Recurrence of arteriovenous malformation in an adult patient after complete resection: illustrative case.

BACKGROUND: Complete resection of an arteriovenous malformation (AVM) is considered a curative treatment. In this paper the authors discuss two possibilities in the event of hemorrhage after satisfactory resection of an AVM: recurrence or remnant. OBSERVATIONS: A 33-year-old female patient was diagnosed with an incidental right frontal AVM that was microsurgically resected and whose postoperative angiography showed no remnant. Eight years later, she presented with an episode of headache and speech arrest. Magnetic resonance imaging showed bleeding in the previous surgical site, and a new angiography revealed the presence of a vascular blush not seen previously. The patient did not show the most frequently associated factors for recurrence described in the literature, which are hemorrhage on presentation and deep venous drainage. In addition, factors related to undetected vascular remnants, such as preoperative hemorrhage and early postoperative angiography, were absent. LESSONS: Considering the characteristics of the case, we believe that the most likely explanation is the development of a de novo vascular formation secondary to factors not yet elucidated. Preexisting views on AVM formation, the curative value of resection, and long-term follow-up in certain patients should be reevaluated.

Aneurisma incidental en mi consultorio / Incidental aneurysm in my office

El neurocirujano que hace consultorio suele encontrarse con pacientes con patologías muy variadas. Hay quienes vienen por síntomas banales, contándonos sucesos que no tienen que ver con su patología, haciéndonos sentir más psicólogos que cirujanos. Otros, que informados por internet pretenden sugerirnos una determinada conducta. En el otro extremo, tenemos al paciente que trae entre sus estudios una patología grave y claramente quirúrgica, como lo es, por ejemplo, un tumor cerebral. En ocasiones, nos vemos enfrentados a situaciones complejas, como es la de aquellas patologías potencialmente peligrosas que aún no se han expresado en síntomas y ese es el caso de los aneurismas incidentales.

Petroclival intravascular papillary endothelial hyperplasia with psammoma body-like structures.

Masson's tumor or intravascular papillary endothelial hyperplasia (IPEH) is considered a non-neoplastic lesion. It is probably an unusual exaggerated reorganization of a thrombus. IPEH may be present as a secondary lesion in hemangiomas. Symptomatic osseous hemangiomas are rare tumors. Few cases of clival and petrous bone hemangiomas have been described. None of them shows secondary IPEH. So far, there are only four reported cases of cranial bone IPEHs in the literature, two in the skull, one in the clivus and one in the petrous apex. The aim of this study is to report an additional case of osseous hemangioma with secondary IPEH of the petroclival region. We review the literature and describe the main clinical features of IPEHs and hemangiomas of the clivus and the petrous bone. Additionally, we report an unusual histological feature observed in our case of IPEH, the presence of psammoma body-like structures. This feature has been rarely mentioned previously in IPEH. We consider that IPEH should be included in the lesions that may present psammoma bodies to avoid misdiagnosing it as a tumor that commonly shows psammoma bodies, such as intraosseous meningioma or, less frequently, metastasis of thyroid or ovarian carcinoma.

Simultaneous Resection of Pituitary Macroadenoma and Sphenoid Sinus Inverted Papilloma: The Challenge of Operating Sinonasal and Skull Base Pathologies Through a Single-Stage Endoscopic Endonasal Approach.

BACKGROUND: Coexistence of sinonasal and skull base tumors is uncommon but possible, and the endonasal route seems to be the best option to manage both lesions simultaneously. We report the first case in the English literature of concomitant sphenoid sinus inverted papilloma and pituitary macroadenoma treated through an endoscopic endonasal approach. CASE DESCRIPTION: A 68-year-old man presented with a history of progressive visual loss and nasal obstruction. Clinical examination disclosed bitemporal hemianopsia. Computed tomography scan and magnetic resonance imaging obtained on admission showed a large sellar/suprasellar enhancing lesion with a marked mass effect on the optic chiasm. Imaging also showed a second mass extending from the sphenoid sinus to the left nasal cavity with obstruction of the maxillary sinus ostium and development of maxillary sinus mucocele. Both tumors were entirely resected by an endoscopic endonasal approach. Additionally, middle meatal antrostomy and marsupialization with drainage of the maxillary mucocele was performed. Biopsy confirmed the coexistence of a pituitary macroadenoma and sphenoid sinus inverted papilloma. CONCLUSIONS: This case and the literature suggest that patients with concomitant nasal and skull base pathologies can be simultaneously managed. The otolaryngologist plays an essential role in removing the sinonasal lesion to ensure a safe surgical corridor before entering the intracranial cavity and for planning for the skull base reconstruction.

