E. Úrculo

Plasmocitoma de base craneal con inestabilidad cráneo-cervical

Resumen Introduccion La inestabilidad craneo-cervical constituye, en ocasiones, el principal problema neuroquirurgico en la patologia tumoral de la base craneal posterior. Presentamos un caso clinico en el que un plasmocitoma solitario origino inestabilidad craneocervical. Durante la cirugia de estabilizacion, se lesiono la arteria vertebral. Revisamos la anatomia quirurgica desde el punto de vista de la prevencion de las complicaciones vasculares. Caso clinico Mujer de 66 anos diagnosticada de plasmocitoma solitario de base craneal, tratada con radio y quimioterapia con remision completa, que presenta tetraparesia y disfagia. Tras el diagnostico de inestabilidad craneo-cervical, se indica estabilizacion mediante instrumentacion occipito-cervical. Es intervenida bajo traccion craneal con atornillado C1-C2 segun tecnica de Magerl y extension occipital. Durante la cirugia se lesiono la arteria vertebral derecha sin repercusion clinica. Dos anos mas tarde, la paciente es capaz de llevar una vida independiente. Conclusiones La instrumentacion craneo-cervical con tornillos transarticulares C1-C2, como parte del sistema de fijacion C0-C1-C2, parece eficaz para corregir la inestabilidad en lesiones osteoliticas, a expensas de un riesgo considerable de lesion de la arteria vertebral, especialmente en presencia de algunas variaciones anatomicas.

Multiple extraneural metastasis of glioblastoma multiforme

INTRODUCTION Glioblastoma multiforme is the most frequent primary tumor in the brain. Despite improvements in its surgical, chemotherapy and radiotherapy treatment, prognosis remains poor. Extracranial metastases of glioblastoma are a rare complication in this disease. Its appearance has been described in lung, liver, bone or lymph nodes. CASE REPORT We describe the case of a 20 year-old patient who complained of a subacute-onset headache. In the MRI an enhancing right temporal lesion was detected suggesting a high grade glioma as first diagnosis. Surgery was performed, obtaining a gross total resection of the lesion. Our patient underwent adjuvant radiotherapy and chemotherapy treatment, according to our hospitals protocol. Five months after initial surgery our patient complained of chest pain and a hacking cough. A thoracic-abdominal-pelvic CT scan was obtained, which showed bilateral lung infiltrates with pleural effusion, a pancreatic nodule and several vertebral lytic lesions. The lung lesions were biopsied. The pathologic diagnosis was metastatic glioblastoma multiforme. The patient died eight months after initial diagnosis. CONCLUSION Extracranial metastases of glioblastoma remain a rare event although its incidence is increasing, probably due to the improvement in survival among these patients and better imaging techniques. The mechanisms for extracranial dissemination of glioblastoma are not entirely known, as several theories exist in this regard. Physicians must be aware of this complication and keep it in mind as a differential diagnosis to improve the quality of life of our patients.

Spinal cord compression due to a epidural lipoma

INTRODUCTION The spinal extradural space is normally occupied by adipose tissue and a venous plexus, so it should be not surprising that lipomas arise and reach sufficient size to compress symptomatically the spinal cord. Nevertheless, the spinal epidural lipomas are rare and benign tumours may present as a progressive spinal cord compression syndrome. Magnetic resonance imaging is useful in demonstrating the full extent and characteristics of these lesions, the severity of cord compression and the location in the canal. Usually, the lesion is amenable to total surgical extirpation and the functional prognosis is good. Histopathologically the tumour consists of a mature adipose cells matrix intermixed with vascular endothelial channels, that is the reason why it is also named angiolipomas. CASE REPORT A 47 year-old woman complained of dorsal and bilateral submamarian pain lasting two years and progressive loss of sensibility and weakness in her legs. Following magnetic resonance studies a posterior spinal cord compression by an extradural tumour at T3-T7 levels was observed. She was operated on and we found an extradural yellow tumour easily to dissect and it was completely removed. One year later she is asymptomatic. CONCLUSIONS Spinal epidural lipoma is a benign tumour which initially presents itself with local or radicular pain accompanied by progressive spinal cord compression syndrome. The choice treatment is laminectomy and total excision. Probably, this is one of the easiest tumours to remove of the spinal canal and a source of satisfaction because a complete recovery can usually be achieved.

