Angiomas cavernosos epidurales espinales / Spinal epidural cavernous angiomas

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Cerebrospinal fluid diversion devices and infection. A comprehensive review.

Hydrocephalus is a common neurosurgical disease affecting approximately 40 per 100,000 people. Cerebrospinal fluid diversion devices are essential in the management of this pathology. These devices include internal shunts and external ventricular drains. Infection is the most significant complication resulting from the high frequency of appearance and the consequences it involves, since it is associated with increased morbidity and mortality. It also involves increased hospital costs (approximately 40,000 euro per episode). In the present report the authors make a comprehensive review of cerebrospinal fluid diversion devices and their most important complication: infection. The authors make special emphasis on the epidemiology, aetiology, pathogenesis, risk factors, symptoms and signs, diagnosis, treatment and prevention of infection.

Hematoma crónico expansivo intracerebral / Chronic expanding intracerebral hematoma

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[Hemangiopericytoma of the posterior fossa: case report]. / Hemangiopericitoma de la fosa posterior: a propósito de un caso.

Hemangiopericytoma is an uncommon mesenchymal neoplasm arising from Zimmerman's pericytes, which usually locates in soft tissues. Meningeal hemangiopericytoma accounts for less than 1% of all intracranial tumours. Typically, it behaves aggressively, showing distinct tendency to recur locally or distantly along the neural axis and to present extraneural metastases. We describe a 74-year-old patient who presented unspecific symptoms and whose physical exam revealed a painless retroauricular mass which was adhered to skin. Neuroimaging studies showed a large posterior fossa tumour with intense enhancement after contrast infusion that caused striking occipital-mastoid osteolysis and which was exclusively fed by external carotid artery branches. The patient underwent gross total resection of the tumour, and once the histological diagnosis of hemangiopericytoma was confirmed, she underwent initial adjuvant radiotherapy. Sixteen months after surgery, the patient remains recurrence free. The treatment of choice of intracranial hemangiopericytoma is gross total resection, which must be attempted when technically feasible, followed by adjuvant radiotherapy providing total doses over 50 Gy. This combination has demonstrated increasing recurrence- free interval in these patients. Close and longterm follow-up is mandatory in order to achieve early diagnosis of recurrence or metastases in these patients, since they can appear several years, even decades, after initial proper treatment.

Hemangiopericitoma de la fosa posterior: a propósito de un caso / Hemangiopericytoma of the posterior fossa: case report

El hemangiopericitoma es un tumor mesenquimalinfrecuente originado de los pericitos de Zimmerman,que habitualmente asienta en tejidos blandos. Suvariante meníngea supone menos del 1% de todos lostumores intracraneales. Característicamente presentaun comportamiento agresivo, con marcada tendencia arecurrir localmente y a lo largo del neuroeje, así como ametastatizar en localizaciones extraneurales.Presentamos el caso de una paciente de 74 años quedebutó con clínica inespecífica, observándose durantela exploración física una masa retroauricular no dolorosaa la palpación, adherida a la piel. El estudio deneuroimagen demostró una lesión de gran tamaño localizadaen la fosa posterior que realzaba intensamentetras la administración de contraste, asociada a llamativaosteolisis occípito-mastoidea y cuya vascularizaciónprovenía exclusivamente de ramas de la arteria carótidaexterna. La paciente se sometió a la resección quirúrgicacompleta de la lesión, administrándose radioterapia inicialadyuvante una vez confirmado histológicamenteel diagnóstico de hemangiopericitoma. Dieciséis mesesdespués de la intervención, la paciente se encuentralibre de enfermedad.El tratamiento de elección del hemangiopericitomaintracraneal es su resección quirúrgica completa, siempreque sea técnicamente posible, seguida de radioterapiaadyuvante con dosis superiores a los 50 Gy. Estacombinación ha demostrado aumentar el intervalo detiempo libre de recurrencia. Un estrecho seguimiento alargo plazo de estos pacientes es esencial para detectarrecurrencias o metástasis a distancia precozmente,pudiendo aparecer incluso décadas después del adecuadotratamiento inicial (AU)

Hemangiopericytoma is an uncommon mesenchymalneoplasm arising from Zimmerman’s pericytes, whichusually locates in soft tissues. Meningeal hemangiopericytomaaccounts for less than 1% of all intracranialtumours. Typically, it behaves aggressively, showingdistinct tendency to recur locally or distantly along theneural axis and to present extraneural metastases.We describe a 74-year-old patient who presentedunspecific symptoms and whose physical exam revealeda painless retroauricular mass which was adhered toskin. Neuroimaging studies showed a large posteriorfossa tumour with intense enhancement after contrastinfusion that caused striking occipital-mastoid osteolisisand which was exclusively fed by external carotid arterybranches. The patient underwent gross total resectionof the tumour, and once the histological diagnosis ofhemangiopericytoma was confirmed, she underwentinitial adjuvant radiotherapy. Sixteen months after surgery,the patient remains recurrence free.The treatment of choice of intracranial hemangiopericytomais gross total resection, which must beattempted when technically feasible, followed by adjuvantradiotherapy providing total doses over 50 Gy.This combination has demonstrated increasing recurrence-free interval in these patients. Close and longtermfollow-up is mandatory in order to achieve earlydiagnosis of recurrence or metastases in these patients,since they can appear several years, even decades, afterinitial proper treatment (AU)

