[Isolated intracranial Rosai-Dorfman disease: a case report and literature review]. / Enfermedad de Rosai-Dorfman intracraneal. Presentación de un caso y revisión de la literatura.

INTRODUCTION: Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease (RDD) is an idiopathic histiocytosis that usually affects the lymph nodes. Occasionally it may affect the CNS, being exceptional intracranial involvement without lymph node lesions. In the absence of typical radiological signs, affected patients are generally operated under the suspicion of a meningioma. The histological diagnosis is obtained after the surgical procedure. It is a clinicopathological entity not well known, controversy exists about its pathogenesis, clinical course and therapeutic management. CASE REPORT: We report the case of a 40-year-old male presented two generalized tonic-clonic seizures and brain MRI showed a left parieto-occipital extra-axial lesion extending into the posterior fossa, without presenting lesions at other levels. A partial resection of the lesion was performed and the histological findings were reported as Rosai-Dorfman disease. CONCLUSIONS: Despite its low frequency, the ERD should be included in the differential diagnosis of dural-based masses, compared to more common, such as meningiomas. Due to lack of specificity of additional studies its diagnosis is fundamentally histologic. More research is needed to define the best therapeutic option.

[Bilateral lower limb compartment syndrome after lumbar schwannoma surgery in genupectoral position]. / Síndrome compartimental bilateral en miembros inferiores tras cirugía deschwannoma lumbar en posición genupectoral.

Lower limb compartment syndrome is an unusual complication of the genu-pectoral position in lumbar spine surgery. We report a case of compartment syndrome in a patient who was operated in the genu- pectoral position for lumbar schwannoma resection. Overweigth and long time surgery could be important predisposing factors. Early diagnosis and treatment are mandatory to prevent permanent neurological deficits and other possible complications.

[Giant arteriovenous malformation of the scalp. Case report]. / Malformación arteriovenosa gigante de cuero cabelludo: caso clínico.

Arteriovenous malformations (AVM) in the scalp are infrequent vascular lesions. Its clinical presentation varies from annoying and unaesthetic mass of the skin to devastating hemorrhages. Its origin can be congenital or traumatic. The diagnosis of AVM is based on physical examination and confirmed by internal and external carotid angiography. Nowadays the gold standard treatment is the surgical intervention although the endovascular approach is gaining field in order to reduce blood losses as presurgical or like lonely treatment. A 50 year old woman was admitted with a huge mass in scalp, with subcutaneous enlarged vessels and no other symptoms. A head traumatic antecedent had occurred 12 years before. The angiography evidenced a mottled AVM with blood supplies from the external and internal carotid arteries, with meningeal transosseous branches from both ophthalmic arteries. Endovascular treatment could not be performed due to high risk of uni or bilateral amaurosis. Thus, a conventional surgical treatment was done without complications. The treatment of AVM of scalp offers various possibilities but the individualization of each case becomes essential to decide the correct management in order to avoid complications.

Malformación arteriovenosa gigante de cuero cabelludo: caso clínico / Giant arteriovenous malformation of the scalp. Case report

Las malformaciones arteriovenosas (MAV) en el cuero cabelludo son lesiones vasculares muy infrecuentes. Sus síntomas son variados, desde molestas y antiestéticas tumoraciones de la piel, hasta hemorragias que pueden ser devastadoras. Su origen puede ser congénito o traumático. El diagnóstico de las mismas es clínico, mediante la inspección del enfermo, y la angiografía de las carótidas interna y externa confirma el diagnóstico. Las posibilidades terapéuticas son variadas, siendo la extirpación quirúrgica el tratamiento de elección, aunque cada vez se utiliza más el tratamiento endovascular como tratamiento único o prequirúrgico, para disminuir las pérdidas hemáticas. Presentamos el caso de una paciente de 50 años de edad que presentaba una gran tumoración en cuero cabelludo, con dilataciones vasculares muy marcadas y sin otra sintomatología asociada. Describió un antecedente traumático hacía 12 años. La angiografía mostró una MAV abigarrada, con aporte vascular dela carótida externa y también de la interna, a cargo de ramas meníngeas transoseas provenientes de arterias etmoidales y dependientes de ambas arterias oftálmicas. El tratamiento endovascular de los aportes intracraneales no fue posible, debido al alto riesgo de amaurosis uni o bilateral, por lo que la lesión se resecó quirúrgicamente, sin presentarse complicaciones. El tratamiento de las MAV de cuero cabelludo ofrece diversas posibilidades pero se hace imprescindible la individualización de cada caso a la hora de decidir el abordaje correcto para evitar las posibles complicaciones

Arteriovenous malformations (AVM) in the scalp are in frequent vascular lesions. Its clinical presentation varies from annoying and unaesthetic mass of the skin to devastating hemorrhages. Its origin can be congenitalor traumatic. The diagnosis of AVM is based on physical examination and confirmed by internal and external carotid angiography. Nowadays the gold standard treatment is the surgical intervention although the endovascular approach is gaining field in order to reduce blood losses as presurgical or like lonely treatment. A 50 year old woman was admitted with a huge mass in scalp, with subcutaneous enlarged vessels and no other symptoms. A head traumatic antecedent had occurred 12 years before. The angiography evidenced amottled AVM with blood supplies from the external and internal carotid arteries, with meningeal transosseous branches from both ophthalmic arteries. Endovascular treatment could not be performed due to high risk of uni-or bilateral amaurosis. Thus, a conventional surgical treatment was done without complications. The treatment of AVM of scalp offers various possibilities but the individualization of each case becomes essential to decide the correct management in order to avoid complications

[Space-occupying cerebellar infarcts: surgical or conservative treatment?]. / Infarto cerebeloso expansivo: tratamiento quirúrgico o conservador?

INTRODUCTION: Space-occupying cerebellar infarcts (SOCI) make up a subgroup within the ischemic pathologies of the brain which are generally well tolerated clinically and usually respond well to medical treatment. Yet, in some cases, due to their volume and localisation, they can be accompanied by a progressive deterioration that requires surgical treatment. We report the clinical cases of two patients with SOCI that illustrate both therapeutic alternatives. CASE REPORTS: We describe the case of a 65-year-old male patient with vertiginous syndrome, inability to walk and headache. Computerised axial tomography (CAT) scanning showed a SOCI in the left hemisphere that displaced the 4th ventricle, effaced the cisterns and gave rise to the hydrocephalus. The patient improved clinically with medical treatment and a week later was able to walk unaided. We also describe the case of a 75-year-old female patient with symptoms of deterioration in the level of consciousness. CAT and magnetic resonance scans showed an extensive SOCI in the right hemisphere with displacement of the 4th ventricle, effacement of the perimesencephalic cisterns and triventricular hydrocephalus. A suboccipital craniectomy was performed, along with excision of any necrotic material and duroplasty. At 24 h the patient expressed herself coherently and followed orders. She presented ataxia and dysmetry on the right-hand side following the operation, which were compensated with rehabilitating therapy. CONCLUSIONS: Our clinical case reports illustrate the alternatives available when dealing with patients with cerebellar infarct that show expanding clinical-radiological characteristics. These patients must be carefully controlled because of the risk of clinical deterioration, in which case timely surgical intervention can increase their survival.