Microanatomía de las malformaciones arteriovenosas: consideraciones quirúrgicas / Arteriovenous malformation microanatomy: surgical considerations

Las malformaciones arterovenosas (MAV) son una patología complicada que plantea importantes dilemas en su tratamiento. La cirugía directa constituye una de las pricipales armas terapéuticas y, para su correcta realización, es necesario conocer la arquitectura y microanatomía de las (MAV). Estas se componen de 3 partes: porción aferente o arterial, nido y porción eferente o venosa. Se describen las características de lcada una de estas partes y las maniobras quirúrgicas que en experiencia del autor son útiles para la resección quirúrgica. Se mencionan las posibles complicaciones que pueden sobrevenir durante la cirugía y como intentar solucionarlas. Se enfatiza la necesidad de evaluar lo más exhaustivamente posible la resonancia magnética y la angiografía preoperatorias para elegir la mejor estrategia quirúrgica. Palabras clave: cirugía, malformaciones arteriovenosas, microanatomía.(AU)

Arterio-venous malformations (AVM) are a complicated pathology that raise important dilemmas in their treatment. Direct surgery is one of the principal therapeutic options and, for its correct accomplishment it is necessary to know their architecture and microanatomy. They consist of 3 portions: afferent or arterial, nest and the efferent or venous. The characteristics of each one of them and the surgical steps that, in the experience of the author, are useful for the surgical resection are described. The possible complications that can appear during surgery are mentioned and also how to solve them. The need to evaluate, as exhaustively as possible, magnetic resonance images and preoperative angiography, to choose the best surgical strategy is emphasized. Key words: arterovenous malformations, microanatomy, surgery.(AU)

Microanatomía de las malformaciones arteriovenosas: consideraciones quirúrgicas / Arteriovenous malformation microanatomy: surgical considerations

Las malformaciones arterovenosas (MAV) son una patología complicada que plantea importantes dilemas en su tratamiento. La cirugía directa constituye una de las pricipales armas terapéuticas y, para su correcta realización, es necesario conocer la arquitectura y microanatomía de las (MAV). Estas se componen de 3 partes: porción aferente o arterial, nido y porción eferente o venosa. Se describen las características de lcada una de estas partes y las maniobras quirúrgicas que en experiencia del autor son útiles para la resección quirúrgica. Se mencionan las posibles complicaciones que pueden sobrevenir durante la cirugía y como intentar solucionarlas. Se enfatiza la necesidad de evaluar lo más exhaustivamente posible la resonancia magnética y la angiografía preoperatorias para elegir la mejor estrategia quirúrgica. Palabras clave: cirugía, malformaciones arteriovenosas, microanatomía.(AU)

Arterio-venous malformations (AVM) are a complicated pathology that raise important dilemmas in their treatment. Direct surgery is one of the principal therapeutic options and, for its correct accomplishment it is necessary to know their architecture and microanatomy. They consist of 3 portions: afferent or arterial, nest and the efferent or venous. The characteristics of each one of them and the surgical steps that, in the experience of the author, are useful for the surgical resection are described. The possible complications that can appear during surgery are mentioned and also how to solve them. The need to evaluate, as exhaustively as possible, magnetic resonance images and preoperative angiography, to choose the best surgical strategy is emphasized. Key words: arterovenous malformations, microanatomy, surgery.(AU)

Microanatomía de las malformaciones arteriovenosas: consideraciones quirúrgicas / Arteriovenous malformation microanatomy: surgical considerations

Las malformaciones arterovenosas (MAV) son una patología complicada que plantea importantes dilemas en su tratamiento. La cirugía directa constituye una de las pricipales armas terapéuticas y, para su correcta realización, es necesario conocer la arquitectura y microanatomía de las (MAV). Estas se componen de 3 partes: porción aferente o arterial, nido y porción eferente o venosa. Se describen las características de lcada una de estas partes y las maniobras quirúrgicas que en experiencia del autor son útiles para la resección quirúrgica. Se mencionan las posibles complicaciones que pueden sobrevenir durante la cirugía y como intentar solucionarlas. Se enfatiza la necesidad de evaluar lo más exhaustivamente posible la resonancia magnética y la angiografía preoperatorias para elegir la mejor estrategia quirúrgica. Palabras clave: cirugía, malformaciones arteriovenosas, microanatomía.

Arterio-venous malformations (AVM) are a complicated pathology that raise important dilemmas in their treatment. Direct surgery is one of the principal therapeutic options and, for its correct accomplishment it is necessary to know their architecture and microanatomy. They consist of 3 portions: afferent or arterial, nest and the efferent or venous. The characteristics of each one of them and the surgical steps that, in the experience of the author, are useful for the surgical resection are described. The possible complications that can appear during surgery are mentioned and also how to solve them. The need to evaluate, as exhaustively as possible, magnetic resonance images and preoperative angiography, to choose the best surgical strategy is emphasized. Key words: arterovenous malformations, microanatomy, surgery.