Ganglioneuroma lipomatoso paravertebral con extensión intraespinal. Descripción de un caso y revisión de la literatura / Paravertebral lipomatous ganglioneuroma with intraspinal extension. Case report and literature review

Los ganglioneuromas lipomatosos son una variante poco frecuente de los ganglioneuromas, que se caracterizan por presentar un componente adipocítico maduro entremezclado con un componente convencional de ganglioneuroma. Presentamos el caso de un paciente de 34 años con una lesión paravertebral L1-L4 derecha con extensión intraespinal y con déficit neurológico secundario, que fue intervenido en nuestro centro. La anatomía patológica confirmó la presencia de una neoplasia encapsulada amarillenta, que al microscopio presentaba áreas de ganglioneuroma mezcladas con áreas de grasa madura. En el seguimiento, el paciente se encontraba asintomático, con la paresia en la extremidad inferior derecha recuperada. En el último control de imagen no presentaba datos de recidiva de la lesión. Existen menos de 10 casos de ganglioneuroma lipomatoso descritos en la bibliografía. Este es el primero a nivel paravertebral con extensión intraespinal y con déficit neurológico, de ahí el interés de este trabajo

Lipomatous ganglioneuromas are a rare variant of ganglioneuromas characterized by a mature adipocytic component admixed with a conventional ganglioneuroma component. We present the case of a 34 year old patient with a paravertebral right lesion L1-L4 with intraspinal extension and secondary neurological deficit, who underwent surgery in our hospital. The pathological anatomy showed a yellowish encapsulated neoplasm, which under microscopic evaluation showed areas of ganglioneuroma admixed with areas of mature fat. In the follow up, the patient was asymptomatic, had recovered paresis in the right lower extremity and in the last image control did not present data of lesion recurrence. Fewer than 10 cases of lipomatous ganglioneuromas have been reported in the literature, being this the first paravertebral case wih intraspinal extension and with neurological deficit, hence the interest of this work

Paravertebral lipomatous ganglioneuroma with intraspinal extension. Case report and literature review. / Ganglioneuroma lipomatoso paravertebral con extensión intraespinal. Descripción de un caso y revisión de la literatura.

Lipomatous ganglioneuromas are a rare variant of ganglioneuromas characterized by a mature adipocytic component admixed with a conventional ganglioneuroma component. We present the case of a 34 year old patient with a paravertebral right lesion L1-L4 with intraspinal extension and secondary neurological deficit, who underwent surgery in our hospital. The pathological anatomy showed a yellowish encapsulated neoplasm, which under microscopic evaluation showed areas of ganglioneuroma admixed with areas of mature fat. In the follow up, the patient was asymptomatic, had recovered paresis in the right lower extremity and in the last image control did not present data of lesion recurrence. Fewer than 10 cases of lipomatous ganglioneuromas have been reported in the literature, being this the first paravertebral case wih intraspinal extension and with neurological deficit, hence the interest of this work.

Pseudotumor retroodontoideo en un paciente con hiperostosis esquelética idiopática difusa / Retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis

El pseudotumor retroodontoideo es una lesión provocada por granulación inflamatoria o por hipertrofia de partes blandas asociado a inestabilidad atloaxoidea crónica. Sin embargo, cerca de un tercio de los casos recogidos en la literatura no demostraron claramente esta inestabilidad. Los autores exponen el caso de un hombre de 76 años, previamente diagnosticado de hiperostosis esquelética idiopática difusa, que presenta un cuadro de mielopatía severa progresiva. Las imágenes de resonancia magnética de la columna cervical mostraron una masa predural retroodontoidea con compresión marcada del cordón medular. Se realizó laminectomía del atlas y fusión occipitocervical. Tras la cirugía el paciente mejoró significativamente y se redujo el tamaño del pseudotumor

Retro-odontoid pseudotumors are lesions caused by inflammatory granulation or reactive soft tissue hypertrophy from chronic atlantoaxial subluxation. However, one-third of the cases reported in the medical literature did not show atlantoaxial instability clearly. The authors present the case of a 76-year-old man previously diagnosed with diffuse idiopathic skeletal hyperostosis who presented with severe progressive myelopathy. A magnetic resonance imaging of his cervical spine revealed a retro-odontoid predural mass, which caused a severe compression of the cervical spinal cord. The patient underwent a posterior laminectomy of the atlas and an occipitocervical fusion. After surgery, the pseudotumor was considerably smaller and the neurological symptoms improved

[Retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis]. / Pseudotumor retroodontoideo en un paciente con hiperostosis esquelética idiopática difusa.

