[Combined anterior-posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case report and review of literature]. / Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa. Caso clínico y revisión de la literatura.

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateral-mass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome.

Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa. Caso clínico y revisión de la literatura / Combined Anterior-Posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case Report and review of literature

La mielopatía cervical espondiloartrósica es una complicación frecuente en pacientes jóvenes afectados por parálisis cerebral infantil (PCI) que presentan un importante componente distónico y atetósico. Su tra- tamiento quirúrgico es problemático, caracterizado por tasas elevadas de fracaso precoz de la artrodesis, tanto en los abordajes anteriores como en los posteriores a la columna. Ofrecemos una revisión histórica del tratamiento de la mielopatía cervical en este subgrupo de pacientes, aportando un caso clínico en el que se ha decidido descomprimir y realizar artrodesis tanto por la vía anterior como por la vía cervical posterior, con fijación con tornillos a masas laterales, complementando el tratamiento quirúrgico con la inyección de toxina botulínica en el seguimiento postoperatorio, logrando un buen resultado clínico (AU)

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateralmass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome (AU)

[Spinal pleomorphic xantoastrocytoma. Case report]. / Xantoastrocitoma pleomórfico espinal. Caso clínico.

INTRODUCTION: we report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma, an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature. CASE REPORT: a 60 years old woman consulted with doctor because she felt progressive clumsiness accompanied by occasional paresthesias on her left hand. Neurological examination showed up weakness and slight propioceptive disturbances. The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma. Patient underwent surgical gross total remove. Histopathological examination confirmed the diagnosis of pleomorfic xanthoastrocytoma. We performed MRI controls at 6, 12, 24 and 36 months that did not reveal recurrence. Nowadays, the patient has regained her previous quality of life. DISCUSSION AND CONCLUSION: comparing to published cases about intracranial pleomorphic xanthoastrocytomas, spinal pleomorphic xanthoastrocytomas (SPXA) present different epidemiological characteristics. The known SPXAs affected to cervical and/or high thoracic levels. The hypothesis about a more aggressive behaviour of PXA in spinal cord may be corroborated after literature review. Extension examination is mandatory since dissemination along the neuroaxis has been described. Removal extension is crucial in the prevention of tumour recurrence. Adyuvant radiotherapy should only be considered when there is postoperative residual tumour and/or anaplastic features. Randomized clinical trials or databases are necessary to know all the aspects of this pathological entity.

Xantoastrocitoma pleomórfico espinal. Caso clínico / Spinal pleomorphic xantoastrocytoma. Case report

Introducción. Presentamos los aspectos clinicopatológicos y radiológicos de uno de los escasos casos dexantoastrocitoma pleomórfico espinal publicado, una entidad neoplásica infrecuente en una realmente rara localización. Revisamos la breve literatura inglesa disponible y establecemos un apropiado manejo en función de ésta.Caso clínico. Mujer de 60 años de edad que consultó por acorchamiento progresivo de su mano izquierda, acompañado de ocasionales parestesias de dos meses de evolución. La exploración neurológica mostró debilidad y un leve trastorno de la sensibilidad propioceptiva de la extremidad superior derecha. El diagnóstico diferencial tras las pruebas de imagen se estableció entre astrocitoma y ependimoma. La paciente recibió tratamiento quirúrgico obteniéndose una resección completa y el diagnóstico de xantoastrocitoma pleomórfico. En los controles de imagen realizados a los 6, 12, 24 y 36 meses no seo bjetivó recidiva tumoral. Actualmente la paciente ha recuperado su calidad de vida previa.Discusión y conclusión. Comparando con los xantoastrocitomas pleomórficos intracraneales, aquellos con localización espinal (XAPE) presentan diferentes características epidemiológicas, con afectación predominante de niveles cervical y dorsal alto. La hipótesis de comportamiento más agresivo de los XAPE podría ser corroborada tras la revisión de la literatura. El estudio de extensión es fundamental para descartar la descrita diseminación a través del neuroeje. El grado de extensión de la resección quirúrgica es crucial en la prevención de la recurrencia tumoral. La radioterapia adyuvante debería únicamente considerarse cuando aparece tumor residual y/o anaplasia. Ensayos clínicos randomizados y bases de datos multicéntricas son necesariaspara conocer todos los aspectos de esta entidad neoplásica (AU)

Summary Introduction. We report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma,an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature.Case report. A 60 years old woman consulted with doctor because she felt progressive clumsiness accompanied by occasional paresthesias on her left hand.Neurological examination showed up weakness and slight propioceptive disturbances. The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma. Patient under went surgicalgross total remove. Histopathological examination confirmed the diagnosis of pleomorfic xanthoastrocytoma.We performed MRI controls at 6, 12, 24 and 36 months that did not reveal recurrence. Nowadays, the patient has regained her previous quality of life.Discussion and conclusion. Comparing to published cases about intracranial pleomorphic xanthoastrocytomas, spinal pleomorphic xanthoastrocytomas (SPXA)present different epidemiological characteristics. The known SPXAs affected to cervical and/or high thoraciclevels. The hypothesis about a more aggressive behaviour of PXA in spinal cord may be corroborated after literature review. Extension examination is mandatory since dissemination along the neuroaxis has been described.Removal extension is crucial in the prevention of tumour recurrence. Adyuvant radiotherapy should only be considered when there is postoperative residualtumour and/or anaplastic features. Randomized clinical trials or databases are necessary to know all the aspects of this pathological entity (AU)