Category Archives: Articulos

Journal of Neurosurgery Pediatrics March 2015

38th annual meeting of the american society of pediatric neurosurgeons, January 25-30, 2015

Cranial base pathology in pediatric osteogenesis imperfecta patients treated with bisphosphonates.

Mechanical thrombectomy for pediatric stroke arising from an atrial myxoma: case report.

Primitive neuroectodermal tumors of the brainstem in children treated according to the HIT trials: clinical findings of a rare disease.

Concussion symptoms in youth motocross riders: a prospective, observational study.

Degenerative changes in adolescent spines: a comparison of motocross racers and age-matched controls.

High occurrence of head and spine injuries in the pediatric population following motocross accidents.

Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury ?

The feasibility and safety of using sublaminar polyester bands in hybrid spinal constructs in children and transitional adults for neuromuscular scoliosis.

Ventriculoiliac shunt: a cadaveric feasibility study.

Occipital aneurysmal bone cyst rupture following head trauma: case report.

Flow diversion for complex intracranial aneurysms in young children.

Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings.

Letter to the Editor: Surgical bailout of giant supraclinoid ICA aneurysm following treatment with Pipeline Embolization Device.

Craniopharyngioma arising in a Rathke’s cleft cyst: case report.

Continue reading Journal of Neurosurgery Pediatrics March 2015

Journal of Neurosurgery: Spine, March 2015

Effect of preservation of the C-6 spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3–6 laminoplasty.

The diagnostic value of magnetic resonance imaging measurements for assessing cervical spinal canal stenosis.

Stabilization with the Dynamic Cervical Implant: a novel treatment approach following cervical discectomy and decompression.

Odontoid balloon kyphoplasty associated with screw fixation for Type II fracture in 2 elderly patients.

Vincenzo Quercioli (1876-1939), researcher and pioneer of the atlas fracture.

Main thoracic curve adolescent idiopathic scoliosis: association of higher rod stiffness and concave-side pedicle screw density with improvement in sagittal thoracic kyphosis
restoration.

Depression as a predictor of worse quality of life outcomes following
nonoperative treatment for lumbar stenosis.

Effects of vertebroplasty on endplate subsidence in elderly female spines.

Continue reading Journal of Neurosurgery: Spine, March 2015

Neurocirujano promete trasplantar cabezas

El neurocirujano  asegura que el paciente estaría 36 horas en el quirófano y la intervención costaría unos 10 millones de euros. “Esto podría suceder en el plazo de dos años”, sostuvo.

“Con un equipo de 150 personas, 36 horas de quirófano y diez millones de euros se podría trasplantar una cabeza a un nuevo cuerpo de un donante. Esto podría suceder en el plazo de dos años, contados a partir del momento que un comité ético diera su aprobación. Quienes dicen que no es posible, se equivocan”. Así de contundente se muestra Sergio Canavero (Turín, 1964), neurocirujano del hospital turinés Molinette,

Canavero fue invitado para exponer su proyecto en la Conferencia anual de la Academia Americana de Neurólogos y Cirujanos Ortopédicos, prevista en Annapolis (Maryland, EE.UU.) el próximo junio.

El profesional cita al cirujano norteamericano Robert White, que ya en 1970 realizó una operación parecida, pero el chimpancé no podía moverse, porque no se unió la médula espinal y solamente vivió nueve días.

La clave, que aún hoy no es posible resolver, es unir las fibras nerviosas que salen del sistema nervioso central y llegan a la médula, para luego dar el movimiento a brazos o piernas. Pero el neurocirujano italiano está convencido de que ahora es posible conectar las partes seccionadas de la médula espinal utilizando una sustancia química llamada polietilenglicol.

Esa sustancia actúa como adhesivo para favorecer la adhesión de las membranas celulares de donante y receptor. El paciente sería mantenido en coma durante cuatro semanas para mantenerlo inmóvil. Al despertarlo, Sergio Canavero prevé que estaría en condiciones de moverse y hablar. Un año después podría caminar tras intensa fisioterapia.

-Sus colegas dicen que es un proyecto sin fundamento. ¿Qué efecto le hacen esas críticas?

