Scielo RSS <![CDATA[Revista argentina de neurocirugía]]> http://www.scielo.org.ar/rss.php?pid=1850-153220090003&lang=es vol. 23 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.ar/img/en/fbpelogp.gif http://www.scielo.org.ar <link>http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300001&lng=es&nrm=iso&tlng=es</link> <description/> </item> <item> <title><![CDATA[Neurocirugía y neurocirujanos: Qué creemos de nosotros mismos y qué esperamos]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300002&lng=es&nrm=iso&tlng=es <![CDATA[Asociación Argentina de Neurocirugía]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300003&lng=es&nrm=iso&tlng=es <![CDATA[Patologia vascular en pacientes menores de un año]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300004&lng=es&nrm=iso&tlng=es Objetivo. Analizar nuestra experiencia en patología neuroquirúrgica vascular en los pacientes menores de un año. Material y método. Entre el 1/1/89 y el 1/6/09 se trataron en el Servicio de Neurocirugía del Hospital Nacional de Pediatría Juan P. Garrahan 235 pacientes con malformación vascular del SNC. De ellos 19 (8%) eran menores de un año;11 fueron varones y 8 mujeres, con una edad media de 4,5 meses al diagnóstico, en un rango desde prenatal a 1 año. Se analizaron las historias clínicas y los estudios neurradiológicos de cada uno de ellos. Resultados. Todos los pacientes fueron estudiados con TAC inicial excepto las malformaciones aneurismáticas de la vena de Galeno (MAVG) que se diagnosticaron en un principio, con ecografía. En 16/19 pacientes se realizó angiografía digital cerebral, y en uno de los casos se efectuó angiografía espinal, hallándose la malformación a ese nivel. Los tipos de lesiones halladas fueron: 6 MAVG (4 coroideas y 2 murales), 6 malformaciones arteriovenosas (MAV), 2 fístulas arteriovenosas (A-V) piales (1 cerebral y 1 medular), 1 fístula A-V medular, 1 cavernoma, 1 aneurisma sacular y 2 malformaciones embrionarias en fosa posterior. Conclusión. Es remarcable la variabilidad y complejidad de las malformaciones vasculares del SNC en el primer año de vida. Es necesaria la integración del equipo endovascular al neuroquirúrgico, no sólo para el diagnóstico, sino también para completar o facilitar el tratamiento de alguna de estas lesiones. Las malformaciónes vasculares más frecuentes en este grupo son la MAVG y las MAV , seguidas de las fístulas A-V.<hr/>Objective. To analyze our experience in neurosurgical vascular disease in patients under one year. Materials and Methods. Between 1/1/89 and 1/6/09 we treated at the Department of Neurosurgery of the Hospital Nacional de Pediatría Juan P. Garrahan 235 patients with vascular malformation of the central nervous system. Of these 19 (n = 19; 8%) were infants under one year, 11 were males and 8 females, mean age at diagnosis 4.5 months (range from prenatal to 1 year). We evaluated all charts and neuroradiologic studies of each patient. Results. All patients were studied with initial CT scan except one patient with Vein of Galen Aneurysmal Malformation (VGAM) who was diagnosed antenatal by ultrasound. The types of lesions were 6 VGAM (4 choroidal type and 2 mural type), 6 Arteriovenous Malformations (AVM), 2 Pial Arteriovenous Fistulas (1 brain and 1 spinal), 1 spinal Dural Arteriovenous Fistula, 1 Cavernoma, 1 Aneurysm and 2 Embryologic Dural Sinus Malformations at the posterior fossa. Conclusion. It is remarkable variability and complexity of vascular malformations of the central nervous system in the first year of life. It is necessary to integrate the endovascular neurosurgical team, not only for diagnosis but also to complement or facilitate the treatment of any of theses vascular disease. The most frequent vascular malformations in our group were the VGAM and the AVM followed by AV Fistulas. <![CDATA[Uso de pericardio humano en neurocirugía]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300005&lng=es&nrm=iso&tlng=es Objetivo. Describir y analizar una serie de pacientes operados en nuestro Dervicio por diferentes patologías, en los cuales se utilizó pericardio de donante no vivo para la realización de la duroplastía, obtenido del Banco de Tejidos de nuestro Hospital. Material y método. Se realizó un análisis retrospectivo de las historias clínicas de 33 pacientes en los cuales se utilizó pericardio humano, operados entre los años 2006 y 2008. Resultados. La edad de los pacientes fue entre 1 mes y 19 años (promedio: 6,6 años). 17 masculinos, 16 femeninos. Las cirugías en las cuales se utilizó, por diferentes motivos, pericardio humano para el cierre de la duramadre fueron: 7 cirugías por tumores de fosa posterior, 6 por tumores supratentoriales, 5 por traumatismos encefalocraneanos, 3 por malformación de Arnold-Chiari, 3 por hematomas espontáneos, 2 por malformaciones arteriovenosas, 2 por lipomas lumbosacros, 2 por encefaloceles, 1 por cirugía de la epilepsia, 1 por tumor espinal, y 1 por tumor de tronco. Las complicaciones encontradas fueron: 2 pseudomeningoceles y 1 fístula de líquido cefalorraquídeo, las que se resolvieron sin necesidad de nueva intervención quirúrgica. No se presentaron infecciones de la herida quirúrgica ni rechazo del injerto. Follow up: 18,6 meses. Conclusión. Consideramos que este material se comporta en forma excelente como sustituto de la duramadre, presentando ventajas tales como: ser impermeable, fácil de suturar y manejar, proporcionando un sellado hermético, baja antigenicidad y no inducir reacciones a cuerpo extraño.