PR-LncRNA signature regulates glioma cell activity through expression of SOX factors

Long non-coding RNAs (LncRNAs) have emerged as a relevant class of genome regulators involved in a broad range of biological processes and with important roles in tumor initiation and malignant progression. We have previously identified a p53-regulated tumor suppressor signature of LncRNAs (PR-LncRNAs) in colorectal cancer. Our aim was to identify the expression and function of this signature in gliomas. We found that the expression of the four PR-LncRNAs tested was high in human low-grade glioma samples and diminished with increasing grade of disease, being the lowest in glioblastoma samples. Functional assays demonstrated that PR-LncRNA silencing increased glioma cell proliferation and oncosphere formation. Mechanistically, we found an inverse correlation between PR-LncRNA expression and SOX1, SOX2 and SOX9 stem cell factors in human glioma biopsies and in glioma cells in vitro. Moreover, knock-down of SOX activity abolished the effect of PR-LncRNA silencing in glioma cell activity. In conclusion, our results demonstrate that the expression and function of PR-LncRNAs are significantly altered in gliomagenesis and that their activity is mediated by SOX factors. These results may provide important insights into the mechanisms responsible for glioblastoma pathogenesis.

[Neuronavigation in the surgery for atlantoaxial instability: «the spinal shift»].

Hemos leído con atención el artículo publicado por Bescós et al en un número anterior de Neurocirugía1. Los autores presentaron una serie casos de pacientes con inestabilidad de las primeras dos vértebras cervicales operados mediante dos técnicas: la instrumentación transarticular de Magerl y la estabilización interarticular de Goel. El mismo grupo, del Hospital Universitario Germans Trias i Pujol de Barcelona, había publicado su experiencia con la primera técnica en 20022. Al igual que los autores, nuestro grupo incorporó la técnica de Goel3 y la neuronavegación para el tratamiento de estos pacientes. De nuestra experiencia, pudimos extraer las siguientes conclusiones que podrían complementar la discusión que tan acertadamente presentan los autores sobre estas técnicas, que en el momento actual siguen en constante evolución. Pedimos disculpas de antemano si incurrimos en repeticiones de conceptos que los citados autores han descrito con mayor eficacia.

Compresión medular por lipoma epidural dorsal

Resumen Introduccion El espacio extradural raquideo se encuentra normalmente ocupado por tejido adiposo y por un rico plexo venoso, por lo que no es sorprendente que sea el asiento de tumores de estirpe lipidica que pueden alcazar un tamano suficiente como para comprimir la medula espinal. Los lipomas epidurales son infrecuentes y se manifiestan clinicamente con un sindrome de compresion medular y/o radicular progresivo. La resonancia magnetica del raquis suele ser la clave en el diagnostico, pues demuestra con claridad tanto la naturaleza como la localizacion del tumor y su extension en relacion al cordon medular. Con frecuencia se trata de lesiones accesibles para la extirpacion quirurgica y tienen un excelente pronostico en cuanto a la recuperacion funcional. Desde el punto de vista histopatologico se las describe como lesiones de aspecto similar al tejido graso maduro mezclados con numerosos canales vasculares, razon por la cual se los ha denominado angiolipomas. Caso ilustrativo Mujer de 47 anos que consulta por dolor submamario bilateral de dos anos de duracion acompanado de perdida progresiva de sensibilidad y debilidad en las extremidades inferiores. El estudio por resonancia magnetica llevo al diagnostico de una compresion medular por una masa epidural a nivel D3-D7. Durante la intervencion quirurgica se identifico un tumor amarillento facilmente disecable que se extirpo completamente. Un ano mas tarde la paciente se encuentra asintomatica. Conclusion Los lipomas extradurales raquideos son tumores benignos que suelen presentarse como un sindrome radicular seguido de sindrome de compresion medular. El tratamiento de eleccion es la extirpacion quirurgica a traves de una laminectomia. Probablemente se trata de los tumores tecnicamente mas faciles de extirpar del raquis y que mas satisfacciones produce al neurocirujano y al paciente ya que la recuperacion funcional suele ser completa.