-Todas las críticas que me hacen son equivocadas. Yo llevo trabajando en este proyecto 30 años y he inventado un montón de cosas para llegar a este objetivo. Algunos dicen que es imposible, pero no saben de qué hablan.

-Por primera vez se trasplantó una mano en 1988, en Lyon. Dos años y cuatro meses después el hombre pidió que se la cortaran porque mentalmente se sentía separado de ella. ¿Se podrá superar el rechazo psicológico de verse en un cuerpo nuevo?

-Es una de las pocas objeciones justas que me han hecho. Ahora los pacientes con trasplantes de manos o de cara son preparados psicológicamente y no hay rechazo. Para el trasplante de cabeza, el paciente será sometido a un entrenamiento con la ayuda de psicólogos. Durante al menos seis meses, antes de la operación, se colocará unas gafas que le mostrarán su cabeza con un nuevo cuerpo .

-¿Tiene fecha, lugar y financiación para realizar el proyecto?

-Necesitaré 150 personas para hacer esta operación. Claramente tendremos que comenzar desde cero. Para coordinar el equipo, a partir del momento en que tengamos hospital y la aprobación por parte de un comité ético, serán necesarios dos años. Necesito diez millones de euros. Un ruso, que se ha ofrecido como paciente porque sufre distrofia muscular, me ha aconsejado hacer un «crowdfunding», una financiación colectiva. He escrito también un libro, cuyas ventas servirán igualmente para financiar el proyecto. El trasplante lo haremos probablemente en Estados Unidos.

-¿Cuenta ya con candidatos para el trasplante?

-Ciertamente. Ya hay unas cincuenta personas, la mayor parte transexuales dispuestas a trasplantar su cabeza a otro cuerpo. Y también decenas de personas con distrofia muscular y parapléjicos.

-Aparte de las objeciones médicas, hay un problema ético. ¿Vale la pena una operación tan invasiva para alargar la vida de enfermos terminales o con enfermedades degenerativas?

-Para mí no hay duda. Si uno tiene una enfermedad degenerativa, no hay un problema ético. Con pacientes de este tipo, el trasplante se hace, y punto. No me interesa lo que piensen otros.

-¿Es un pionero o un visionario?

-Soy un visionario en sentido positivo, al pensar y en ver qué sería posible en el mañana. Yo tengo un lema: Quien arriesga, gana.

Journal of Neurosurgery March 2015

Convection-enhanced delivery to the central nervous system

Microsurgical anatomy of the central lobe

Grüber’s ligament as a useful landmark for the abducens nerve in the transnasal approach

Endoscopic fenestration at the splenial-habenular junctional area for symptomatic cavum and tumor at the foramen of Monro: case reports and anatomical review

The endoscopic endonasal approach to the odontoid and its impact on early extubation and feeding

Classification of middle fossa floor dehiscence syndromes

Surgical management of ruptured middle cerebral artery aneurysms with large intraparenchymal or sylvian fissure hematomas.

Continue reading Journal of Neurosurgery March 2015

Neurosurgery March 2015

Blevins LS Jr. The art of medicine. Neurosurgery. 2015 Mar;11 Suppl 2:1-2. doi: 10.1227/NEU.0000000000000637. PubMed PMID: 25706375.

Hurlbert RJ, Hadley MN, Walters BC, Aarabi B, Dhall SS, Gelb DE, Rozzelle CJ, Ryken TC, Theodore N. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2015 Mar;76 Suppl 1:S71-83. doi: 10.1227/01.neu.0000462080.04196.f7. PubMed PMID: 25692371.

Parker SL, McGirt MJ. Determination of the minimum improvement in pain, disability, and health state associated with cost-effectiveness: introduction of the concept of minimum cost-effective difference. Neurosurgery. 2015 Mar;76 Suppl
1:S64-70. doi: 10.1227/01.neu.0000462079.96571.dc. PubMed PMID: 25692370.

Desai A, Ball PA, Bekelis K, Lurie J, Mirza SK, Tosteson TD, Weinstein JN. SPORT: Does Incidental Durotomy Affect Longterm Outcomes in Cases of Spinal Stenosis? Neurosurgery. 2015 Mar;76 Suppl 1:S57-63. doi:10.1227/01.neu.0000462078.58454.f4. PubMed PMID: 25692369.

Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery. 2015 Mar;76 Suppl 1:S42-56. doi: 0.1227/01.neu.0000462077.50830.1a. PubMed PMID: 25692368.

Karikari IO, Nimjee SM, Hodges TR, Cutrell E, Hughes BD, Powers CJ, Mehta AI, Hardin C, Bagley CA, Isaacs RE, Haglund MM, Friedman AH. Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients. Neurosurgery. 2015 Mar;76 Suppl 1:S4-S13. doi: 10.1227/01.neu.0000462073.71915.12. PubMed PMID:
25692367.

Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, Ames C, Smith JS, Shaffrey CI, Glassman S, Farcy JP, Lafage V. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2015 Mar;76 Suppl 1:S33-41. doi:
10.1227/01.neu.0000462076.73701.09. PubMed PMID: 25692366.

Debernardi A, DʼAliberti G, Talamonti G, Villa F, Piparo M, Collice M. The craniovertebral junction area and the role of the ligaments and membranes. Neurosurgery. 2015 Mar;76 Suppl 1:S22-32. doi:
10.1227/01.neu.0000462075.73701.d2. PubMed PMID: 25692365.

Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames CP; ISSG. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2015
Mar;76 Suppl 1:S14-21. doi:  0.1227/01.neu.0000462074.66077.2b. PubMed PMID:
25692364.

 

Continue reading Neurosurgery March 2015

Update: Choroid plexus cyst of the third ventricle

Choroid plexus cyst of the third ventricle

J.Sales-Llopis

Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain

Choroid plexus cysts are frequent benign intraventricular lesions that infrequently cause symptoms, usually in the form of obstructive hydrocephalus 1).

Difficult to detect on routine investigations and may lead to the wrong choice of treatment.

These instances are even less common in the adult population.

Although these lesions may float freely within the ventricle leading to intermittent obstruction of the cerebrospinal fluid (CSF) circulation at variable points in a single patient, such a phenomenon has only been documented using cranial ultrasonography and observed intraoperatively by Azab et al. 2).

When warranted, treatment seeks to reestablish cerebrospinal fluid flow and does not necessarily require resection of the cyst itself. Hence, endoscopic exploration of the ventricles with subsequent cyst ablation is the current treatment of choice for these lesions.

The extension of the cyst and whether the hemisphere involved is dominant or not, determines the ideal endoscopic trajectory 3).

Case Reports

1998

In a 6-week-old boy a ventriculoatrial shunt was implanted for correction of an active asymmetrical hydrocephalus of unknown origin. When he was 3 months of age a water-soluble contrast CT ventriculography revealed a noncolloid cyst localised predominantly in the upper portion of the III ventricle. At that time the ventricular catheter obstructed with choroid plexus was removed; new bilateral catheters in a parieto-occipital region were implanted. In the course of the next 4 years, first the atrial catheter had to be extracted and then the peritoneal catheter was changed, in both cases because of obstruction. Periods of normal life alternated with periods of transient and intermittent symptoms of increased intracranial pressure, papilloedema, and myoclonic jerks. Repeated computed tomography (CT) and magnetic resonance imaging (MRI) showed stabilised hydrocephalus with an enlarged left lateral ventricle. When the boy was 16 years old MRI revealed a choroid plexus cyst in the left lateral ventricle 2 cm in diameter, with a ballvalve type of obstruction of the foramen of Monro. CT stereoendoscopic resection of the wall of a large cyst filled with cerebrospinal fluid was performed, and two additional adnexal small cysts were coagulated using the bipolar coagulator, Diomed 25 laser and scissors; the symptoms then regressed, except for superior bilateral altitudinal anopsia. Light and electron microscopy of the cyst wall is reported. The cyst was composed of collagenic connective tissue lined with a basal lamina lacking in epithelial cells. The preoperative and postoperative MRI are presented. According to the literature this case is only the third ever described in a child 4).