<hr/>Objective. To describe and to analyze a series of patients operated in our service by different pathologies, in which we used pericardium of alive donor for dural closure, stored at 80°C below cero in our hospital. Method. A retrospective analysis was designed to evaluate the medical records of 33 patients in which human pericardium were used, in a period of time between 2006 and 2008. Results. The age of the patients ranged from 1 month to 19 years old (average age: 6.6). 17 were male and 16 female. The surgeries in which we used, by different reasons, human pericardium for dural closure were: 7 posterior fossa tumors, 6 supratentorial tumors, 5 traumatic brain injury (intracranial hypertension), 3 Arnold-Chiari malformations, 3 spontaneous haematomas, 2 arterio-venous malformations, 2 lumbo-sacral lipomas, 2 encephaloceles, 1 surgery for epilepsy, 1 spinal cord tumor, and 1 brainstem tumor. The complications found were: 2 pseudomeningoceles and 1 CSF fistula. There were no systemic allergic reactions or local skin changes or infections. Follow up: 18.6 months. Conclusion. We considered that human pericardium is an excellent, effective and safe cranial and spinal dural substitute, presenting advantages such as: to be impermeable, easy to suture and to handle, providing hermetic sealing, low antigenicidad and not to induce reactions to strange body. <![CDATA[Aneurismas experimentales en ratas]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300006&lng=es&nrm=iso&tlng=es Objective. 1. The creation of an aneurysm model in an arterial bifurcation for microsurgical training in rats. 2. To verify angiographically the aneurysms patency performing endovascular maneuvers. Material and method. 10 Wistar rats weighted 400-600g were used. Ten aneurysms were performed, 9 in the final aortic bifurcation and one in the origin of the renal artery. The aneurismal sac derived from the external iliac vein. Angiography in each animal was done to examine aneurysm patency. At the same time we tried to manipulate microcateter and microguidewire in the aortic lumen. After that the aneurysm was microscopically inspected in order to verify the angiographic findings. Results. The aneurysms and the angiographic study could be performed in every animal. Four aortic and the renal artery aneurysms were not visualized in the angiography (totally thrombosed). The other five were partially thrombosed. Under microscopic aneurismal inspection could be found thrombus into the sac. The endovascular navigation was difficult due to the animal size. Conclusion. The bifurcation aneurysm model is a good microsurgical training. In our hands the aneurysms created had a high rate of spontaneous thrombosis. Because of animal size it is not a good model for endovascular training. <![CDATA[Aneurismas experimentales en cerdos con la técnica de Varsos]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300007&lng=es&nrm=iso&tlng=es Objective. To achieve an aneurysm model in swine with a low rate of sponatneous thrombosis. Material and method. Five swines were operated using a two stages technique (Varsos technique). In the first step ten carotidjugular fistulas in the neck (4 internal and 6 external jugular vein) were performed. The two vessels formed a 45° angle after the anastomosis. After a week the venous component of the fistula was occluded in order to create an aneurysm. The aneurysms patency was angiographically studied fifteen days later. At this time several types of stents and coils could be released. Results . The fistula and the aneuysms could be performed without complications. Seven of 10 aneurysm were angiogaphically patent. Three were thrombosed, all of them were created with the internal jugular vein. A carotid stenosis was observed at the anastomosis site in a thrombosed aneurysm. Conclusions. The Varsos technique in swines, specially when performed with the external yugular vein has a low rate of spontaneous aneurysm thrombosis. <![CDATA[Diagnósticos diferenciales en patología tumoral de la base de craneo anterior]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300008&lng=es&nrm=iso&tlng=es Objective. To describe a series of tumoral lesions of the anterior fossa that were treated at the Hospital de Clinicas during a determined lapse of time. Material and Methods. We evaluated the image archive and medical charts of all the patients operated on between January 2005 and May 2009 at the Neurosurgery Division of the Hospital de Clínicas. Results. From a total of 142 surgeries for expansive supratentorial lessions, 19 were for lessions of the anterior skull base (n=19) of which 7 were meningiomas (36%); four patients with gliomas (21%); one with GBM (5%); one