RESUMEN

INTRODUCTION: Upper limb spasticity is a surgical challenge, both in diminishing agonists spasticity and reconstructing antagonist function. Brachioradialis (BR) is often involved in elbow flexors spasticity. Finger extension is often impaired in spastic patients. This study aims to demonstrate the feasibility of BR motor branch to posterior interosseous nerve (PIN) during BR selective neurectomies, and to describe fascicles topography inside the radial nerve to facilitate PIN dissection. MATERIAL AND METHOD: Ten upper limbs from 10 fresh frozen anatomical specimens were dissected. Motor branches to the BR, wrist extensors, supinator, PIN and radial sensory branch were identified. BR to PIN transfer was realized and its feasibility was studies (donor length, tensionless suture). RESULTS: BR to PIN transfer was achievable in 9 out of 10 cases. The position of the sensory branch of the radial nerve was inferior or medial in all cases. The position of the PIN was lateral in 90% of the cases. CONCLUSION: BR to PIN nerve transfer is achievable in most cases (90%). The lateral topography of the PIN and the inferomedial topography of the sensory branch in most cases allows for an easier intraoperative finding of the PIN when stimulation is not possible. LEVEL: IV, feasibility study.

Asunto(s)

Cadáver , Estudios de Factibilidad , Dedos , Espasticidad Muscular , Transferencia de Nervios , Nervio Radial , Humanos , Nervio Radial/cirugía , Nervio Radial/anatomía & histología , Transferencia de Nervios/métodos , Espasticidad Muscular/cirugía , Dedos/inervación , Dedos/cirugía , Codo/inervación , Codo/cirugía , Masculino , Femenino

RESUMEN

OBJECTIVE: The purpose of this study is to explore the feasibility of reconstructing the APB with a pedicled PQ flap, and to report results in a child presenting with bilateral radial deficiency. METHODS: Twenty-one injected cadaver upper extremities were dissected. The muscle was pedicled distally on the transverse carpal artery, and reinnervated with the flexor digiti minimi (FDM) motor branch. The transfer was evaluated on 3 parameters: surgical feasibility, length of the distal pedicle and distance from the coaptation site to the muscle entry of recipient nerve. A bilateral PQ pedicled transfer was accomplished in a 17-month old child with bilateral radial deficiency. RESULTS: In the cadaver study, transfer of PQ to the APB was feasible and the distal end of the PQ transfer was reaching the radial side of the first metacarpophalangeal joint in all cases. The length of the distal pedicle on the transverse carpal artery was 38.5±0.20mm. The distance from coaptation of the FDM to the PQ muscle entry was 43.0±3.77mm. At 7 months, there was a cosmetic improvement of the thenar eminence, a bilateral M3 abduction of the thumb and a functional improvement from bilateral PQ pedicled transfer. CONCLUSIONS: Reconstruction of the APB may be achieved with a PQ pedicled transfer reinnervated, improving the function and the cosmetic aspect of the thenar eminence without sacrificing any function of the hand.

Asunto(s)

Antebrazo , Pulgar , Cadáver , Niño , Humanos , Lactante , Músculo Esquelético , Colgajos Quirúrgicos

RESUMEN

STUDY DESIGN: Retrospective observational survey-based study. INTRODUCTION: In France, intracranial aneurysm (IA) patients are managed by neurosurgeons and by interventional neuroradiologists. The growth of endovascular treatment led us to reflect on the role of neurosurgeons in the management of patients with IA. The present study aimed to highlight the current organization of IA management in France. METHOD: A 60-question survey was sent to the neurosurgeons in 34 hospitals managing IA patients. Thirty-three questions dealt with standards of care, follow-up procedures and the involvement of the specific specialist. RESULTS: Twenty-seven centers (79.4%) responded to the survey. A Vascular Multidisciplinary Discussion Team was organized, including both surgeons and neuroradiologists, in 92% of responding centers. There were department protocols in 66% of centers, a local registry in 33% and clinical trials in IA in 60%. Patients with unruptured IA were first seen by a neurosurgeon or by an interventional neuroradiologist, with different practices. For ruptured IA, the neurosurgeons were contacted first in 93% of cases, and were systematically involved in initial intensive care unit management. The patients were hospitalized in the neurosurgery department in 89% of the centers. The neurosurgeons took care of initial follow-up in 85% of the centers, and of lifetime follow-up in 36%. In most centers, radiological monitoring of IA was based on MRI angiography for patients who were embolized or under surveillance, and on CT angiography after microsurgery. CONCLUSION: Despite the growth of endovascular treatments, the present survey and the literature highlight a major role of neurosurgeons in treatment, follow-up and care coordination.

