Migración posterior epidural de fragmento discal / Epidural posterior migration of disc fragment

Introducción. La migración posterior epidural de un fragmento de hernia discal lumbar es una presentación clínica infrecuente. Caso clínico. Presentamos el caso de un paciente varón de 76 años, que acude por dolor lumbar y paraparesia progresiva en extremidades inferiores, con la aparición a los 4 días del ingreso de un síndrome de cauda equina. La resonancia magnética muestra espondilosis lumbar y una masa intrarraquídea bien delimitada en el espacio epidural posterior. Se realiza una exéresis quirúrgica de la masa epidural. El estudio anatomopatológico informó de fragmento de disco intervertebral, por lo que se trataba de una migración completa de una hernia discal lumbar. Tras la intervención quirúrgica y un tratamiento rehabilitador específico remitió la clínica del paciente. Conclusiones. Los pacientes con migración posterior de un fragmento de disco presentan graves déficits neurológicos como el síndrome de cauda equina. Debido a que las imágenes radiológicas de los fragmentos del disco son similares a los de otras lesiones como metástasis, quiste sinovial, absceso dural o hematoma, el diagnóstico definitivo se realiza mediante exéresis y estudio anatomopatológico. El tratamiento quirúrgico urgente es necesario para evitar déficits neurológicos severos (AU)

Introduction. The posterior epidural migration of a fragment of lumbar disc herniation is a rare clinical presentation. Case report. We report the case of a 76-year-old with back pain and progressive paraparesis in the lower limbs, with the emergence of a cauda equina syndrome 4 days after admission. MRI showed lumbar spondylosis and a well-defined intra-spinal mass in the posterior epidural space. Surgical resection of the epidural mass was performed. The pathological study revealed an intervertebral disc fragment; thus it was a complete migration of a herniated lumbar disc. The patient was healed after surgery and specific rehabilitation treatment. Conclusions. Patients with posterior migration of disc fragment may present with severe neurological deficits, such as cauda equina syndrome. Because the radiological images of disc fragments are similar to those of other lesions, such as metastasis, synovial cyst, dural abscess or haematoma, definitive diagnosis is made by excision and pathological study. Emergency surgery is required to prevent severe neurological deficits (AU)

[Epidural posterior migration of disc fragment]. / Migración posterior epidural de fragmento discal.

INTRODUCTION: The posterior epidural migration of a fragment of lumbar disc herniation is a rare clinical presentation. CASE REPORT: We report the case of a 76-year-old with back pain and progressive paraparesis in the lower limbs, with the emergence of a cauda equina syndrome 4 days after admission. MRI showed lumbar spondylosis and a well-defined intra-spinal mass in the posterior epidural space. Surgical resection of the epidural mass was performed. The pathological study revealed an intervertebral disc fragment; thus it was a complete migration of a herniated lumbar disc. The patient was healed after surgery and specific rehabilitation treatment. CONCLUSIONS: Patients with posterior migration of disc fragment may present with severe neurological deficits, such as cauda equina syndrome. Because the radiological images of disc fragments are similar to those of other lesions, such as metastasis, synovial cyst, dural abscess or haematoma, definitive diagnosis is made by excision and pathological study. Emergency surgery is required to prevent severe neurological deficits.

Glioblastoma cerebeloso. Caso clínico / Cerebellum glioblastoma. Clinical case

Introducción: El glioblastoma multiforme(GBM) es el más frecuente y maligno de los tumorescerebrales. Su presentación en cerebelo es excepcional.Caso clínico: Paciente de 42 años con historiabreve de trastorno de la marcha y cefalea.La resonancia magnética cerebral mostró una lesiónde unos 4 cm de diámetro sólida y quística, conedema, en hemisferio cerebeloso dcho. Se extirpóun Glioblastoma multiforme con p53 positiva.Conclusiones: La edad y la p53 hacen pensarque se trate de una forma secundaria de GBM.La bibliografía revisada constata que se trata deuna localización infrecuente.El tratamiento inicial es quirúrgico pero las supervivenciasson cortas a pesar de la radioterapia ydel uso de nuevos quimioterápicos como la Temozolomida

Introduction: Glioblastoma is the mostfrequent and malignant of the brain tumours.However, it is exceptionally observed in thecerebellum.Clinical case: A case of a 42 year old womanwith a short history of gait disturbance andheadache is reported. A MRI brain scan showed a 4cm diameter, solid and cystic tumour with edema inthe right cerebellum.Surgery removed a glioblastoma multiforme witha positive p53.Conclusions: Age and positive p53 indicatethat it is a secondary form. Bibliography certifiesthat it is an infrequent location. Initial treatment issurgery, but survival is short in spite of radiotherapyand chemotherapy with temozolamide

[Advantages of neuroendoscopy in the management of non-communicating hydrocephalus]. / Utilidad de la neuroendoscopia en el manejo de la hidrocefalia no comunicante.

INTRODUCTION: Non-communicating hydrocephalus is defined as a blockade of the physiological cerebrospinal fluid (CSF) flow from the choroid plexus to the subarachnoid space. Usually, a ventricle peritoneal shunt with a valve is employed as treatment but this does not provide a physiological restoration on the CSF flow. OBJECTIVE: The aim of the study is to introduce a more physiological solution by means of endoscopic technique. We also pretend to find out some prognostical factors related to successful treatment. PATIENTS AND METHODS: We present a prospective non-randomized series of 32 endoscopic III ventriculostomies performed in patients with non-communicating hydrocephalus. When the blockade was due to a tumor, an endoscopic biopsy was performed at the same surgical time. In the same way, if the cause was a ventricular hematoma, an endoscopic aspiration was performed. The patients follow-up was two years. RESULTS: The procedure was considered successful (83.8% of the cases) when the clinical symptoms resolved without ventricle-peritoneal shunt. We study the relationship of the blockade level and the highest value of intracranial pressure during endoscopy with the results of the procedure in terms of success and morbidity. We have found significant relation between high pressure during endoscopy and the practice of a complementary biopsy or hematoma evacuation. CONCLUSIONS: Endoscopic third ventriculostomy provides an effective and physiological solution to non communicating hydrocephalus. Complementary endoscopic procedures can be associated at the same surgical time, however this association can be related to increased values of intracranial pressure during surgical performance.

[Diagnostic and therapeutic criteria of adult normal-pressure hydrocephalus. Descriptive multicenter national study]. / Criterios diagnósticos y terapéuticos en la hidrocefalia normotensiva del adulto. Estudio nacional multicéntrico descriptivo.

INTRODUCTION: There are some controversial items concerning normal pressure hydrocephalus (NPH). The incidence of NPH is unknown since there is not agreement concerning diagnostic criteria. The choice of shunt location and valve type may be difficult if we consider the wide range of options available. We present a descriptive multicentric study which pretends evaluate the consensus between different centers. MATERIAL AND METHODS: We have requested 19 neurosurgical departments about diagnostic criteria, shunt location, valve type, cases number per year and therapeutic results. RESULTS: The study shows the lack of agreement in our sample. We observed some kind of relationship between the number of cases/year and the use of more complex and invasive diagnostic procedures. The most frequently shunt location was ventricleperitoneal. Concerning type valve, most of departments use to have a predilection for a certain type and model which was ever used. However, the model was frequently different on each department. Anyway, differential pressure valve was the more frequent choice. The average therapeutic result of the sample was 77.6%. CONCLUSIONS: In our opinion, is advisable to define a common diagnostic criteria for NPH in order to establish the real incidence of this entity.