Assuntos

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BACKGROUND: Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical procedures. PNC with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes is a characteristic radiological finding of the "Mount Fuji sign." In addition to presenting our own case, we reviewed the most relevant clinical features, diagnostic methods, and conservative management for this condition. CASE DESCRIPTION: A 74-year-old male was diagnosed with meningioma of olfactory groove several years ago. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. A computed tomography (CT) scan of the skull performed 24 h later showed a neuroimaging that it is described as the silhouette of Mount Fuji. The treatment was conservative and used continuous oxygen for 5 days. Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma. CONCLUSION: The review of the literature, we did not find any cases of tension pneumocephalus documented previously through a supraorbital keyhole approach. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.

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INTRODUCTION: Neural Tube Defects (NTD) are the second congenital malformation, second only to cardiac malformations. Myelomeningocele (MMCL) is the most frequent NTD and the more complex. In Bolivia, like in many countries in South America, the low socio economical level of the population increases its incidences and complicates its management. MATERIALS AND METHODS: Retrospective study of 70 cases of MMC at Hospital Universitario Japonés (HUJ), Santa Cruz de la Sierra, between 2008-2011. Sixty had surgery. RESULTS: Prenatal care in 27 women (38.6%), positive diagnosis for spinal disraphism in 2 (7.4%). The child arrived after 24 hours of birth (65.5%). Lumbosacral lesion (64.3%). Of those 67.2% were open, with 32.9% evidencing partial motor lesion in contrast with 47.1% who were paraplegic bellow the level of the lesion. Three children were not operated because they had complex and severe malformations associated to the MMCL. The most common surgical complications were; wound dehiscence or infection (16.6%), CSF fistula (10%) CNS infection (11.7%). Mortality and specifically postoperative mortality were 7.1% y 3.3%, respectively. Hydrocephalus wass evident in 80% of the patients who were operated, they received a VP shunt medium pressure. Nine patients who had long term follow up presented with tethered cord. CONCLUSIONS: A characteristic, delayed referral. No gender predominance. Majority of cases were lumbar or lumbar sacral. Mortality similar to what is reported in the literature. Few patients came for follow up. MMCL is a pathology that requires concentrated attention by the national authorities. A multi center and multi national study will improve our management of these patients.

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The practice of neurosurgery in Bolivia began thousands of years ago with skull trepanation. This procedure dates from the earliest period of the Tiwanaku culture, a preInca civilization. Neurosurgical development in Bolivia has its origins in the late 19(th) century and can be divided in two stages. At the beginning, before the advent of neurosurgery as a discipline, some general surgeons performed procedures on the skull and brain. Formal neurosurgery in Bolivia was developed with the arrival of neurosurgeons trained in the United States and some countries of South America. The Bolivian Neurosurgical Society was created in 1975. Nowadays, our national society has 74 members. It is affiliated with the World Federation of Neurosurgical Societies and the Latin American Federation of Neurosurgical Societies. Presently, neurosurgery in Bolivia is similar to that seen in developed countries. In this sense, government programs should dedicate more financial support to establish specialized healthcare centers where the management of complex central nervous system lesions could be offered. In contrast, we believe that encouraging the local training of young neurosurgeons is one of the most important factors in the development of neurosurgery in Bolivia or any other country.

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BACKGROUND: Injuries to humans caused by attacks from large predators are very rare, especially in the United States, Europe, or Latin America. A few cases were reported on accidents in zoos or animal farms, being very uncommon in children. The purposes of this report include describing the case of a child who sustained an attack by a lion named "Bang-Bang", which resulted in injuries to the head, chest, and abdomen, as well as the subsequent neurosurgical treatment and providing a review of the literature. CASE DESCRIPTION: We report the case of an 8-year-old boy who was attacked by a lion during a circus show. The patient underwent an emergent neurosurgical procedure, including parietal craniectomy, cleaning, and extensive surgical debridement of the wounds. Despite open severe head trauma with brain damage as well as thorax and abdomen trauma, the child survived, with minimal neurological sequelae. CONCLUSIONS: Human injury resulting from encounters with nondomesticated animals is increasingly rising throughout the world. This case highlights the potentially violent and aggressive nature of wild mammals held in captivity. Unusual wild animal attacks and the complex injuries that result may pose a challenge to surgeons practicing in resource-limited settings. In this sense, the best treatment in the mentioned case is the prevention of human injuries by these animals. In addition, to attend to these infrequent cases, the authors emphasize the importance of a multidisciplinary approach to achieve the best cosmetic and functional results.

Assuntos

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BACKGROUND: Glioneuronal tumor with neuropil-like islands (GTNI) was recently added as a novel lesion in the most recent update of the World Health Organization classification of tumors of the central nervous system in 2007. Since this tumor's initial description, approximately 28 cases of GTNI have been published. In this report, we describe the ninth case of a spinal GTNI in the world literature. METHODS: We report a case arising in a 2-year-old female patient who presented with headaches associated with intermittent vomiting due to a tetraventricular hydrocephalus. RESULTS: After ventriculoperitoneal shunt placement, the patient presented with lower extremity motor weakness and sensory disturbance. A dorsolumbar spine magnetic resonance imaging scan revealed an intramedullary spinal neoplasm involving T12 through L2 in association with the thick linear enhancement of the spinal cord surfaces. A brain magnetic resonance imaging scan demonstrated focal leptomeningeal enhancement in the Sylvian fissures, the basal cistern, tentorium, and multiple small cystic-like lesions extending on the cerebellar surface, brainstem, and temporal lobes. The patient underwent a T11-L2 laminectomy for a gross total tumor resection. Histology revealed a World Health Organization grade II GTNI. CONCLUSIONS: GTNI is a rare type of glioneuronal tumor that has recently been described in the literature. The outcome of this case seems to have an unfavorable clinical course despite their low-grade morphology. However, the combination of gross total resection and adjuvant chemo-radiotherapy can enhance chances for longer survival among children with spinal GTNI associated with meningeal dissemination, and a clinical follow-up of a large series will be necessary to evaluate the long-term prognosis.

Assuntos

Assuntos

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BACKGROUND: Ventriculoperitoneal (VP) shunts are among the most frequently performed operations in the management of hydrocephalus. Hepatic cerebrospinal fluid (CSF) pseudocyst is a rare but important complication in patients with a VP shunt insertion. In addition to presenting our own case, we performed a PubMed search to comprehensively illustrate the predisposing factors, clinical picture, diagnostic methods, and surgical treatment. This article represents an update for this condition. CASE DESCRIPTION: A 40-year-old male was admitted to a hospital complaining of fever, abdominal distention, and pain. He had undergone a VP shunt for communicating hydrocephalus caused by a head trauma one year earlier. Laboratory studies showed liver enzymes alterations, and imaging studies demonstrated a well-defined intraaxially hepatic cyst with the shunt catheter placed inside. Staphylococcus epidermis was cultured via CSF. After removing the VP shunt and an adequate antibiotic treatment, the complication of hepatic CSF pseudocyst was resolved. CONCLUSION: Hepatic CSF pseudocyst is a rare complication of a VP shunt. Once the diagnosis is verified and if the CSF is sterile, just simply remove the peritoneal catheter and reposition a new one in the abdomen. We believe that it is not necessary to remove or aspirate the hepatic intraaxial pseudocyst, because of the risk of bleeding. In case of CSF infection, the VP shunt can be removed and/or an external derivation can be made, and after treatment with antibiotics, a new VP shunt is placed in the opposite side of the peritoneum.