J.M. Santín-Amo

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.

Hematoma subdural crónico asociado a quiste aracnoideo: Presentación de 12 casos

Resumen Objetivos Analizar las caracteristicas clinicas, neurologicas y resultado neurorradiologico de una serie de pacientes con quiste aracnoideo asociado a un hematoma subdural cronico. Pacientes y metodo Revisamos retrospectivamente 12 casos de pacientes con quiste aracnoideo que presentaron como complicacion un hematoma subdural cronico. Resultados Entre enero de 1984 y abril de 2008, 12 pacientes (0.9%) de 1.253 casos con hematoma subdural cronico presentaban un quiste aracnoideo intracraneal. La localizacion de los quistes fue en 10 casos en la fosa temporal y los otros dos en la convexidad. Los sintomas de presentacion fueron cefalea en 6 pacientes (50%), seguidos por convulsiones (3 casos). En once pacientes se realizo agujero de trepano y drenaje del HSC, la paciente de mas edad fue tratada de forma conservadora. Unicamente se trataron 3 quistes aracnoideos mediante craneotomia y fenestracion, con resolucion completa del quiste. Conclusiones Los pacientes con quiste aracnoideo, sobre todo si esta localizado en la fosa temporal, tienen un mayor riesgo de sufrir un hematoma subdural cronico. La primera opcion terapeutica es el drenaje del hematoma subdural y si persiste la sintomatologia debera tratarse el quiste aracnoideo.

Hematoma subdural crónico bilateral: análisis de una serie de 190 pacientes

OBJECTIVE The aim of this study is to analyse the clinical findings and surgical results in a series of patients with bilateral chronic subdural haematoma (BCSDH), and compare the results with a series of patients treated for unilateral chronic subdural haematoma (UCSDH). PATIENTS AND METHODS A retrospective study was performed on 1523 patients diagnosed and surgically treated for chronic subdural haematoma over a period of 30 years. Patients were divided into 2 groups: The study group consisting of 190 patients operated on for a BCSDH and the control group consisting of patients operated on for an UCSDH (1333 cases). RESULTS The patient series included 126 males (66.3%) and 64 females (33.7%), with a mean age at diagnosis of 74.8±10.2. The control group consisted of 870 males (65.2%) and 463 women (34.8%), with a mean age of 73.2±12.1. The most common presenting symptoms was cognitive impairment in 63 patients (33.2%) with BCSDH and 416 (29.5%) with UCSDH. Recurrence rates were 9.4% (18 patients) and 5.7% (77 patients) in unilateral and bilateral haematomas, respectively. The mortality was 10 patients (5.2%) with BCSDH and 55(4%) with UCSDH. Factors significantly related to recurrence in the univariate analysis were being male (P=.040), anticoagulant/antiplatelet therapy (P=.032), and poor neurological status at admission (P=.039). CONCLUSIONS This study indicates that BCSDH is more frequent in males, and the most common presentation is headache. The most important factors influencing recurrences are being male, intake of anticoagulant-antiaggregant drugs, and worse clinical status at admission.

Ependimomas del filum terminal: Análisis de 20 casos consecutivos

Resumen Objetivos Analizar las caracteristicas clinicas, radiologicas y los resultados quirurgicos de una serie de ependimomas del filum terminal. Pacientes y metodo Se estudia retrospectivamente 20 pacientes con 21 ependimomas del filum terminal tratados durante un periodo de 21 anos (1988-2008). Todos los pacientes fueron diagnosticados con resonancia magnetica e intervenidos quirurgicamente. Resultados La relacion varon-mujer fue de 1:1.5 y la media de edad al diagnostico de 44.8 anos (rango 15–64). El primer sintoma fue dolor radicular (12 casos) y lumbalgia en los 8 restantes, con una duracion media de la sintomatologia antes del diagnostico de 8.7 anos (rango 0.6–32). Todos los pacientes fueron intervenidos quirurgicamente realizandose reseccion completa de 17 tumores y subtotal de 4. Histologicamente 20 tumores fueron ependimomas mixopapilares (grado I) y un caso grado II. El periodo de seguimiento fue de 8 anos (rango 1–18). Conclusiones Los ependimomas del filum terminal, son tumores de crecimiento lento con una mayor incidencia en adultos jovenes. La forma de presentacion mas habitual es con dolor lumbar con un largo tiempo de evolucion. Aunque la mayoria son tumores de bajo grado histologico, tienen una especial tendencia a crecer y las recidivas locales no son raras.

Apoplejía pituitaria. Revisión del tema

Resumen La apoplejia pituitaria es un sindrome caracterizado por una necrosis o hemorragia en el seno de un tumor hipofisario. Clinicamente cursa con cefalea repentina, signos de irritacion meningea, alteraciones en la agudeza visual, incluso ceguera y en ocasiones disminucion del nivel de conciencia. Para el diagnostico es fundamental la realizacion de pruebas radiologicas, siendo la de eleccion la resonancia magnetica. El tratamiento consiste en la descompresion quirurgica sellar transesfenoidal urgente y terapia sustitutiva con altas dosis de corticoides.

Hematoma epidural secundario al empleo de cabezal autoestático en un adulto

Resumen El cabezal autoestatico es un instrumento utilizado habitualmente en las intervenciones neuroquirurgicas y a pesar de su utilizacion adecuada, puede ser el causante de algunas complicaciones graves como la perforacion craneal y el desarrollo de hemorragias intracraneales. Presentamos el caso de un paciente varon de 19 anos sometido a una ventriculocisternostomia endoscopica y que presento un hematoma epidural secundario a la penetracion intracraneal de uno de los pinchos del cabezal.

