Malformación de Chiari tipo I tratada con descompresión de la fosa posteriorapoyada por ultrasonido intraoperatorio / Management of Chiari type I malformation with posterior fossa craniectomy decompression supported by intraoperative ultrasound

Objetivo: Describir la utilidad intraoperatoria de la ultrasonografía en la descompresión de fosa posterior en la cirugía de la malformación de Chiari tipo I. Caso clínico: Paciente masculino, de 11 años de edad, que acudió a consulta de Neurocirugía en el Hospital Pediátrico Universitario de Holguín “Octavio de la Concepción de la Pedraja”, acompañado de sus padres, quienes refirieron que hacía aproximadamente cuatro meses había tenido pérdida de la conciencia aguda, y, luego, comenzó con cefaleas occipitales opresivas. Dos meses después del iniciode las primeras manifestaciones, presentó movimientos involuntarios en las piernas, y dificultad para la deglución de los alimentos sólidos. Al examen físico se constató: fasciculaciones en la lengua, dismetría bilateral a predominio derecho, disdiadococinesia, Romberg con lateralización a la derecha, reflejos osteotendinosos aumentados a predominio crural, con clonus rotuliano derecho y tobillo izquierdo, Babinski derecho. En la resonancia magnética de cráneo se observó descenso de lasamígdalas cerebelosas, a través del agujero magno, y se diagnosticó malformación de Chiari tipo I. Sele realizó tratamiento quirúrgico: descompresión de la fosa posterior mediante craniectomía sin duroplastia, apoyado por ultrasonido intraoperatorio. El paciente evolucionó favorablemente.Conclusiones: El ultrasonido intraoperatorio proporcionó información sobre la circulación del líquidocefalorraquídeo (LCR) a través de la unión craneoespinal. Con este resultado el equipo quirúrgico no tuvo que realizar la apertura dural y el paciente presentó una evolución satisfactoria(AU)

Objective: To describe the intraoperative utility of ultrasonography in decompressing the posterior fossa in the Chiari type I malformation surgeryCase report: An 11-year old male patient went to the neurosurgery service at Octavio de la Concepción de la Pedraja University Pediatric Hospital in Holguín accompanied by his parents. They reported that approximately four months ago the child had lost acute consciousness, and he began withoppressive occipital headaches. Two months after the beginning of the first manifestations, he had involuntary movements in the legs, and difficulty swallowing solid foods. The physical examination showed fasciculations in the tongue, bilateral dysmetry at right predominance, dysdiadocokinesia,Romberg with lateralization to the right, osteotendinous reflexes increased to crural predominance, with right patellar clone and left ankle, right Babinski. Magnetic resonance imaging of the skullshowed a decrease in cerebellar tonsils, through the great hole, and Chiari type I malformation was diagnosed. He underwent surgical treatment, decompression of the posterior fossa by craniectomy without duroplasty, supported by intraoperative ultrasound. The patient evolved favorably.Conclusions: Intraoperative ultrasound provided information on cerebrospinal fluid (CSF) circulation through the cranioespinal junction, which allowed the surgical team not to perform the dural opening and the patient had a satisfactory evolution(AU)

Use of near infrared fluorescence during robot-assisted laparoscopic partial nephrectomy.

BACKGROUND: Partial nephrectomy is the treatment of choice for T1a tumours. The open approach is still the standard method. Robot-assisted laparoscopic surgery offers advantages that are applicable to partial nephrectomy, such as the use of the Firefly® system with near-infrared fluorescence. OBJECTIVE: To demonstrate the implementation of fluorescence in nephron-sparing surgery. CASE REPORT: This case concerned a 37-year-old female smoker, with obesity. The patient had a right kidney tumour measuring 31 mm, which was found using tomography. She therefore underwent robot-assisted laparoscopic partial nephrectomy, with a warm ischaemia time of 22 minutes and the use of fluorescence with the Firefly® system to guide the resection. There were no complications. The tumour was a pT1aN0M0 renal cell carcinoma, with negative margins. Robot-assisted renal laparoscopic surgery is employed for nephron-sparing surgery, with good oncological and functional results. The combination of the Firefly® technology and intraoperative ultrasound can more accurately delimit the extent of the lesion, increase the negative margins and decrease the ischaemia time. CONCLUSION: Near-infrared fluorescence in robot-assisted partial nephrectomy is useful for guiding the tumour resection and can potentially improve the oncological and functional results.