A. García-Allut

Chronic subdural haematoma: surgical treatment and outcome in 1000 cases

Chronic subdural haematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice. To evaluate the clinical features, computed tomography findings, surgical results, and complications our series was statistically analysed to elucidate the factors affecting the post-operative outcome. A retrospective study (1980-2002) of the records of 1000 patients harbouring 1097 chronic subdural haematoma treated with burr-hole craniotomy with closed-system drainage was carried out. The series included 628 males and 372 females, age range 12-100 years, mean age 72.7+/-11.4 years. The mean interval from trauma to appearance of clinical symptoms was 49.1+/-7.4 days (15-751). The principal symptom was headache (29.7%) in the over 70s, and behavioural disturbance (33.8%) in the under 70s. The CSDH was right sided in 432 patients, left sided in 471, and bilateral in the remaining 97 cases. Post-operative complications occurred in 196 patients and 21 patients died in hospital. Poor prognosis was related to patients age (>70) and clinical grade on admission (grades 0-2 versus grades 3-4).

Management of brain abscess in children

Aim:  Brain abscesses continue to pose a problem in paediatric neurosurgery because the associated morbidity and mortality have remained significant throughout the antibiotic and CT era. The objective of this paper is to report the treatment of 28 children with the diagnosis of brain abscess.

Hematoma subdural crónico en el paciente mayor de 80 años

Resumen Introduccion el hematoma subdural cronico constituye el tipo mas frecuente de hemorragia intracraneal postraumatica. La mayoria, de los casos se desarrollan en pacientes de edad avanzada, presentando problemas especificos derivados de las patologias frecuentes en este grupo de edad. Pacientes y metodos realizamos un estudio retrospectivo sobre 90 pacientes mayores de 80 anos afectos de hematoma subdural cronico intervenidos en los ultimos 15 anos. Para la evaluacion clinica al ingreso y alta hospitalaria empleamos la escala especifica propuesta por Markwalder. La tecnica quirurgica empleada fue similar en todos los casos y consistente en la realizacion de un agujero de trepano e implantacion de un drenaje subdural cerrado. Resultados al ingreso, 73 pacientes (80%) se encontraban en buena situacion clinica (grados 0–2) y 17 (20%) en grados 3 o 4. Siete pacientes (7.7%) fallecieron durante el ingreso pero ninguno de ellos en relacion directa con la cirugia. Seis pacientes (6.6%) requirieron una segunda intervencion quirurgica por recidiva del hematoma. Al alta el 76.6% de los pacientes se encontraban en grados 0 o 1. Conclusiones en nuestra experiencia el hematoma subdural cronico en este grupo de edad debe ser tratado como primera opcion mediante una perforacion craneal y drenaje subdural. Dado los buenos resultados obtenidos la existencia de patologia sistemica asociada no debe considerarse como una contraindicacion para el tratamiento quirurgico.

Endovascular treatment of an acutely ruptured intracranial aneurysm in pregnancy: report of eight cases

Treatment of acutely ruptured intracranial aneurysms in pregnancy represents a clinical challenge requiring a meticulously selected strategy. We report eight cases of ruptured cerebral aneurysms in eight pregnant patients treated safely and effectively via an endovascular approach.

Meningiomas of the lateral ventricles. A review of 10 cases

BACKGROUND Intraventricular meningiomas are rare tumours that represent about 2% of all intracranial meningiomas, and represent one of the most challenging problems in neurosurgery. They are located deep within the brain and often are sizable and highly vascular. We report on a series of 10 meningiomas of the lateral ventricles treated at our institution during the last 28 years. PATIENTS Ten patients (6 women, 4 men; mean age 41.6 yrs) were admitted to our medical center between 1978-2005 with meningioma of the lateral ventricles. Headache was the first symptom in 8 cases and ocular signs were present in 5 patients. RESULTS Seven tumours were located in the right ventricle (70%) ranging in size from 2-8 cm, with 7 tumours larger than 3 cm in diameter. Nine patients underwent surgery with total excision in 8 cases and subtotal in the other; the remaining patient only received radiosurgery. CONCLUSIONS Total resection is the gold standard for treatment which was possible in all but one of the cases undergoing surgery.

