Ramón Serramito-García

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.

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.

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.

Spontaneous cerebrospinal fluid leaks in the anterior skull base secondary to idiopathic intracranial hypertension

Spontaneous cerebrospinal fluid (CSF) leaks represent a clinical entity in which CSF rhinorrhea occurs in the absence of any inciting event. Spontaneous CSF leaks are associated with elevated intracranial pressure (ICP) or have underlying idiopathic intracranial hypertension (IIH). We report a cohort of patients who have undergone nasal endoscopic repair for spontaneous CSF leaks. We review our perioperative complications and the effectiveness of the nasal endoscopic approach to repair spontaneous CSF leaks. Also, we examine the evidence correlating spontaneous CSF leaks and IIH and the role of decreasing ICP in the treatment of nasal spontaneous CSF leaks. A retrospective analysis of patients with nasal spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, ICP, clinical follow-up, and complications were collected. Thirty-five patients had nasal spontaneous cerebrospinal fluid leaks with evidence of IIH’s symptoms. The most common sites were the cribriform plate, the ethmoid roof, and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Postoperatively, all patients underwent lumbar drainage and acetazolamide therapy. Nasal spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical, or surgical means.

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.

Absceso cerebral por Scedosporium apiospermum: Presentación de un caso con revisión de la literatura

Resumen Scedosporium apiospermum es un hongo que se encuentra en el suelo y en las aguas contaminadas, que habitualmente ocasiona infecciones cutaneas y excepcionalmente puede contaminar el sistema nervioso central. Sus infecciones se relacionan habitualmente con situaciones de inmunosupresion. Los autores presentan el caso de una mujer de 73 anos con insuficiencia renal cronica que se presento con dolor de cabeza durante 2 semanas y que en la tomografia computarizada se observo una lesion en anillo en el lobulo temporal izquierdo. Con el diagnostico de absceso cerebral se practico una craneotomia temporal y extirpacion completa de la lesion. La paciente fallecio 5 dias despues de la intervencion. En el cultivo del material evacuado se aislo Scedosporium apiospermum. Se realiza una revision de los casos publicados de absceso cerebral por Scedosporium apiospermum.