Asunto(s)

Aneurisma Intracraneal , Neurocirujanos , Francia , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Práctica Profesional , Estudios Retrospectivos

RESUMEN

STUDY DESIGN: Observational retrospective survey-based study. INTRODUCTION: Intracranial aneurysms (IA) can be treated with microsurgery or by endovascular treatments (EVT). EVT have taken an increasingly important part in IA management; the ability of neurosurgical teams to perform such surgery as well as the quality of their training is being questioned. We therefore wanted to assess the proportion of IA treated by microsurgery in France, the demography and caseload of surgeons trained in vascular neurosurgery. METHODOLOGY: A 60-question survey was sent to the 34 French neurosurgical centers treating IA. Twenty-seven questions dealt with the demography of neurovascular surgeons and caseload. Descriptive data are reported here. RESULTS: Twenty-seven centers answered, giving us a response rate of 79.4%. A total of 209 neurosurgeons worked in these centers. Forty-six neurosurgeons were designated as referents in vascular neurosurgery, 47% of them were under 45 years old. Among the centers, 96.3% had at least one surgeon that was a referent in neurovascular surgery. A total of 88 surgeons performed IA surgery, but only 11 operated more than 20 IA per year. Two thousand four hundred and thirty seven unruptured IA were treated every year in these centers, 25% of which by microsurgery. A total of 2727 ruptured IA were treated in these centers, of which 15% were treated by microsurgery. The most common indications for microsurgical treatment of IA were: middle cerebral artery aneurysms, wide-neck intracranial aneurysms, and giant intracranial aneurysms, as well as aneurysms associated with a hematoma for the ruptured ones. CONCLUSION: Demography of vascular neurosurgeons remains favorable, with a referent neurosurgeon in most centers, who, in half of the cases, is a young practitioner. The percentage of microsurgery in the treatment of IA is low, especially for ruptured ones. The most frequently operated types of intracranial aneurysm correspond to good practice recommendations.

Asunto(s)

Aneurisma Roto , Aneurisma Intracraneal , Aneurisma Roto/cirugía , Demografía , Francia , Humanos , Aneurisma Intracraneal/cirugía , Microcirugia , Persona de Mediana Edad , Neurocirujanos , Procedimientos Neuroquirúrgicos , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

BACKGROUND: Approximately 10% of IDH-mutant gliomas harbour non-canonical IDH mutations (non-p.R132H IDH1 and IDH2 mutations). OBJECTIVE: The aim of this study was to analyse the characteristics of non-canonical IDH-mutant gliomas. MATERIALS AND METHODS: We retrospectively analysed the characteristics of 166 patients with non-canonical IDH mutant gliomas and compared them to those of 155 consecutive patients with IDH1 p.R132H mutant gliomas. RESULTS: The median age at diagnosis was 38 years in patients with non-canonical IDH mutant gliomas and 43 years in glioma patients with IDH1 p.R132H-mutant tumours. Family history of cancer was more frequent among glioma patients harbouring non-canonical IDH mutations than in patients with IDH1 p.R132H mutations (22.2% vs 5.1%; P < 0.05). Tumours were predominantly localised in the frontal lobe regardless of the type of IDH mutation. Compared to IDH1 p.R132H-mutant gliomas, tumours with non-canonical IDH mutations were more frequently found in the infratentorial region (5.5% vs 0%; P < 0.05) and were often multicentric (4.8% vs 0.9%; P < 0.05). Compared to IDH1 P.R132H-mutant gliomas, tumours with non-canonical IDH1 mutations were more frequently astrocytomas (65.6% vs 43%, P < 0.05), while those with IDH2 mutations were more frequently oligodendrogliomas (85% vs 48.3%; P < 0.05). The median overall survival was similar in patients with IDH1 p.R132H-mutant gliomas and patients with non-canonical IDH-mutant gliomas. CONCLUSION: Gliomas with non-canonical IDH mutations have distinct radiological and histological characteristics. The presence of such tumours seems to be associated with genetic predisposition to cancer development.

