysfunction at one year is 40% and at two years, the risk ups to 53% with obstruction of the system and infection being the two principal causes. The usefulness of a lumbar puncture for late detection of SAH lies in the red cells in the Cerebrospinal Fluid (CSF). When the CT is negative and the clinical suspicion remains, the lumbar puncture (LP) continues with higher sensitivity despite is over 12 hours of the onset clinic symptoms. CONCLUSION: This case encourages to follow a rigorous protocol study for patients with multiple shunt dysfunction and chronic hydrocephalus. Also, this case invites to consider a hidden SAH secondary to a vascular pathology as a differential diagnosis for a multiple shunt dysfunction.