Use of a protein-based tissue adhesive as an aid for the surgical reconstruction of advanced and recurrent skin cancer tumors to the head and neck region: a technical report.

BACKGROUND: Patients with advanced skin cancer present a unique challenge to neurosurgeons. Treatment involves aggressive surgical intervention and lengthy reconstructive procedures with considerable morbidity to obtain adequate and safe oncological margins. We reviewed our experience with BioGlue Surgical Adhesive, a protein-based adhesive, as an adjunct in free tissue transfer procedures to prevent CSF leakage and seroma formation. METHODS: Between January 2000 and June 2004, 11 patients ranging in age from 32 to 87 years presented with advanced skin cancer tumors in the head and neck. Pathology included squamous (7) and basal (3) cell carcinoma and malignant schwannoma (1). Of the 11 patients, 8 had undergone previous surgery and/or radiation therapy. All were treated with a combination of craniotomy, skull base, and craniofacial approaches with reconstruction of the large defects using muscular or myocutaneous free flaps in a single operation. Fat, muscle, and a 1-mm epidural layer of BioGlue were used to seal the dural sutures and to obliterate any potential seroma-forming dead space. RESULTS: A total of 6 patients underwent craniofacial resection with orbital exenteration and partial rhinectomy, whereas the remaining 5 underwent frontal, parietal, and/or occipital craniotomies. All patients required dural repair. Three patients required additional brain resection because of tumor infiltration. No patient developed a CSF leak or seroma. There were no adverse events related to the use of BioGlue. Three patients died of medical complications (pulmonary embolism, myocardial infarction, late-onset myelodysplasia). The remaining patients are alive, and our follow-up (range, 9-58 months) has revealed no recurrence or distal metastasis. CONCLUSIONS: Advanced skin cancer tumors in the head and neck region are associated with complex and disfiguring surgical procedures with increased morbidity. We demonstrate that an adjunctive use of a sufficiently strong tissue adhesive can yield acceptable outcomes and minimize comorbidity in this challenging patient population.

Factores de riesgo en los pacientes con aneurismas multiples intracraneales / Risk factors in patients with multiple intracraneal aneurysm

Los aneurismas múltiples intracraneales son una patología de gran controversia en la neurocirugía, debido a que estos pacientes afrontan una realidad muy diferente a los casos con lesiones únicas. Esta patología no se ha estudiado de manera tan amplia como las aneurismas simples, por lo cual en esta investigación se intenta conocer un poco más de esta enfermedad. Se estudian los factores de riesgo los pacientes con aneurismas múltiples intracraneales que fueron tratados en el Servicio "Miguel Pérez Carreño" entre los años 1991 y 1998. Se evaluó los siguientes factores: edad, sexo, antecedentes tabáquicos e hipertensivos. Se buscó la tendencia de estos factores en la población y se correlacionaron con el número promedio de aneurismas por pacientes. Se determinó que esta patología predomina en el sexo femenino y su relación con sexo masculino se incrementa al ir aumentado el número de lesiones por pacientes. Hay una tendencia franca de antecedentes tabáquicos y de hipertensión arterial en la población estudiada aunque estadísticamente no fue significativo la presencia o no de estos factores al correlacionarlos con el número promedio de aneurismas por pacientes. Por otro lado se encontró que esta enfermedad que predomina en los adultos menores de 50 años

Hemangioblastoma de localización multiple supra e infratentorial: primer caso en Venezuela / Multiple supratentorial and infratentorial hemangioblastoma: first case at Venezuela

Presentamos un caso inusual de hemangioblastomas supre e infratentoriales de diferente histología. Se describen las características y los estudios neuroradiológicos que permitieron identificar esta necesidad de considerar esta patología como uno de los diagnósticos diferenciales en los procesos tumorales del Sistema Nervioso Central

Tratamiento neuroendovascular de los aneurismas intracraneales: experiencia venezolana / Neuroendovascular treatment of the intracranial aneurysm: venezuelan experience

The recent development of new techniques and devices has made the neuro-endovascular approach, a suitable treatment for intracranial aneurysm. We describe our experience in 36 patients treated and 1996