Asunto(s)

Neoplasias Encefálicas/patología , Glioma/patología , Isocitrato Deshidrogenasa/genética , Mutación , Adulto , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/terapia , Terapia Combinada , Femenino , Estudios de Seguimiento , Predisposición Genética a la Enfermedad , Glioma/genética , Glioma/terapia , Humanos , Masculino , Pronóstico , Tasa de Supervivencia

RESUMEN

INTRODUCTION: Hours attributed to teaching anatomy have been reduced in medical curricula through out the world. In consequence, changes in anatomical curriculum as well as in teaching methods are becoming necessary. New methods of teaching are being evaluated. We present in the following paper an example of interactive anatomical teaching associating topographic anatomy with ultrasonographic radiological anatomy. The aim was to explicitly show anatomical structures of the knee and the ankle through dissection and ultrasonography. METHODS: One cadaver was used as an ultrasonographic model and the other was dissected. Anatomy of the knee and ankle articulations was studied through dissection and ultrasonography. RESULTS: The students were able to simultaneously assimilate both anatomical aspects of radiological and topographic anatomy. They found the teaching very helpful and practical. CONCLUSION: This body of work provides example of a teaching method combining two important aspects of anatomy to help the students understand both aspects simultaneously.

Asunto(s)

Anatomía Regional/educación , Educación de Pregrado en Medicina/métodos , Tobillo/anatomía & histología , Tobillo/diagnóstico por imagen , Cadáver , Curriculum , Disección , Francia , Humanos , Rodilla/anatomía & histología , Rodilla/diagnóstico por imagen , Especialidad de Fisioterapia/educación , Radiografía , Encuestas y Cuestionarios , Enseñanza , Ultrasonografía

RESUMEN

INTRODUCTION: Inferolateral pontine infarcts are well-described lesions of the anterior inferior cerebellar artery territory with a wide variety of clinical presentations. We report the case of isolated unilateral hearing loss and contralateral sensation of coldness due to a dorsolateral lower pontine infarct. CASE DESCRIPTION: We describe the case of a 48-year-old female patient who developed isolated selective high-frequency hearing loss on the left side, and contralateral hemibody sensation of coldness. MRI showed a left-sided dorsolateral lower pontine ischemic lesion. A subsequent angiogram revealed the lesion to result from the spontaneous dissection of a long circumferential branch of the basilar artery. CONCLUSION: To our knowledge, this is the first reported case of a vascular alternating syndrome consisting of isolated ipsilateral hearing loss and contralateral thermal dysesthesia from a dorsolateral lower pontine infarct. Occlusion of a long perforating branch of the basilar artery and consequent posterolateral lower pontine infarct may result in an alternating syndrome with subtle clinical symptoms. Knowledge of this type of syndrome may direct physicians towards the diagnosis of a dorsolateral lower pontine infarct, despite vague clinical complaints.

