Articles

Autologous bony edge cranioplasty for convexity meningiomas with hyperostotic activity

Raúl López-Serna, Duval Darío Molina-Chóez, Juan Luis Gómez-Amador, Juan Bargés-Coll, Miguel Ángel Celis-López

Meningiomas are extra-axial brain tumors of the central
nervous system. They represent 30% of primary brain neoplasms and originate from arachnoid cap cells. Meningiomas belong to a very heterogeneous tumor group in terms of location, invasiveness and histological pattern. Skull bone invasiveness by these tumors was first described by Brissaud and Lerebaullet n 1903 in hyperostotic areas induced by the neoplasm. In 1957, Simpson established the extent of tumor removal as the most important factor against recurrence in convexity meningiomas; complete resection of tumor, duramater hyperostotic areas (Simpson I) was associated with lesser rates of recurrence. This conclusion found histological support when meningothelial tumor cells were demonstrated in hyperostotic areas. Patients and methods: in this paper we communicate our preliminary experience of 7 patients with convexity meningiomas with hyperostosing activity. For this purpose we used a relief technique based on «in situ» modelling of methyl methacrylate prostheses using autologous bone as cranioplasty margin and affected bone as molding background. Conclusions: 7 patients were treated with excellent cosmetic results. No recurrence was documented during the follow-up period. We consider the addition of a 2cm free margin outside the bony implant (hyperostotic area) may lead to complete macroscopic and microscopic resection of convexity meningiomas. This free margin let surgeons to establish what we define as an «Osseous Simpson 0» resection; through this cheap and easy-to-do procedure oncological cure may be
achieved without sacrificing adequate cosmetic results.

Microvascular decompression in trigeminal neuralgia and multiple sclerosis

Rogelio Revuelta-Gutiérrez, Jorge Navarro-Bonnet, Duval Molina-Choez, José de Jesús Flores-Rivera, José de Jesús Martínez-Manrique, Jaime Jesús Martínez-Anda

Trigeminal neuralgia in multiple sclerosis, kwon as symptomatic trigeminal neuralgia (STN), is present in 3% of
multiple sclerosis patients. Despite the fact that a demyelinating plaque near the trigeminal system in the brainstem
is accepted as the pathophysiological mechanism, it has been proved a vascular compressive component as well,
that has made considered microvascular decompression (MVD) an effective treatment in these patients. We present
the case of a 32 years old male with diagnosis of secondary progressive multiple sclerosis and brainstem lesions,
associated with STN treated by MVD achieving an excellent pain control.

Cervicothoracic fibrous dysplasia

Serrano Rubio Apolinar Alejandro¹*, Molina Choez Duval Dario¹, Orenday Barraza José Manuel², Arriada Mendicoa Nicasio¹
¹Subdirección de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía.
²Departamento de Investigación Clínica, Instituto Nacional de Neurología y Neurocirugía.

Polyostotic Fibrous Dysplasia (PFD) is a form of fibrous displasia affecting more than one bone, mainly craniofacial, ribs and costal, femoral, pelvic and tibial bones. In less proportion it also can develope in the vertebral column. Due to it’s pathophysiologic characteristic, it can compromise any bone.

We present the case of a 25 years old, female patient, with a history of moderate shooting pain over the right scapula, with proximal weakness of the right lower extremity followed by weakness of contralateral extremity, abdominal paresthesia and lose of sphincters’ control. Due to the image studies findings (thoracic X-ray, cervico-dorsal computed tomography and magnetic resonance imaging), the subject was submitted to a medullary decompression with dorsal approach. Histopathologic results, from the tissue sample taken during surgery, confirmed the presence of bone fibrous dysplasia.

Following the detection of PFD lesions, it is paramount to make imaging studies to the vertebral column for immediate detection of lesions in this site, and bring timely treatment to maintain a stable column and hamper neurologic damage.

