[Endoscopic third ventriculostomy: risk factors for failure and evolution of ventricular size]. / Ventriculostomía endoscópica: influencia de factores predisponentes al fallo y evolución del tamaño ventricular.

INTRODUCTION: Endoscopic third ventriculostomy is the treatment of choice for non communicating hydrocephalus at our institution. Several factors have been associated with failure of endoscopic third ventriculostomy. The goals of the study have been to evaluate the outcome, the influence of factors theoretically prone to failure of ventriculostomy and the evolution of ventricular size. MATERIAL AND METHODS: Fifty-six patients (mean age 48.5 yrs) treated with an endoscopic third ventriculostomy during the period 1997-2002 were analysed retrospectively. Hydrocephalus was classified as acute (68%) and chronic forms. Etiology was classified in space-occupying lesions (59%), primary aqueductal stenosis (34%) and Chiari malformation (7%). The presence of the following factors theoretically prone to failure was considered: age below one year, history of mielomeningocele, cerebrospinal fluid (CSF) infection, intracranial haemorrhage, radiotherapy, craniotomy and previous treatment of hydrocephalus with a shunt. Ventricular size was measured linearly with four ventricular index pre- and postoperatively. RESULTS: The global success rate was 71.4% (mean follow-up 26 months). Endoscopic third ventriculostomy for hydrocephalus secondary to cerebral metastases obstructing CSF pathways was associated with a higher risk of failure (p=0.006). None of the risk factors considered was associated with a higher risk of failure. The evolution of the ventricular size measured with linear methods is associated with outcome. Evans ratio, third ventricle index, cella media index and ventricular score decreased in patients whose outcome is satisfactory and increased in those cases deemed clinical failures (p< 0.05). CONCLUSION: The risk of failure increases in patients with cerebral metastases close to CSF pathways, likely due to the concurrence of mechanisms other than obstruction. Changes in ventricular size are associated with outcome.

Déficit neurológico transitorio secundario a quiste leptomeníngeo en un paciente adulto / Transient neurological deficit secondary to a leptomeningeal cyst in an adult patient

Introducción. Una complicación poco frecuente de las fracturas craneales en la infancia es el quiste leptomeníngeo, también denominado fractura evolutiva. El quiste leptomeníngeo postraumático puede ocurrir en sujetos adultos pero es mucho más raro y se atribuye a una fractura craneal sufrida en la infancia. Esta complicación se origina por un desgarro de la duramadre a través del cual se hernia la aracnoides por las pulsaciones del líquido cefalorraquídeo. La manifestación clínica más frecuente consiste en una tumoración o abultamiento de partes blandas que aparece en la cabeza. Caso clínico. Se describe el caso de un varón de 47 años con antecedentes de traumatismo craneal en la infancia que presentó un cuadro de acorchamiento en miembro superior derecho y desviación de la comisura bucal del que se recuperó en una hora. Los estudios de neuroimagen mostraron una destrucción irregular del hueso temporal derecho y una hipodensidad en el tejido cerebral subyacente.La intervención quirúrgica y el estudio histológico del hueso demostraron que se trataba de un quiste leptomeníngeo asociado a un infarto cerebral en el seno de una fractura craneal antigua. Conclusiones. El quiste leptomeníngeo postraumático en un paciente adulto se origina por un desgarro de la duramadre producido por una fractura craneal en la infancia, puede asociarse con un infarto cerebral y es posible que debute exclusivamente con síntomas neurológicos focales transitorios (AU)

[Transient neurological deficit secondary to a leptomeningeal cyst in an adult patient]. / Déficit neurológico transitorio secundario a quiste leptomeníngeo en un paciente adulto.

INTRODUCTION: An uncommon complication of fractures of the skull in infancy is a leptomeningeal cyst, which is also known as a growing skull fracture. A post traumatic leptomeningeal cyst may occur in adults, but is much rarer and may be attributed to a fracture of the skull which occurred in childhood. This complication is caused by a tear in the dura mater, through which pulsation of the cerebro spinal fluid forces the arachnoid layer to herniate. The commonest clinical finding is a soft tissue swelling or tumour appearing on the head. CLINICAL CASE: We report the case of a 47 year old man, with a past history of a head injury in childhood. He presented complaining of loss of sensation in the right arm and deviation of the mouth, from which he recovered within an hour. Neuro imaging studies showed irregular destruction of the right temporal bone and hypodensity of the underlying brain tissue. Surgical operation and histological study of the bone removed showed that it was a leptomeningeal cyst, associated with a cerebral infarct at the site of an old skull fracture. CONCLUSIONS: A post traumatic leptomeningeal cyst in an adult patient is caused by a tear in the dura mater caused by a skull fracture during childhood. It may be associated with a cerebral infarct. It may present with only transient focal neurological symptoms.

Multiple meningiomas of the fourth ventricle in infancy: case report.

Meningiomas are uncommon tumors in infancy. Intraventricular meningiomas do occur more frequently in infancy than in adulthood, although the establishment and growth of such tumors in the fourth ventricle is exceptional in children. The occurrence of multiple meningiomas is currently estimated to be less than 8%. We present the case of a girl who displayed two meningiomas in the fourth ventricle. Five years later, the child had four more meningiomas detected and extirpated from the same site. Eighteen months later, a new tumor appeared in the lower third of the clivus; after resection this was found to be another meningioma. The presence in a child of the repeated occurrence of multiple meningiomas, both in the fourth ventricle and in other areas of the posterior fossa, have led the authors to consider that the case is both curious and rare. Twelve similar cases of meningiomas developing exclusively in the fourth ventricle have been published; of these, only 3 occurred during infancy. A discussion is offered concerning the etiology and pathogenesis of these tumors; in which the possibility of unknown neuro-oncogenic factors that might induce meningiomas is postulated.