Asunto(s)

Disección Aórtica/complicaciones , Infartos del Tronco Encefálico/complicaciones , Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Unilateral/etiología , Aneurisma Intracraneal/complicaciones , Puente/irrigación sanguínea , Trastornos de la Sensación/etiología , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/fisiopatología , Infartos del Tronco Encefálico/diagnóstico por imagen , Infartos del Tronco Encefálico/fisiopatología , Angiografía Cerebral/métodos , Coma/etiología , Dominancia Cerebral , Urgencias Médicas , Femenino , Pérdida Auditiva Sensorineural/fisiopatología , Pérdida Auditiva Unilateral/fisiopatología , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/etiología , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/fisiopatología , Persona de Mediana Edad , Puente/fisiopatología , Trastornos de la Sensación/fisiopatología , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/etiología , Síndrome , Insuficiencia Vertebrobasilar/etiología , Insuficiencia Vertebrobasilar/fisiopatología

RESUMEN

BACKGROUND: Both tracheotomy and ventriculoperitoneal shunting procedures may be required for the same critically ill patient. However, the risk of surgical site infection (SSI) may be increased if both procedures are performed simultaneously. METHOD: We performed a retrospective analysis of 41 consecutive patients who underwent both procedures simultaneously in our institution between March 2000 and January 2008. RESULTS: Analysis revealed no difference in SSI rate between patients undergoing both procedures simultaneously and in staged procedures. CONCLUSIONS: VP shunting and tracheotomy procedures could be performed simultaneously without increasing the risk of surgical site infection. Such strategy may shorten the length of stay in critical care units.

Asunto(s)

Hidrocefalia/cirugía , Tempo Operativo , Traqueotomía , Derivación Ventriculoperitoneal , Adulto , Anciano , Hemorragia Cerebral/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Riesgo , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugía , Traqueotomía/métodos , Derivación Ventriculoperitoneal/métodos

RESUMEN

Aplasia cutis congenita (ACC) of the vertex is a rare and potentially severe malformation. We report the case of a newborn boy presenting ACC of the vertex with a skull defect. Surgical closure of the skin was performed 5 days following birth, which allowed skin healing. The skull spontaneously remodelled perfectly 6 months later. When associated with skull defect, this rare malformation characterized by the absence of skin carries the risk of severe complications such as rupture of the superior sagittal sinus or infections. Based on a review of the literature, we purpose an overview of the medical and surgical management of vertex ACC, which depends on the size of the skin defect and the presence of a skull defect.

Asunto(s)

Displasia Ectodérmica , Displasia Ectodérmica/diagnóstico , Displasia Ectodérmica/terapia , Humanos , Recién Nacido , Masculino

RESUMEN

AIM OF THE STUDY: To prove in vivo and on cadaveric lungs, the constancy of the collateral type of distribution for the right and left pulmonary arteries as described in classical books and modern studies; to estimate the frequency of the main branches observed and define an arterial tree of reference set up with the most common branches for reading the CT pulmonary angiographies. PATIENTS AND METHODS: Sixty three-dimensional reconstructions of pulmonary arterial trees (right: 30; left: 30) using the Volume Rendering Technique (VRT) performed from CT angiographic studies of 30 patients without bronchial, arterial or pulmonary pathology. Dissection of 16 pulmonary arteries from eight fresh cadavers injected with latex. Finally, 76 pulmonary arteries (right: 38; left: 38) were examined. RESULTS: The most common division of the pulmonary artery is a collateral distribution but in seven cases from 38 (18.4%) at right and one case from 38 (2.6%) at left the artery ended in two or three terminal lobar trunks which provided the segmental arteries. The mediastinal artery for the upper right lobe was always found, with a complementary scissural artery in 89.5% of cases; a middle lobar trunk was observed in 22 of the 38 right lungs (57.9%). On the left tree, four different but usually not coexisting mediastinal arteries were identified for the upper lobe, three for the culmen and one for the lingula; six various scissural arteries were noted, three for the culmen and three for the lingula; the segment 6 received one or two segmental arteries, exceptionally three. An arterial tree of reference could be defined for both sides. CONCLUSION: The division in terminal lobar trunks of the pulmonary arteries is a variation demonstrated for the first time. The data obtained from 3D reconstruction imaging in vivo are in conformity with the results of studies performed on injected cadaveric lungs for this point and to define the arterial tree of reference.