2001

A 53-year-old woman with a history of hypertension who sustained a blunt traumatic injury to the occipital region and subsequently developed a progressively worsening right-sided headache. Radiological examinations over the next 2 years revealed an enlarged right lateral ventricle and, ultimately, a choroid plexus cyst in its anterior and middle third, near the foramen of Monro, which is a rare location for these lesions. The cyst was removed en bloc, and follow-up examinations showed a significant improvement in her headache and a minimal differences in size between right and left ventricles 5).

2002

Unusual small choroid plexus cyst obstructing the foramen of monroe 6).

2007

A 2-year-old boy. The patient presented with markedly declining mental status, vomiting, and bradycardia over the course of several hours. Computed tomography scans demonstrated enlarged lateral and third ventricles with sulcal effacement, but no obvious mass lesions or hemorrhage. There was no antecedent illness or trauma. A right frontal external ventricular drain was placed in the patient, resulting in decompression of only the right lateral ventricle. Magnetic resonance (MR) imaging demonstrated a lobulated cyst arising from the choroid plexus of the left lateral ventricle and herniating through the foramen of Monro into the third ventricle, occluding both the foramen of Monro and the cerebral aqueduct. The patient underwent an endoscopic fenestration of the cyst, and histological results confirmed that it was a choroid plexus cyst. Postoperative MR imaging showed a marked reduction in the cyst size. The cyst was no longer in the third ventricle, the foramen of Monro and the aqueduct were patent, and the ventricles were decompressed. The patient was discharged home with no deficits. This case is illustrative because it describes this entity for the first time, and more importantly highlights the need to obtain a diagnosis when a patient presents with acute hydrocephalus without a clear cause 7).

2008

A 3-year-old female child presented with rapid loss of consciousness for the first time. Computed tomography and magnetic resonance imaging scans only showed triventriculomegaly. Endoscopy revealed a cyst of the third ventricle, which was excised, leading to good recovery 8).

2009

11-week-old girl presented to the emergency department with a 1-day history of projectile vomiting, lethargy, and dysconjugate gaze. Hydrocephalus was confirmed on head CT. During hospitalization, the symptoms resolved with a decrease in ventricular size. One week later, the patient again presented with similar symptoms, and MR images with 3D-constructive interference in steady state sequences revealed that a cyst was blocking the third ventricle. The patient subsequently underwent endoscopic fenestration of the cyst with resolution of hydrocephalus and symptoms 9).

2011

A patient was seen in the emergency department with fevers, acute onset of headaches, and lethargy. Computed tomography demonstrated dilated lateral and third ventricles with a relatively normal-sized fourth ventricle. An external ventricular drain was placed. Despite decompression of the lateral ventricles, follow-up magnetic resonance imaging demonstrated a dilated third ventricle with a possible thin-walled mass extending from the foramen of Monro into the posterior portion of the third ventricle. The patient subsequently underwent endoscopic fenestration of the cyst with endoscopic third ventriculostomy. Although two other cases of symptomatic choroid plexus cysts of the third ventricle have been previously reported in children, our paper highlights the possibility of endoscopic cyst fenestration together with a third ventriculostomy as a treatment option in cases where the cyst extends into the posterior third ventricle. Despite adequate decompression, we were concerned that due to CSF pulsations the remnant cyst wall could result in acute aqueduct obstruction and subsequent hydrocephalus 10).

2013

In a case of a 25-year-old female patient with a 3-week history of intermittent headaches, the computerized tomography (CT) of the head detected supratentorial hydrocephalus, with enlargement of the lateral and third ventricles. Magnetic resonance imaging revealed a homogeneous cystic lesion in the third ventricle. A right-sided, pre-coronal burr hole was carried out, followed by endoscopic exploration of the ventricular system. A third-ventriclostomy was performed. With the aid of the 30-degrees endoscope, a cyst arising from the choroid plexus was visualized along the posterior portion of the third ventricle, obstructing the aqueduct opening. The cyst was cauterized until significant reduction of its dimensions was achieved and the aqueduct opening was liberated. Postoperative recovery was without incident and resolution of the hydrocephalus was confirmed by CT imaging. The patient reports complete improvement of her headaches and has been uneventfully followed since surgery. The video can be found in http://youtu.be/XBtj_SqY07Q. (http://thejns.org/doi/abs/10.3171/2013.V1.FOCUS12332). 11).