Investigación clínicaHematoma subdural crónico bilateral: análisis de una serie de 190 pacientesBilateral chronic subdural haematoma: Analysis of a series of 190 patients

OBJECTIVE The aim of this study is to analyse the clinical findings and surgical results in a series of patients with bilateral chronic subdural haematoma (BCSDH), and compare the results with a series of patients treated for unilateral chronic subdural haematoma (UCSDH). PATIENTS AND METHODS A retrospective study was performed on 1523 patients diagnosed and surgically treated for chronic subdural haematoma over a period of 30 years. Patients were divided into 2 groups: The study group consisting of 190 patients operated on for a BCSDH and the control group consisting of patients operated on for an UCSDH (1333 cases). RESULTS The patient series included 126 males (66.3%) and 64 females (33.7%), with a mean age at diagnosis of 74.8±10.2. The control group consisted of 870 males (65.2%) and 463 women (34.8%), with a mean age of 73.2±12.1. The most common presenting symptoms was cognitive impairment in 63 patients (33.2%) with BCSDH and 416 (29.5%) with UCSDH. Recurrence rates were 9.4% (18 patients) and 5.7% (77 patients) in unilateral and bilateral haematomas, respectively. The mortality was 10 patients (5.2%) with BCSDH and 55(4%) with UCSDH. Factors significantly related to recurrence in the univariate analysis were being male (P=.040), anticoagulant/antiplatelet therapy (P=.032), and poor neurological status at admission (P=.039). CONCLUSIONS This study indicates that BCSDH is more frequent in males, and the most common presentation is headache. The most important factors influencing recurrences are being male, intake of anticoagulant-antiaggregant drugs, and worse clinical status at admission.

Desarrollo «de novo» de un quiste aracnoideo supraselar

Los quistes aracnoideos (QA) intracraneales son lesiones quisticas formados a partir de las aracnoides y que tienen una prevalencia entre el 1-2% en la poblacion pediatrica. Presentamos el caso clinico de un nino de 2 anos que presento inestabilidad para la marcha y episodios de desviacion ocular; al nacimiento se le habia realizado una ecografia transfontanelar que fue normal. Se le practico una tomografia computarizada (TC) y resonancia magnetica (RM) que evidenciaron un quiste aracnoideo supraselar acompanado de importante hidrocefalia. Se realizo una fenestracion endoscopica del quiste con remision completa de la sintomatologia. En la revision de la literatura unicamente hemos encontrado 6 casos previos de QA sin un origen congenito o traumatico, y exclusivamente uno de ellos de localizacion supraselar. Analizamos las caracteristicas clinicas, radiologicas y el tratamiento en los casos publicados con anterioridad.Intracranial arachnoid cysts are fluid-filled cavities that arise within the cranial arachnoid, representing approximately 1%-2% of all intracranial lesions among the paediatric population. We present the case of a 2-year-old boy who presented with instability and episodes of ocular deviation. A computed tomography scan (CT scan) and magnetic resonance imaging (MRI) of the brain revealed a suprasellar cyst and obstructive hydrocephalus. At birth a transfontanellar ultrasound was normal. The cyst underwent endoscopic fenestration with complete remission of symptoms. In the review of the literature, we found only 6 previous cases of an intracranial arachnoid cyst whose origin was not clearly congenital or traumatic, and ours is the second case of a suprasellar arachnoid cyst to arise de novo. The clinical features, imaging characteristics and treatment of the previously reported cases are discussed.

Diagnóstico por imagen de los quistes aracnoideos

espanolLos quistes aracnoideos son lesiones quisticas malformativas que contienen en su interior un liquido de caracteristicas similares al liquido cefalorraquideo. Constituyen alrededor del 1% de todos los procesos ocupantes de espacio a nivel intracraneal y, en los ultimos anos, su incidencia se ha incrementado ligeramente debido a la mejora en las tecnicas de diagnostico radiologico. Aunque la mayoria de los quistes aracnoideos se situan en la cavidad craneal, especialmente en la region de la cisura de Silvio, un menor numero de casos pueden localizarse a nivel espinal. Realizamos una revision sobre las diferentes tecnicas de diagnostico por imagen de los quistes aracnoideos, analizando la indicacion de cada una de ellas en funcion de la localizacion y edad de los pacientes. EnglishArachnoid cysts are malformed lesions that contain a fluid similar to the cerebrospinal fluid, and are usually located within the arachnoidal membrane. They represent 1% of all intracranial lesions, and in recent years, with the development of radiological techniques, the clinical detectability of arachnoid cysts seems to have increased. Although the majority of diagnosed arachnoid cysts are located in the cranial cavity and especially in the Sylvian fissure, a small number are located at spinal level and they can occur extra- or intra-spinally. An analysis is carried out, detailing the various tests used for the diagnosis of both intracranial and spinal arachnoids cysts, analysing the indications of each one depending on the location of the cysts and patient age.

Lesiones intracraneales originadas con pistola de bala cautiva

Resumen Las pistolas de bala cautiva o clavija perforadora son empleadas para aturdir al animal como paso previo al sacrificio. Colocadas en la frente del mismo inducen una inmediata perdida de consciencia, logrando asi una “humanizacion” del proceso. Su uso con fines suicidas es raro, casi exclusivo de personas que tienen acceso a las mismas dada su ocupacion laboral, causando graves lesiones a nivel cerebral. Analizamos tres casos que se presentaron en nuestro servicio. Uno de ellos fallece como consecuencia de las lesiones ocasionadas.