Asunto(s)

Pulmón/diagnóstico por imagen , Arteria Pulmonar/anatomía & histología , Arteria Pulmonar/diagnóstico por imagen , Cadáver , Disección/métodos , Ecocardiografía , Ecocardiografía Tridimensional , Variación Genética , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Pulmón/anatomía & histología , Tomografía Computarizada por Rayos X/métodos

RESUMEN

BACKGROUND AND PURPOSE: Skull base chondrosarcomas are rare. Gross total removal is the treatment of choice, but can be difficult depending on the closeness of noble structures. Proton beam therapy can be associated in most cases. METHODS: Retrospective study of five cases treated in 13 years and study of the literature. RESULTS: Median age of patients was 34 years [28-46]. Cranial nerve palsy was the common clinical presentation. Tumor location was variable but always off midline. Treatment was surgical in all patients with a maximal resection and proton beam therapy associated for two cases. Surgical complications were rare with cranial nerve palsy as the main side effect. Outcomes were good with a median follow-up of 12.4 years [4.3-16.2]. DISCUSSION: The review of the literature showed that chondrosarcomas of skull base are rare. The best outcome is achieved with total surgical resection. Medical imaging can only give clues to the diagnosis. Pathology is required to obtain a precise immunohistochemistry diagnosis. Multidisciplinary treatment using proton beam therapy and surgical removal enables a good local control (90-100%) at 5 years with good quality-of-life. It is difficult to determine how many cases have been published (around 220 cases in the literature) since many surgical or radiotherapy series included the same patients.

Asunto(s)

Condrosarcoma/terapia , Neoplasias de la Base del Cráneo/terapia , Adulto , Condrosarcoma/radioterapia , Condrosarcoma/cirugía , Terapia Combinada , Traumatismos del Nervio Craneal/etiología , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias , Protones , Estudios Retrospectivos , Cráneo/diagnóstico por imagen , Neoplasias de la Base del Cráneo/radioterapia , Neoplasias de la Base del Cráneo/cirugía , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

RESUMEN

Many controversies mark the long road of the history of anatomy. The hand is not exempt of them. Even Galen's clear thinking, founded on the strict determinism between the structure of an organ and its function, and based on animal dissection, was criticized. In view of the structural complexity of the hand, we will limit our study to one of the most symptomatic conceptual disagreements: whether the human thumb has two or three phalanges, according to whether we include the first metacarpus, or if the thumb's first phalanx is considered as the initial element. According to the latter theory, there is a missing element in the first digital row, and this missing element is the metacarpus. This theory is ancient and its evolution throughout history is discussed in our study. Finally, we explain the origin and bases of the reasoning that led us to suggest the word 'metaphalanx' to designate the first metacarpus.

Asunto(s)

Anatomía/historia , Falanges de los Dedos de la Mano/anatomía & histología , Metacarpo/anatomía & histología , Pulgar/anatomía & histología , Europa (Continente) , Historia del Siglo XVI , Historia del Siglo XXI , Historia Antigua , Historia Medieval , Humanos , Terminología como Asunto

RESUMEN

BACKGROUND AND PURPOSE: Anterior lumbar interbody fusion (ALIF) has gained popularity for the treatment of degenerative disease of the lumbar spine. In this report, we present our experience with the ALIF procedure for treatment of failed back surgery syndrome following lumbar discectomy in a noncontrolled retrospective cohort. METHODS: From 1st January to 31 December 2005, we performed an ALIF in 46 patients presenting with low back pain with or without radiculopathy. All patients had a history of intractable pain resistant to conventional medical treatment and failed posterior lumbar surgery. Clinical and radiological outcomes were recorded. Neurological pain and functional outcomes were measured postoperatively (at 1, 3 and 12 months). Operative data, intraoperative complications, and the fusion rate were recorded. RESULTS: Forty-six patients with a preoperative diagnosis of failed back surgery syndrome underwent ALIF. The mean follow-up was 21 months. Back pain and leg pain completely disappeared in 60.9% of patients, decreased but required occasional medication in 28.3%, and 10.8% declared no benefit from ALIF surgery. CONCLUSION: On the basis of our results, we found ALIF to be a safe and effective procedure for the treatment of failed back surgery syndrome.