Quiste aracnoideo extradural no comunicante en la región dorsolumbar / No disponible

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[Surgical management of dural arteriovenous fistulae in six patients]. / Manejo quirúrgico de las malformaciones arteriovenosas durales craneales. Serie de seis casos.

OBJECTIVES: In this article, we describe our experience in surgical management of dural arteriovenous fistulae (dAVF). MATERIALS AND METHODS: From August 2001 to February 2006 a total of six patients, were admitted at our hospital, 2 women and 4 men with ages between 40 and 68 years. RESULTS: Four of the six cases were entered through the service of Emergency Service by neurological deficit (in two cases) or decrease in the level of consciousness (in two patients); the remaining two patients were referred by lengthy headache and alterations on neuroimaging studies suggestive of dAVF. All of them showed dAVF in different locations which were treated successfully with surgery after angiographic studies. CONCLUSION: Although multiple therapeutic options are available, surgery is the treatment of choice in dAVF which shows aggressive clinical course, especially intracranial hemorrhage.

Manejo quirúrgico de las malformaciones arteriovenosas durales craneales. Serie de seis casos / Surgical management of dural arteriovenous fistulae in six patients

Objetivos. En este artículo describimos la experiencia quirúrgica de nuestro centro en el manejo quirúrgico de las malformaciones arteriovenosas duralesintracraneales (MAVd´s).Material y métodos. Presentamos una serie de seis casos, dos mujeres y cuatro hombres, con edades comprendidas entre 40 y 68 años, en el periodo que transcurre entre los años 2001 y 2006, en el Hospital Clínico San Carlos de Madrid. Resultados. Cuatro de los seis casos fueron ingresados a través del servicio de Urgencias por clínica deficitaria (en dos casos) o disminución del nivel de conciencia (en dos pacientes); los dos restantes fueron remitidos desde consultas externas por cefalea de larga evolución y alteraciones en el estudio de neuroimagen sugerentes de FAVd o MAVd. En todos ellos el tratamiento quirúrgico fue definitivo. Conclusiones. A pesar las múltiples opciones terapéuticas, la cirugía es de elección en MAVd que presenta especial tendencia a comportarse de forma agresiva; fundamentalmente con riesgo de hemorragia intracraneal

Objetives. In this article, we describe our experience in surgical management of dural arteriovenous fistulae (dAVF).Materials and methods. From Agust 2001 to Febrery2006 a total of six patients, were admitted at our hospital, with ages between 40 and 68 years. Results. Four of the six cases were entered through the service of Emergency Service by neurological defecit (in two cases) or decrease in the level of consciousness(in two patients); the remaining two patients were refered by lengthy headache and alterations on neuroimagen studies suggestive of dAVF. All of them showed dAVF in different locations which were treated successfully with surgery of the unique mortality of treatment after angiographical studies. Conclusion. Although multiple therapeutic option sare avaible, surgery is in dAVF which shows aggressive clinical course, especially intracranial hemorrhage

Absceso cerebral asociado a la enfermedad de Rendu-Osler-Weber / Cerebral abscess associated to Rendu-Osler-Weber

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[Aneurysmal bone cyst of the sphenoid sinus]. / Quiste óseo aneurismático del seno esfenoidal. A propósito de un caso

Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysplasia and giant-cell tumors. We report the case of a patient with an aneurysmal bone cyst in the sphenoid sinus causing vision dysfunction.

Quiste óseo aneurismático del seno esfenoidal. A propósito de un caso / Aneurysmal bone cyst of the sphenoid sinus

El quiste óseo aneurismático es una patología infrecuente que asienta generalmente en las metáfisis de huesos largos y vértebras. La afectación del seno esfenoidal es excepcional. Su origen se encuentra aún por definir, pero podemos considerarlos como un fenómeno vascular secundario a una lesión del hueso subyacente. Puede asociarse a otras enfermedades, presentes de forma metacrónica o sincrónica en distintas localizaciones de un mismo sujeto, como la displasia fibrosa poliostótica o los tumores de células gigantes. En este artículo se expone el caso de un paciente que presenta un quiste óseo aneurismático en el seno esfenoidal y alteración de la visión

Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysplasia and giant-cell tumors. We report the case of a patient with an aneurysmal bone cyst in the sphenoid sinus causing vision dysfunction