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Nuestro objetivo es compartir nuestra experiencia en tumores neurogénicos del área sacra, una patología infrecuente, valorando las vías de abordaje, técnicas intraoperatorias, complicaciones y evolución de los pacientes en una serie de casos. Métodos: Realizamos un análisis retrospectivo de 19 casos de tumores neurogénicos de la región sacra diagnosticados y operados en nuestro centro, de los cuales ocho eran hombres y 11 mujeres, registrando una edad media al diagnóstico de 51 años (con un rango de edades entre 25 y 78 años). Seis se encontraban asintomáticos y fueron diagnosticados incidentalmente, mientras que la mayoría (11 pacientes) presentaban dolor lumbar acompañado de otros síntomas: dolor irradiado a miembros inferiores (MMII), dolor pélvico, alteraciones sensitivas y pérdida de fuerza en MMII. Dos pacientes presentaban otro síntoma principal al diagnóstico: dolor pélvico y en miembro inferior izquierdo (MII). A todos los pacientes se les realizó como mínimo una prueba de imagen (RM/TC). Nueve pacientes tenían tumores limitados al sacro o con extensión posterior, practicándose una intervención por vía posterior. En seis se realizó un abordaje exclusivamente por vía anterior debido a la localización presacra de la tumoración; y en cuatro de ellos fue preciso un abordaje tanto anterior como posterior. Resultados: Los seis pacientes asintomáticos al diagnóstico continuaron sin síntomas tras la intervención. En ocho desaparecieron los síntomas después de la cirugía, y al alta cuatro presentaron dolor lumbar o de miembros que mejoró en consultas sucesivas. Una paciente presentó clínica consistente en déficit motor y sensitivo en el miembro inferior derecho derivada de la afectación del nervio ciático poplíteo externo. El tiempo medio de seguimiento fue de 69 meses (desde seis hasta 178 meses) (AU)

Our objective is to share our experience in neurogenic tumors of the sacral area, an uncommon disease, and assess approaches, intraoperative techniques, complications and clinical course of patients in a case series. Methods: We conducted a retrospective analysis of 19 cases of patients with neurogenic tumors in the sacral area who were diagnosed and underwent surgery at our center. Of them, 8 were male and 11 were female. They had a mean age at diagnosis of 51 years (with an age range of 25-78 years). Six patients were asymptomatic and were diagnosed incidentally, while the majority (11 patients) presented with lumbar pain accompanied by other symptoms: pain radiating to the legs, pelvic pain, sensory alterations and loss of strength in the legs. Two patients presented with another primary symptom on diagnosis: pain in the pelvic region and in the left leg. All patients underwent a least one imaging test (MRI/CT scan). Nine patients had tumors limited to the sacrum or with subsequent spread, with surgery via the posterior route. In 6 cases, an exclusively anterior approach was employed owing to the pre-sacral location of the tumor; 4 cases required both an anterior and posterior approach. Results: The 6 patients who were asymptomatic at diagnosis continued to have no symptoms after surgery. In 8 patients, symptoms resolved after surgery, and at discharge 4 had pain in the lumbar region or legs, which improved in subsequent consultations. One patient had symptoms consistent with motor and sensory deficit in the right leg deriving from impairment of the external popliteal sciatic nerve. The mean follow-up period was 69 months (6-178 months) (AU)

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Objetivos: Un buen conocimiento anatómico del cerebelo es fundamental para llevar a cabo abordajes al IV ventrículo (frecuentes en la neurocirugía pediátrica) de forma segura, evitando secuelas como el mutismo cerebeloso. El propósito del presente trabajo es realizar una disección didáctica del cerebelo humano centrándonos especialmente en los pedúnculos cerebelosos y en los núcleos dentados (DN); estructuras en riesgo durante estos procedimientos. Material y métodos :Se disecó el órgano, siguiendo el método de Klingler para fibras blancas, usando material de microcirugía estándar y específico, bajo un microscopio D. F. Vasconcellos M900 con aumento x6-x40. Se utilizó una cámara Canon EOS T7 con un objetivo de 18-55 mm y se editaron las imágenes con Adobe Lightroom Classic CC y Keynote. Se emplearon métodos especiales como la iluminación endoscópica con luz LED para la obtención de algunas fotografías. Resultados: Se logró disecar con éxito los DN del cerebelo y describir su relación con los pedúnculos cerebelosos, vermis inferior y velos medulares. Mediante esta guía de tres pasos (1. cara tentorial; 2. cara suboccipital; 3. estructuras del IV ventrículo) se consiguió mostrar los elementos más importantes para el estudio del órgano y caracterizar sus implicaciones en los distintos abordajes al IV ventrículo. Conclusiones: La mejor forma de completar el estudio de neuroanatomía es la disección de especímenes, ya que aporta una visión 3 D. La transiluminación con luz LED se reveló como una herramienta útil para el registro fotográfico de estructuras del IV ventrículo, lo que mejora la visión espacial. Su principal aplicación la encontramos en los velos medulares y forámenes de la fosa romboide, ya que son permeables a la luz. La guía de disección en tres fases propuesta en este trabajo puede ayudar a los neurocirujanos, en cualquier etapa de su formación, a comprender mejor el cerebelo (AU)