with astrocitoma (5%); two with oligodendroglioma (10%); three patients presented tumors of the paranasal sinuses (15%); two had mucoceles (10%); one with squamous cell carcinoma (5%); three with orbital tumors; one with fibrous bone dysplasia (5%) and one with metastasis of a meduloblastoma of the posterior fossa (5%). Conclusion. The most frequent pathology found at this site is the meningioma, and secondly, gliomas. The third in frequency are the paranasal sinus tumors whose most malignant pathology is the squamous cell carcinoma. Our findings are statistically correspondent to other large series in literature. <![CDATA[Schwannomas intracraneanos: Nuestra experiencia (2000-2009)]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300009&lng=es&nrm=iso&tlng=es Objective. To present and evaluate the surgical results in the treatment of intracranial schwannomas. Method. We present 26 patients with intracranial schwannomas for a period of 10 years treated with surgery, analyze kind of presentation and postoperative results. Results. One of the cases corresponded to schwanoma of III pair, another case to schwanoma of the V pair, two other cases corresponded to schwanoma of the IX pair and twenty two cases corresponded to schwanomas of the VIII pair. Average age was 51,95 años (19-73). Total resection was made in 25 patients, partial resection was made in other. Facial nerve preservation was made in the remaining 22 patients. Preservation auditory nerve function was made in all the cases. We had 3 cases of cerebrospinal fluid leak.There were no mortal cases associated to the surgical procedure. Conclusion. The goal of treatment of intracranial schwanomas is total resection with anatomical and functional preservation of neurological structures around. This could be accomplished by retrosigmoid approach by experienced neurosurgeons. <![CDATA[Sindromes de compresión neurovascular descompresión microvascular: Nuestra experiencia (2003-2009)]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300010&lng=es&nrm=iso&tlng=es Objective. To present and evaluate the surgical results of microvascular decompression in the treatment of trigeminal neuralgia, glossopharyngeal neuralgia and hemifacial spasm. Material and Method. We present 15 patients with compressive syndrome of cranial nerve during a period of 6 years: 11 patients with trigeminal neuralgia, 2 patients with glossopharyngeal neuralgia and 2 patients with hemifacial spasm. Results. We achieved total improvement in 8 patients and partial in 4. The most frequent symptom after surgery was hypoesthesia in V2 in patients with trigeminal neuralgia. 3 patients presented temporary facial paresis. Conclusion. Microvascular decompression is an effective treatment with low morbidity in patients with compressive syndrome of cranial nerves. The goal of treatment should be complete disappearance of symptoms. <![CDATA[Neuralgia del glosofaríngeo presentación de dos casos]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300011&lng=es&nrm=iso&tlng=es Objective. To present 2 cases of glossopharyngeal neuralgia treated by microvascular decompression. Description. Case one. 37-year- old male suffering pain in the posterior region of the left half of the tongue for 3 years. The diagnosis was left glossopharyngeal neuralgia. We performed microvascular decompression with Teflon felt. The patient has improved however he is still under medication. Case two. 59-year-old female suffering pain in the posterior third of the left half of the tongue. The diagnosis was left glossopharyngeal neuralgia. We performed microvascular decompression with Teflon. Symptoms completely disappeared. Conclusion. Glossopharyngeal neuralgia is infrequent. It can be treated with microvascular decompression with good results. <![CDATA[Malformación de Chiari y siringomielia: experiencia 2000-2008]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300012&lng=es&nrm=iso&tlng=es Objetive. To describe the postoperative outcome of patients with Chiari malformation (CM) and/or syringomyelia (SM). Methods. The clinical records of patients with CM and SM, treated from 2000 to 2008, were retrospectively reviewed. Data about sex, age, previous history, admission symptoms, magnetic resonance imaging (MRI), treatment modalities, outcome (Odom´s scale) and postoperative complications were collected. Results. We treated 17 patients (1 varón, 16 mujeres); mean age: 39 years old (10-66). The admission symptoms were: pain in 11 cases, cerebellum/brain stem in 4 cases and spinal cord in 14 cases. Diagnosis was made by MRI: CM type I with SM 9 cases, CM I without SM 6 cases, CM type II with SM 1 case and idiopathic SM 1 case. MC II had myelomeningocele and ventricular shunting surgery at 3 months old. In 15 cases we performed a suboccipital craniectomy with duraplasty and C1 posterior arch resection (n:12) or C1-C2 posterior arch resection (n:3). One case had surgery at another institution and 1 case was not operated because symptoms did not progressed. SM persisted in 4 of the operated cases; in 3 of them a syringopleural shunting (SPS) was