2015

Azab et al. endoscopically treated a case of third ventricular choroid plexus cyst in a 9-year-old boy who presented with headaches and disturbed conscious level. He underwent a transventricular approach through a single burr hole.

During the procedure, the cyst was noted to intermittently herniate into the lateral ventricle and recede back through the foramen of Monro. Endoscopic ablation of the cyst was achieved and followed by endoscopic third ventriculostomy (ETV). The patient made an excellent recovery after the procedure 12).

1) van Baalen A, Stephani U. Flexible and floating choroid plexus cyst of the third ventricle: an ultrasonographic video documentation. Childs Nerv Syst. 2007 Feb;23(2):259-61. Epub 2006 Nov 15. PubMed PMID: 17106747.
2) , 12) Azab WA, Mijalcic RM, Aboalhasan AA, Khan TA, Abdelnabi EA. Endoscopic management of a choroid plexus cyst of the third ventricle: case report and documentation of dynamic behavior. Childs Nerv Syst. 2015 Feb 26. [Epub ahead of print] PubMed PMID: 25715839.
3) Xi-An Z, Songtao Q, Yuping P. Endoscopic treatment of intraventricular cerebrospinal fluid cysts: 10 consecutive cases. Minim Invasive Neurosurg. 2009 Aug;52(4):158-62. doi: 10.1055/s-0029-1239587. Epub 2009 Oct 16. PubMed PMID: 19838968.
4) Parízek J, Jakubec J, Hobza V, Nemecková J, Cernoch Z, Sercl M, Zizka J, Spacek J, Nemecek S, Suba P. Choroid plexus cyst of the left lateral ventricle with intermittent blockage of the foramen of Monro, and initial invagination into the III ventricle in a child. Childs Nerv Syst. 1998 Dec;14(12):700-8. Review. PubMed PMID: 9881622.
5) Hanbali F, Fuller GN, Leeds NE, Sawaya R. Choroid plexus cyst and chordoid glioma. Report of two cases. Neurosurg Focus. 2001 Jun 15;10(6):E5. PubMed PMID: 16724823.
6) Radaideh MM, Leeds NE, Kumar AJ, Bruner JM, Sawaya R. Unusual small choroid plexus cyst obstructing the foramen of monroe: case report. AJNR Am J Neuroradiol. 2002 May;23(5):841-3. PubMed PMID: 12006289.
7) Nahed BV, Darbar A, Doiron R, Saad A, Robson CD, Smith ER. Acute hydrocephalus secondary to obstruction of the foramen of monro and cerebral aqueduct caused by a choroid plexus cyst in the lateral ventricle. Case report. J Neurosurg. 2007 Sep;107(3 Suppl):236-9. PubMed PMID: 17918533.
8) Kariyattil R, Panikar D. Choroid plexus cyst of the third ventricle presenting as acute triventriculomegaly. Childs Nerv Syst. 2008 Jul;24(7):875-7. doi: 10.1007/s00381-008-0622-8. Epub 2008 Apr 18. PubMed PMID: 18421462.
9) Filardi TZ, Finn L, Gabikian P, Giussani C, Ebenezer S, Avellino AM. Treatment of intermittent obstructive hydrocephalus secondary to a choroid plexus cyst. J Neurosurg Pediatr. 2009 Dec;4(6):571-4. doi: 10.3171/2009.7.PEDS08247. PubMed PMID: 19951046.
10) Eboli P, Danielpour M. Acute obstructive hydrocephalus due to a large posterior third ventricle choroid plexus cyst. Pediatr Neurosurg. 2011;47(4):292-4. doi: 10.1159/000336046. Epub 2012 Feb 22. PubMed PMID: 22378105.
11) de Lara D, Ditzel Filho LF, Muto J, Prevedello DM. Endoscopic treatment of a third ventricle choroid plexus cyst. Neurosurg Focus. 2013 Jan;34(1 Suppl):Video 9. doi: 10.3171/2013.V1.FOCUS12332. PubMed PMID: 23282159.