Asunto(s)

Discectomía/efectos adversos , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Reoperación/métodos , Fusión Vertebral/métodos , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/etiología , Desplazamiento del Disco Intervertebral/cirugía , Estudios Retrospectivos , Insuficiencia del Tratamiento

RESUMEN

We report a new case of skull base chondrosarcoma in Maffucci's syndrome. Maffucci's syndrome combining enchondromatosis with cutaneous haemangioma is rarely associated with chondrosarcoma. The review of literature highlights a small number of this pathological association.

Asunto(s)

Condrosarcoma/diagnóstico , Encondromatosis/complicaciones , Neoplasias de la Base del Cráneo/diagnóstico , Adulto , Condrosarcoma/cirugía , Sordera/etiología , Diagnóstico Diferencial , Encondromatosis/diagnóstico por imagen , Parálisis Facial/etiología , Femenino , Trastornos de Cefalalgia/etiología , Humanos , Hidrocefalia/cirugía , Neoplasias de la Base del Cráneo/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

RESUMEN

BACKGROUND: A surgical and anatomic approach to the skull base using the transmaxillary route is presented. This route is well-known and used for a long time for sinus conditions. METHOD: This study was performed on injected cadavers. This study describes step by step this approach in microsurgical conditions following a vital lead: the infraorbital nerve. RESULTS: Anatomical landmarks are located in order to avoid complications. These complications are on one hand, hemorrhages by vascular lesions and on the other, definitive nerve palsy. CONCLUSION: Several skull base approaches exist, transfacial routes produce cosmetic damages. This route preserves the functional anatomy of the nose because it preserves the integrity of the lateral wall of the nasal cavity.

Asunto(s)

Maxilar/cirugía , Base del Cráneo/cirugía , Traumatismos de las Arterias Carótidas/prevención & control , Arteria Carótida Interna/anatomía & histología , Traumatismos del Nervio Craneal/prevención & control , Femenino , Humanos , Complicaciones Intraoperatorias/prevención & control , Masculino , Arteria Maxilar/anatomía & histología , Arteria Maxilar/lesiones , Microcirugia/métodos , Enfermedades de los Senos Paranasales/cirugía , Enfermedades de la Hipófisis/cirugía

RESUMEN

Most intra-cranial arachnoid cysts are quiescent and remain asymptomatic throughout life. Within the natural course of arachnoid cyst evolution, spontaneous resolution has been known to occur rarely, but its frequency is probably underestimated due to lack of systematic detection and long-term observation. We illustrate the spontaneous regression of arachnoid cysts with a patient which was conjointly diagnosed with an arachnoid cyst and a post-traumatic epidural haematoma. Cyst regression was observed 16 months later, upon examination following a second benign cranial trauma. Mechanisms underlying the resolution of the arachnoid cyst are discussed.

Asunto(s)

Quistes Aracnoideos/diagnóstico por imagen , Adulto , Quistes Aracnoideos/complicaciones , Hematoma Epidural Craneal/complicaciones , Hematoma Epidural Craneal/diagnóstico por imagen , Hematoma Epidural Craneal/cirugía , Humanos , Masculino , Radiografía , Remisión Espontánea

RESUMEN

We report the rare observation of a 38-year-old man diagnosed with capillary hemangioma exclusively involving the ethmoid sinus. Complete resection was obtained via ethmoid endoscopy combined with an intracranial approach. Capillary hemangioma is a rare and benign vascular tumor in adults primarily developing in the skin and subcutaneous tissues of the head and neck, and/or within oral and nasal cavities. No hemangioma exclusively involving the ethmoid sinus has been previously reported. Complete resection is the treatment of choice, providing a favorable prognosis with low risk of recurrence.