Objectives: A thorough understanding of cerebellum anatomy is essential in 4th ventricle approaches (more frequent in pediatric neurosurgery), avoiding relevant complications such as cerebellar mutism. The aim of the present work is to show the feasibility of a didactic dissection of human cerebellum focusing on cerebellar peduncles and dentate nucleus (DN), which are structures at high risk during these surgical procedures. Material and methods: The cerebellum was dissected according to the Klingler method for white matter, using standard and specific microsurgery tools. Surgical microscope magnification (x6-x40) provided by a D.F. Vasconcellos M900 was required. A Canon EOS T7 18-55 mm digital camera was used and Adobe Lightroom Classic CC and Keynote were selected as photo enhancing software. Special methods such as LED light endoscopic transillumination were used for photographical reasons. Results: DN dissection was successfully achieved and the relations between these nucleus and the cerebellar peduncles, inferior vermis and medullary velums were described. Through this three steps dissection guide (1. tentorial surface; 2. suboccipital surface; 3. 4th ventricle structures), the most relevant anatomical structures were shown and its implications in different 4th ventricle approaches were characterised. Conclusion: 3 D perspective provided by real specimen anatomical dissection is critical for learning neuroanatomy. ED transillumination was shown as a useful technique for the 4th ventricle structures photographic documentation which improves spatial recognition. This benefit can be applied for the study of the relations between the medullary velums and the rhomboid fossa foramina, which are permeable to light. The proposed three-steps dissection guide helps to a better understanding of human cerebellum and to gain self-confidence, allowing safer practice for neurosurgeons in all stages of their career (AU)

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OBJECTIVES: Our objective is to share our experience in neurogenic tumors of the sacral area, an uncommon disease, and assess approaches, intraoperative techniques, complications and clinical course of patients in a case series. METHODS: We conducted a retrospective analysis of 19 cases of patients with neurogenic tumors in the sacral area who were diagnosed and underwent surgery at our center. Of them, 8 were male and 11 were female. They had a mean age at diagnosis of 51 years (with an age range of 25-78 years). Six patients were asymptomatic and were diagnosed incidentally, while the majority (11 patients) presented with lumbar pain accompanied by other symptoms: pain radiating to the legs, pelvic pain, sensory alterations and loss of strength in the legs. Two patients presented with another primary symptom on diagnosis: pain in the pelvic region and in the left leg. All patients underwent a least one imaging test (MRI/CT scan). Nine patients had tumors limited to the sacrum or with subsequent spread, with surgery via the posterior route. In 6 cases, an exclusively anterior approach was employed owing to the pre-sacral location of the tumor; 4 cases required both an anterior and posterior approach. RESULTS: The 6 patients who were asymptomatic at diagnosis continued to have no symptoms after surgery. In 8 patients, symptoms resolved after surgery, and at discharge 4 had pain in the lumbar region or legs, which improved in subsequent consultations. One patient had symptoms consistent with motor and sensory deficit in the right leg deriving from impairment of the external popliteal sciatic nerve. The mean follow-up period was 69 months (6-178 months). Histologically, 17 cases were classified as schwannomas, one case was classified as neurofibroma, and one case was classified as neurofibrosarcoma, which received radiotherapy. Three patients with benign histologies had further surgery for local recurrences. CONCLUSIONS: When selecting the approach, the large size that these tumors can reach, their relationship with structures, and their anterior or posterior spread should be taken in to account. Resecting the tumor mass as much as possible provides greater benefit to the patient, as this decreases the odds of tumor recurrence without increasing intraoperative and postoperative complications when multidisciplinary teams are also used.

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OBJECTIVES: Our objective is to share our experience in neurogenic tumors of the sacral area, an uncommon disease, and assess approaches, intraoperative techniques, complications and clinical course of patients in a case series. METHODS: We conducted a retrospective analysis of 19 cases of patients with neurogenic tumors in the sacral area who were diagnosed and underwent surgery at our center. Of them, 8 were male and 11 were female. They had a mean age at diagnosis of 51 years (with an age range of 25-78 years). Six patients were asymptomatic and were diagnosed incidentally, while the majority (11 patients) presented with lumbar pain accompanied by other symptoms: pain radiating to the legs, pelvic pain, sensory alterations and loss of strength in the legs. Two patients presented with another primary symptom on diagnosis: pain in the pelvic region and in the left leg. All patients underwent a least one imaging test (MRI/CT scan). Nine patients had tumors limited to the sacrum or with subsequent spread, with surgery via the posterior route. In 6 cases, an exclusively anterior approach was employed owing to the pre-sacral location of the tumor; 4 cases required both an anterior and posterior approach. RESULTS: The 6 patients who were asymptomatic at diagnosis continued to have no symptoms after surgery. In 8 patients, symptoms resolved after surgery, and at discharge 4 had pain in the lumbar region or legs, which improved in subsequent consultations. One patient had symptoms consistent with motor and sensory deficit in the right leg deriving from impairment of the external popliteal sciatic nerve. The mean follow-up period was 69 months (6-178 months). Histologically, 17 cases were classified as schwannomas, one case was classified as neurofibroma, and one case was classified as neurofibrosarcoma, which received radiotherapy. Three patients with benign histologies had further surgery for local recurrences. CONCLUSIONS: When selecting the approach, the large size that these tumors can reach, their relationship with structures, and their anterior or posterior spread should be taken in to account. Resecting the tumor mass as much as possible provides greater benefit to the patient, as this decreases the odds of tumor recurrence without increasing intraoperative and postoperative complications when multidisciplinary teams are also used.