Spinal arachnoid cyst without neural tube defect

Abstract Symptomatic arachnoid cysts of the spine are rare lesions in the pediatric age group. Although most commonly occurring in association with neural tube defects, such as myelomeningocele and diastematomyelia, in some cases the cysts appear in children without spinal anomalies. We describe a 12-month-old girl with lumbar intradural arachnoid cyst with progressive weakness of the lower limbs. There was full recovery after fenestration of the cyst.

Lumbar synovial cyst in a adolescence: case report

BackgroundSpinal extradural cysts are a rare cause of spinal cord or nerve root compression which tends to occur in the elderly but rarely reported in the under 20s.HistoryA 14-year-old girl with a 9-month history of left radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging showed a 1.1-cm extradural cystic lesion with a low signal on T1-weighted images and high signal on T2-weighted images lying in the spinal canal at the L4 vertebral body level. The patient underwent an L4 hemilaminectomy and excision of a synovial cyst, and the radicular pain completely regressed.DiscussionWe discuss the pathogenesis, radiological techniques and management of synovial cyst in a paediatric patientConclusionIntraspinal ganglion cysts are extremely rare in children and only two other cases have been reported previously. They are benign lesions, frequently presenting radiculopathy, and should be considered in the differential diagnosis in patients with low back pain and radiculopathy.

Resolución espontánea de hernia de disco lumbar

Resumen La hernia del disco intervertebral lumbar es una causa frecuente de radiculopatia en miembros inferiores y su tratamiento mas efectivo sigue siendo objeto de controversia. Tanto el tratamiento quirurgico como el conservador consiguen buenos resultados cuando se realiza una correcta seleccion del paciente. La desaparicion espontanea de hernias de disco intervertebral es un hecho conocido con numerosas referencias en la bibliografia. Los autores presentamos el caso clinico de una paciente con radiculopatia secundaria a una hernia de disco lumbar diagnosticada con resonancia magnetica y que se resolvio espontaneamente.

Síndrome de Eagle: Una causa poco frecuente de cervicalgia

Resumen El sindrome de Eagle se caracteriza clinicamente por la presencia de dolor facial y/o orofaringeo en pacientes amigdalectomizados y presentar en los estudios radiologicos un alargamiento de las apofisis estiloides. Presentamos el caso clinico de una paciente de 49 anos con una historia de larga evolucion de dolor cervical y en la que los estudios con tomografia computarizada demostraron un alargamiento de ambas apofisis estiloides.

Hematoma subdural agudo espontáneo de origen arterial

Resumen Introduccion Los hematomas subdurales agudos constituyen una complicacion relativamente frecuente de los traumatismos craneoencefalicos graves; en ocasiones son motivados por el sangrado procedente de la ruptura de un aneurisma o una malformacion arteriovenosa. La presencia de un hematoma subdural agudo espontaneo de origen arterial, es decir sin una causa reconocible, es muy poco frecuente y existen controversias sobre su origen. Objetivos Analizar los ocho casos de hematoma subdural agudo espontaneo de nuestro servicio diagnosticados en los ultimos 19 anos y realizar una revision bibliografica sobre su etiologia. Resultados La serie esta formada por dos mujeres y seis varones con una edad media de 52 anos (rango 20–66). Clinicamente todos ellos presentaron disminucion del nivel de consciencia y signos neurologicos focales. Los ocho pacientes fueron intervenidos quirurgicamente y la mortalidad fue del 25%. Conclusiones El hematoma subdural agudo espontaneo es una entidad poco frecuente y cuyo pronostico va a depender de la situacion neurologica preoperatorio y de los antecedentes clinicos del paciente.