performed. In the idiopathic SM a SPS was also performed, but it became obstructed 3 months later. Complications were: meningitis 1 case, CSF fistula 1 case and meningitis + CSF fistula 1case. In CM outcome after 1 year was: excellent-good in 13 cases, fair in 1 case and poor in 2 cases. Conclusion. In patients with CM and/or SM, postoperative clinical outcome was excellent-good in 13/16 cases. <![CDATA[Hematomas intraparenquimatosos sin causa aparente en pediatría]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300013&lng=es&nrm=iso&tlng=es Objective. Spontaneous intracerebral hemorrhage (ICH) in pediatric population has many causes. Some patients remain non diagnosed in spite of being fully checked. Our objetive is to analyze those patients whose etiology could not be found. Material ando Method. From March 2006 to April 2009 we studied 39 patients with ICH . Trauma and coagulation disorders were excluded. CT scan was performed to diagnose the bleeding, MRI and at least two digital subtraction angiography (DSA) were the methods of diagnosis. Results. Thirty-nine patients presented ICH. Twenty presented AVM, five aneurysm, one tumor, three dural sinus thrombosis. In 4 females and 6 males (ages 2 months to12 years) no etiology could be found. Six patients had headache, four sensory loss and two seizures. The cerebellar hemisphere was involved in two patients, basal ganglia in two, thalamus in one and five were subcortical located. Six presented intraventricular haemorrhage, and needed external ventricular drainage. Six patients underwent clot removal because of mass effect. All patients survived. Four remained with hemiparesia. Coclusion. In 25% of patients with ICH no etiology could be found in spite of being fully checked. The majority of them were between 6 and 12 years old. There were no children over 12 years. There were no deaths in this serie; therefore early surgery due to increased ICP seems to have a favorable outcome. <![CDATA[Resúmenes de trabajos libres: Trabajos de presentación oral]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300014&lng=es&nrm=iso&tlng=es Objective. Spontaneous intracerebral hemorrhage (ICH) in pediatric population has many causes. Some patients remain non diagnosed in spite of being fully checked. Our objetive is to analyze those patients whose etiology could not be found. Material ando Method. From March 2006 to April 2009 we studied 39 patients with ICH . Trauma and coagulation disorders were excluded. CT scan was performed to diagnose the bleeding, MRI and at least two digital subtraction angiography (DSA) were the methods of diagnosis. Results. Thirty-nine patients presented ICH. Twenty presented AVM, five aneurysm, one tumor, three dural sinus thrombosis. In 4 females and 6 males (ages 2 months to12 years) no etiology could be found. Six patients had headache, four sensory loss and two seizures. The cerebellar hemisphere was involved in two patients, basal ganglia in two, thalamus in one and five were subcortical located. Six presented intraventricular haemorrhage, and needed external ventricular drainage. Six patients underwent clot removal because of mass effect. All patients survived. Four remained with hemiparesia. Coclusion. In 25% of patients with ICH no etiology could be found in spite of being fully checked. The majority of them were between 6 and 12 years old. There were no children over 12 years. There were no deaths in this serie; therefore early surgery due to increased ICP seems to have a favorable outcome. <![CDATA[Resúmenes de trabajos libres: Trabajos de presentación en panel]]> http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322009000300015&lng=es&nrm=iso&tlng=es Objective. Spontaneous intracerebral hemorrhage (ICH) in pediatric population has many causes. Some patients remain non diagnosed in spite of being fully checked. Our objetive is to analyze those patients whose etiology could not be found. Material ando Method. From March 2006 to April 2009 we studied 39 patients with ICH . Trauma and coagulation disorders were excluded. CT scan was performed to diagnose the bleeding, MRI and at least two digital subtraction angiography (DSA) were the methods of diagnosis. Results. Thirty-nine patients presented ICH. Twenty presented AVM, five aneurysm, one tumor, three dural sinus thrombosis. In 4 females and 6 males (ages 2 months to12 years) no etiology could be found. Six patients had headache, four sensory loss and two seizures. The cerebellar hemisphere was involved in two patients, basal ganglia in two, thalamus in one and five were subcortical located. Six presented intraventricular haemorrhage, and needed external ventricular drainage. Six patients underwent clot removal because of mass effect. All patients survived. Four remained with hemiparesia. Coclusion. In 25% of patients with ICH no etiology could be found in spite of being fully checked. The majority of them were between 6 and 12 years old. There were no children over 12 years. There were no deaths in this serie; therefore early surgery due to increased ICP seems to have a favorable outcome.