Abstract: OBJECTIVES: To analyse the results of resective surgery in patients in whom it was possible to identify a frontal epileptogenic focus through corpus callosotomy. MATERIAL AND METHODS: Data from patients suffering drug-resistant epilepsy showing persistence of disabling seizures after undergoing corpus callosotomy and subsequent treatment with frontal lobe resective surgery were prospectively reviewed. Classifications according to Engel's scale before and after each intervention were evaluated, as were the percentages of seizure reduction. Additionally, the satisfaction of family members with surgical outcomes was also assessed. RESULTS: Eleven patients were identified. After a median follow-up period of 7 years (IQR: 3-8 years), 63.6% of patients showed improvement of seizures according to Engel's scale, 27.2% remained unchanged and one worsened. One patient was categorised as class i, 8 as class ii, one as class iii and one as class iv. The percentage reduction in the number of seizures was over 90% in 54.5% of patients, between 50% and 90% in 36.4% and less than 50% in 9.1%. Family satisfaction was reported as good or excellent in 90.9% of cases. CONCLUSIONS: In addition to providing better seizure control, corpus callosotomy also appears to be a diagnostic tool allowing the identification of potential targets for resective surgery. Therefore, it should be considered upon suspicion of a frontal epileptogenic focus which could be surgically treated.
Abstract: Sickle cell anemia is a common genetic condition that may have ischemic brain infarct and hemorrhagic complications, these being known as major complications. The incidence of stroke in children with sickle cell anemia is similar to that presented by the elderly in the general population. A case of a schoolchild that debuted with synchronous bilateral intracerebral hemorrhage is discussed. To our knowledge this is the first report in the literature of synchronous bilateral gangliobasal bleeding in a schoolchild with sickle cell anemia.
Abstract: The involvement of the central nervous system by Treponema pallidum has increased in the past 20 years, particularly as a result of the human immunodeficiency virus (HIV) pandemic. However, tertiary forms, and especially syphilitic gumma, are increasingly rare as a result of the widespread use of penicillin. Spinal cord compromise due to syphilitic gumma is an exceptional event; only two cases were found in the literature review. We present the case of a female 47 year-old patient, without HIV infection, with sudden paraplegia and sensation at the T8 level. Surgical resection was performed by means of dorsal laminectomy. The diagnosis of syphilitic gumma was confirmed with microscopic exam and polymerase chain reaction.
Abstract: In utero head traumas are extremely rare and are usually caused by penetrating injuries in the thoracic or abdominal wall that affect the uterine cavity. Transvaginal fetal head injuries have been reported in exceptional cases. This is a case-report of a fetus affected by penetrating head trauma with skull fracture and intra-ventricular hemorrhage after his mother's self-insertion of a blunt object, violently through the vagina. Trauma disrupted the integrity of intrauterine membranes and precipitated preterm labor. After birth, there was a debridement of the scalp and surgical management of the fracture was performed; nevertheless, the patient died four weeks later, due to neonatal sepsis. Management of these wounds must not only be focused on repairing the primary wound, but on preventing the infectious complications.
Abstract: Tumors of the orbit are pathology of considerable complexity in management due to the diverse anatomic and muscular, vascular, cartilagenous and neural components present. We review a series of 35 cases managed at the National Institute of Cancer in Bogota, Colombia. We determine variables such as age, sex, symptoms, histology, location and surgical procedure of these tumors. This review suggest that this complex pathology should be managed by a multidisciplinary team with extensive neurosurgical experience to obtain satisfactory results.
Abstract: Although persistent trigeminal artery (PTA) is uncommonly identified, knowledge of this structure is essential for clinicians who interpret cranial imaging, perform invasive studies of the cerebral vasculature, and operate this region.
Abstract: The presentation of moyamoya disease (MMD) as an aneurysmal subarachnoid hemorrhage (SAH) is relatively frequent and in the absence of aneurysms is extremely rare.
Abstract: We described a patient who had left trigeminal neuralgia by vertebro-basilar dolichoectasia, who underwent microvascular decompression separating the basilar artery of the trigeminal nerve by interposing a vascular graft piece. Symptoms resolved completely after surgery. Nine years later, he has a recurrence of facial pain associated with rapidly progressive brainstem compressive symptoms. The brain MRI showed the vertebro-basilar dolichoectasia exerting compression on the ventral-lateral aspect of the pons and the medulla. In cerebral angiography confirmed the presence of dilated tortuous vertebral arteries, basilar, and of both internal carotid. To our knowledge this is the first case of brain stem compression syndrome preceded by NT in patients with vertebro-basilar dolichoectasia and one of the few cases with coexistence of vertebro-basilar and bilateral carotid dolichoectasia.
Abstract: Clear cell meningioma is a rare variety of meningiomas, occurring frequently at the cerebellopontine angle and spinal canal. A case of a female patient 28 years of age with a complete cauda equina syndrome was described. Magnetic resonance imaging of lumbo-sacral spine revealed a mass lesion occupying the spinal canal from L3 to S1. Subtotal resection was performed and pathological pathological examination revealed a clear cell meningioma. Radiotherapy was indicated, however, it was delayed because we discovered that the patient was pregnant. The recurrence was clinically evident at seven months and a new surgical resection previous complementary radiotherapy was necessary. A systematic review of literature was performed, exposing the behavior of clear cell meningioma in the spinal canal.
Abstract: Metastases of prostate cancer to intracranial meninges are rare and often confused with meningiomas or chronic subdural hematomas. These usually occur in patients with a known cancer diagnosis in advanced stages of the disease, and only in some rare cases do its manifestations precede the detection of the primary tumour. The clinical presentation is unspecific. However, due to the affinity of this tumour for the base of the skull, it must be included in the differential diagnosis of men over 70 years of age with cranial nerve palsy. The treatment of these lesions has not been standardized. Within the therapeutic options we find surgical resection, chemotherapy, radiotherapy or a combination of these measures, and yet survival is poor. We present the case of a 77 year old male patient whose initial symptoms of prostate cancer were caused by a metastatic lesion to the dura, confirmed by histopathology. We also review the epidemiological, clinical and imaging highlights of this condition.
Abstract: postoperative intracerebral hemorrhage after drainage of chronic subdural hematoma is a rarely reported complication; however, its incidence, according to different series may be underestimated.
Abstract: Chiari malformation type I and Poland's syndrome are two rare diseases and their simultaneous presentation had not been previously described in the literature. We report the case of a 27 year old male with history of Poland's syndrome, who referred headache and motor impairment of the intrinsic muscles of the left hand. In a cervical spine MR a Chiari I malformation with syringomyelia from C1 to T2 was found, which was treated by foramen magnum decompression, dural plasty and removal of the posterior arch of the atlas. A discussion of the embryological mechanisms that might be involved in the coexistence of these two entities is presented, emphasizing the role of para-axial mesoderm.
Abstract: Trends in management of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms among neurosurgeons is very variable and had not been previously described in any Latin American country. This study was conducted to determine the preferences of Colombian neurosurgeons in pharmacologic, surgical, and endovascular management of patients with aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms.