Epidemiological and radiological profile of patients with degenerative scoliosis: 20 year experience at a referral institute

García-Ramos CL,* Obil-Chavarría CA,* Molina-Choez DD,* Reyes-Sánchez A*
* Spine Surgeon. National Institute of Rehabilitation

Adult degenerative scoliosis is a complex three-dimensional rotational deformity, in a previously straight spine, resulting in sagittal and axial disbalance. Material and methods: This retrospective study presents the casuistry of patients 40 to 80 years old with adult degenerative scoliosis who underwent surgery in a referral institute from January 1994 to December 2013. Results: The prevalence was 0.087% (CI 95% 67.8-111), with a median age of 64.9 ± 9.4 years old, increased frequency in women and older adults. The prevalence of spondylolisthesis associated with degenerative scoliosis was 21%. The estimated risk for scoliosis in women was OR = 2.37 (CI 95% 1.35-4.15), while men showed OR = 0.4 (CI95% 0.24-0.73). The risk for spondylolisthesis associated to degenerative scoliosis was in men OR = 1.87. Conclusions: The prevalence in our experience is low and the sample age was higher; while gender, severity of the curve and presence of spondylolisthesis and olistesis were similar to the reviewed literature.

Surgical Management of Nondysraphic Giant Thoracic Intramedullary Lipoma: A Case Report

Duval Dario Molina Chóez¹*, María Augusta Carrillo Chóez¹, Kariam Ivanna Sabando Alava², Carlos Arias Pesántez³ and Angel Vinces Gilces¹
¹Department of neurosurgery, “Universidad Técnica de Manabí”, Ecuador
²Laica Eloy Alfaro de Manabí, Ecuador
³Deparment of Neurosurgery, “Universidad del Azuay”, Ecuador

Background: Spinal cord intramedullary lipomas are rare and commonly associated with spinal dysraphism and account for 2% of intramedullary tumors, while lipomas not associated with spinal dysraphism are even less frequent, accounting for 1% of cases. Most of the intradural lipomas are subpial and not intramedullary.
Objective: We aim to provide a summary of the pathology, clinical presentation, and management strategies of true giant thoracic intramedullary lipoma without dysraphism with review of the literature.
Case presentation: We report a case of a patient with giant thoracic intramedullary lipoma who presented with paraparesis and bladder dysfunction. There were not imaging studies that evidenced dysraphism.
The patient underwent surgery and diagnosis was confirmed histopathological. Postoperatively,
neurological symptoms improved in this case.

Meningiomas of the craniovertebral junction: role of posterolateral approach

Molina Choez Duval¹, Serrano Rubio Apolinar Alejandro¹, Orenday Barraza José Manuel², Arriada- Mendicoa Nicasio¹
¹Subdirección de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez.
²Departamento de Investigación Clínica, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez.

Meningiomas of the craniovertebral junction are complex lesions representing a neurosurgical challenge. The aim of the study is to describe the technique of a posterolateral approach and results in a series of patients with meningiomas of the foramen magnum and the first two cervical vertebrae. This posterior approach route with individualized lateral extension could be a safe technique in terms of morbidity and mortality compared to other approaches
for this type of tumors. Material and methods: Sixteen consecutive patients diagnosed with meningioma of the foramen magnum and / or the first 2 cervical vertebrae (C1-
C2) were treated. Resection of the lesion was performed through a posterior midline corridor with a suboccipital craniectomy of 3 cm with opisthion resection and posterior arch of C1 and according to intraspinal extension, spinous process of C2. For meningiomas of the foramen magnum a side drilling was performed towards the condyle, without altering the latter; while in meningiomas of C1-C2 arches of C1 and C2 were drilled having the lateral masses as a limit.
Results: Gross total resection of the lesion was achieved in all patients treated with a minimum recurrence rate. Complications were grouped into intraoperative and postoperative. The complication rate was 6.5%. Fifteen patients showed significant functional recovery.
Conclusions: The posterior approach with lateral extension for the treatment of foramen magnum meningiomas and C1-C2 is safe, showing a low morbidity and mortality providing results comparable to other techniques.

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