Retro-odontoid pseudotumors are lesions caused by inflammatory granulation or reactive soft tissue hypertrophy from chronic atlantoaxial subluxation. However, one-third of the cases reported in the medical literature did not show atlantoaxial instability clearly. The authors present the case of a 76-year-old man previously diagnosed with diffuse idiopathic skeletal hyperostosis who presented with severe progressive myelopathy. A magnetic resonance imaging of his cervical spine revealed a retro-odontoid predural mass, which caused a severe compression of the cervical spinal cord. The patient underwent a posterior laminectomy of the atlas and an occipitocervical fusion. After surgery, the pseudotumor was considerably smaller and the neurological symptoms improved.

Fijación lumbar posterior empleando el sistema de imagen quirúrgica O-arm: experiencia inicial / Posterior lumbar fusion using the O-arm surgical imaging system: initial experience

Objetivo: La fijación con tornillos transpediculares en la columna lumbar es una técnica ampliamente aceptada para el tratamiento de patología traumática y degenerativa. Las complicaciones de la instrumentación espinal pueden ser graves. Sobrepasar caudal o medialmente la cortical del pedículo puede provocar lesiones nerviosas o durotomías incidentales. La cirugía guiada por imagen computarizada ha demostrado tasas más altas de precisión en la colocación de tornillos transpediculares comparada con la fluoroscopia convencional.El O-arm tiene la capacidad de obtener imágenes similares a la tomografía computarizada (TC) y realizar reconstrucciones multiplanares. En este estudio evaluamos una cohorte de pacientes en los que se realizó fijación lumbar posterior con tornillos transpediculares empleando el sistema de imagen quirúrgica O-arm. Métodos Se realizó un estudio retrospectivo de 40 casos consecutivos de fijación lumbar posterior empleando el O-arm. La población a estudio incluía 14 hombres y 26 mujeres. El rango de edad iba de 39 a 85 años, con una media de edad de 63,78 años. Veintiún pacientes presentaban estenosis del canal degenerativa (52,5%) y 19 espondilolistesis (47,5%). Se obtuvieron imágenes con TC intraoperatoria. Se recoge el (..) (AU)

Object: The use of transpedicular screw fixation has been widely accepted for the treatment of degenerative and traumatic pathology of the lumbar spine. Complications of spinal instrumentationcanbeserious.Screwmisplacementcanresultinunintendeddurotomy,nerveroot and/or cauda equina injury. In comparison to fluoroscopy-assisted screw placement, computer-assisted image guidance has been shown to achieve overall higher rates of accuracy. The O-arm is able to obtain computed tomography (CT)-type images with multiplanar reconstruction. In this study we evaluated a cohort of patients who underwent posterior lumbar fusion with pedicle screws utilizing the O-arm imaging system. Methods: A retrospective review of 40 consecutive patients who underwent posterior lumbar fusion surgery with O-arm utilization, was performed. The study population included (..) (AU)

[Posterior lumbar fusion using the O-arm surgical imaging system: initial experience]. / Fijación lumbar posterior empleando el sistema de imagen quirúrgica O-arm: experiencia inicial.

OBJECTIVES: The use of transpedicular screw fixation has been widely accepted for the treatment of degenerative and traumatic pathology of the lumbar spine. Complications of spinal instrumentation can be serious. Screw misplacement can result in unintended durotomy, nerve root and/or cauda equina injury. In comparison to fluoroscopy-assisted screw placement, computer-assisted image guidance has been shown to achieve overall higher rates of accuracy. The O-arm is able to obtain computed tomography (CT)-type images with multiplanar reconstruction. In this study we evaluated a cohort of patients who underwent posterior lumbar fusion with pedicle screws utilizing the O-arm imaging system. METHODS: A retrospective review of 40 consecutive patients who underwent posterior lumbar fusion surgery with O-arm utilization, was performed. The study population included 14 males and 26 females. Age range was 39-85 years with an average of 63.8 years. Twenty one patients had degenerative lumbar stenosis (52.5%) and 19 had spondylolisthesis (47.5%). Intraoperative CT-images were obtained. The mean time for surgery and screw placement was assessed. RESULTS: A total of 252 pedicle screws were sited using O-arm navigation system, with a mean of 6.3 screws per patient (range 4-10). On the basis of intraoperative CT, 3 screws were redirected, representing a 98.81% accuracy rate. The mean duration of surgery was 157.2 (90-240) minutes and the mean time for screw placement was 7.13 (3.08-15) minutes per screw. Three patients (7.5%) developed superficial wound infections which were treated conservatively. No patients required a return to the operating room because of screw malposition. CONCLUSION: The use of intraoperative O-arm imaging system with computer-assisted navigation significantly increases the surgical accuracy and safety of pedicle screw placement in lumbar fusion surgery.