Asunto(s)

Senos Etmoidales/cirugía , Hemangioma Capilar/cirugía , Neoplasias de los Senos Paranasales/cirugía , Adulto , Senos Etmoidales/patología , Hemangioma Capilar/diagnóstico , Hemangioma Capilar/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de los Senos Paranasales/patología , Resultado del Tratamiento

RESUMEN

Hemangioblastomas involving cervical nerve roots are extremely rare. Only one case has been previously reported in the literature. We report the case of a 33-year-old man presenting with a 6-month history of upper limb pain. MRI and cervical angiography demonstrated the presence of a dumbell (intra and extradural) and highly vascularized tumor of the right C7-T1 foramina. Histological examination eventually confirmed the diagnosis of hemangioblastoma. Total removal of such a lesion may require combined (anterior and posterior) approaches and preoperative embolization.

Asunto(s)

Neoplasias de los Nervios Craneales/cirugía , Hemangioblastoma/cirugía , Nervio Vestibulococlear/patología , Adulto , Neoplasias de los Nervios Craneales/diagnóstico por imagen , Neoplasias de los Nervios Craneales/patología , Hemangioblastoma/diagnóstico por imagen , Hemangioblastoma/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía , Resultado del Tratamiento , Nervio Vestibulococlear/diagnóstico por imagen

RESUMEN

OBJECTIVE: Chronic intramedullary spinal cord abscesses are very rare. We present here a new case of this pathology, revealed by a progressive spinal cord compression. This case is particular because of the long follow up before surgery (two years). CASE REPORT: This 69-year-old patient presented a gradually progressive paraparesis and sensory loss associated with leg pain. The past medical history was dominated by a epidermoid cancer of the tongue. MRI showed an intramedullary mass at T10. On the T1-weighted sequences, the lesion was isointense with the spinal cord, Gadolinium infusion showed homogeneous enhancement of the lesion. T2-weighted sequences showed decreased signal within the lesion and an increased signal peripherally (edema). Corticosteroid infusions relieved the symptoms so the patient declined surgery. Two episodes of regressive paraplegia were treated by the same infusions. The patient accepted surgery after a third episode. RESULTS: The intervention was performed two years after the first signs and revealed a hard white mass attached to the spinal cord. Pathologic examination showed infectious inflammation. Bacteriological cultures found a Streptococcus sanguis. Two years later the patient could walk; a minimal deficit persists. CONCLUSION: First, the diagnosis was evoked but not retained because of the long course. The corticosteroid infusions gave relief and did not increase the deficit. The MRI findings remained unchanged. Intramedullary spinal cord abscesses are very rare. This pathology must be recognized because without treatment morbidity is high with a potentially fatal outcome.

Asunto(s)

Enfermedades de la Médula Espinal/microbiología , Enfermedades de la Médula Espinal/cirugía , Infecciones Estreptocócicas/patología , Streptococcus sanguis , Absceso/cirugía , Anciano , Humanos , Imagen por Resonancia Magnética , Masculino , Infecciones Estreptocócicas/cirugía , Resultado del Tratamiento

RESUMEN

Perineal neuralgias may be considered as nerve entrapment syndromes, which have been anatomically poorly studied. The pudendal nerve could be compressed between the sacrospinal and the sacrotuberal ligaments. This study tries to find a correlation between the pelvis and the lumbosacral junction morphometry, and sacrospinal and sacrotuberal ligaments morphometry. We did an anatomical study of eight anatomic specimens, and we performed the measures by using the computed tomography scanner. No correlations were found.

Asunto(s)

Ligamentos/anatomía & histología , Vértebras Lumbares/anatomía & histología , Pelvis/anatomía & histología , Sacro/anatomía & histología , Cadáver , Cóccix/anatomía & histología , Femenino , Cabeza Femoral/anatomía & histología , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Isquion/anatomía & histología , Masculino , Pelvimetría , Perineo/anatomía & histología , Hueso Púbico/anatomía & histología , Tomografía Computarizada por Rayos X