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Background The scalpel sign is a radiological finding observed on sagittal magnetic resonance imaging and computed tomography myelography corresponding to an indentation in the dorsal aspect of the spinal cord resembling a surgical scalpel blade. It is said to be a pathognomonic imaging discovery linked to dorsal arachnoid webs. However, other spine-related conditions may mimic dorsal arachnoid webs on magnetic resonance imaging, such as spinal arachnoid cysts or ventral spinal cord herniation, leading to misdiagnosis. Methods A retrospective review was performed of cases involving 3 different diagnoses at our institution in the last 5 years that shared in common the characteristic focal dorsal indentation of the spinal cord. Results Of 7 cases identified, all but 1 were treated and confirmed intraoperatively. All lesions were located at the dorsal spinal cord. Magnetic resonance imaging was the study of choice for evaluation. Clinical manifestations included back pain and lower extremity numbness and weakness together with compressive myelopathy signs and urinary symptoms. Mean follow-up was 16.8 months with satisfactory postoperative results. Conclusions Isolated radiological presentation of the scalpel sign is not sufficient to distinguish between dorsal arachnoid webs, arachnoid cysts, and ventral herniation of the spine. However, awareness of its importance is relevant for accurate curative surgical planning.

Resumen Objetivo La laminoplastia «open door» es una tecnica ampliamente utilizada para el tratamiento de la mielopatia cervical multinivel. A pesar de presentar resultados funcionales y radiologicos satisfactorios a largo plazo, la paralisis de C5 postoperatoria continua siendo una complicacion severa e invalidante con una incidencia variable en la literatura. El objetivo del presente trabajo es describir e ilustrar la tecnica quirurgica paso a paso con el agregado de la foraminotomia unilateral C4-5, y evaluar los resultados obtenidos hasta el momento, haciendo especial enfasis en la paralisis de C5. Material y metodos Estudio retrospectivo de 20 pacientes intervenidos por mielopatia cervical mediante la tecnica de laminoplastia cervical «extendida» con foraminotomia unilateral, para la cual se detallan los pasos. Resultados Entre enero de 2013 y abril de 2019 se trataron 20 pacientes con «laminoplastia cervical extendida». Un solo paciente agrego deficit de C5 postoperatorio (5%). El porcentaje de recuperacion del Japanese Orthopaedic Association score (JOA modificado) postoperatorio fue del 54,5%, siendo similar a lo observado en otras series. Conclusion Se desarrollo e ilustro la tecnica de laminoplastia cervical «extendida» con foraminotomia unilateral de C4-5 para la prevencion de la paralisis de C5. Se analizaron los resultados, y se obtuvo una incidencia de paralisis de C5 coincidente con el menor porcentaje reportado en la literatura. Seria de utilidad un estudio prospectivo y aleatorizado para valorar el rol de la foraminotomia preventiva C4-5 unilateral.

Resumen Objetivo Los hemangiopericitomas intracraneanos (HPC) son tumores de muy baja frecuencia, alta recidiva local y riesgo de metastasis extracraneal. El objetivo del siguiente trabajo es presentar los resultados en el tratamiento de los HPC en nuestra institucion en los ultimos 20 anos y realizar una revision de la literatura del tema. Material y metodos Se realizo un estudio retrospectivo que incluyo a los pacientes con diagnostico de tumor fibroso solitario/hemangiopericitoma (TFS/HPC) intracraneanos intervenidos quirurgicamente en el periodo 1997-2017. Se incluyeron pacientes con inmunomarcacion positiva para STAT-6 y grado histologico II-III. Se recabaron datos demograficos, caracteristicas tumorales, tratamiento y sobrevida de estos pacientes. Resultados Un total de 19 pacientes cumplieron los criterios de inclusion. La mediana de seguimiento fue de 96 meses (12-230). La mortalidad fue del 21% (n = 4). El 57,9% presentaron al menos una recidiva tumoral (n = 11) (con una recurrencia del 6, del 67 y del 90% a 1, 5 y 10 anos, respectivamente). Cinco pacientes presentaron metastasis extracraneal. Tuvieron mayor sobrevida los pacientes con tumores Conclusiones Se presento una serie de pacientes operados de TFS/HPC segun los nuevos criterios de la OMS. El tamano es un factor predictor de sobrevida. Actualmente no existen criterios validados de reseccion quirurgica en esta patologia. Una clasificacion con orientacion quirurgica seria de utilidad en el futuro.

Objective Intracranial hemangiopericytoma (HPC) is a rare central nervous system tumor characterized by its low incidence, high rate of local recurrence and risk of metastasis. The main objectives of this paper are two: to show the results in the treatment of HPC in our institution in the last 20 years and to make a review of the literature on this topic. Methods Retrospective review that includes patients diagnosed with intracranial solitary fibrous tumor/hemangiopericytoma (TFS/HPC) that have undergone surgery from 1997 to 2017. It includes patients that had nuclear expression of STAT6 (detected by immunohistochemistry) and grade II/III histopathological diagnosis (defined by the World Health Organization in 2016). We collected demographic data, tumor characteristics, treatment and survival of these patients. Results A total of 19 patients fulfilled inclusion criteria. The median follow up was 96 months (12–230). The mortality rate was 21% (n = 4). The median follow up survival was 19.16 years. 57.9% of patients presented at least 1 tumor recurrence (n = 11) (recurrences of 6%, 67% y 90% at 1, 5 and 10 years). Five patients presented extracranial metastasis. Patients with tumors Conclusions A series of patients undergoing TFS / HPC were presented according to the new WHO criteria. Size is a predictor of survival. Currently there are no validated criteria for surgical resection in this pathology. A classification with surgical guidance would be useful.

Objective The open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy. Material and methods Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step. Results Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series. Conclusion The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.

Surgical management of vestibular schwannomas has improved over the last 30 years. Whereas in the past the primary goal was to preserve the patient’s life, today neurological function safeguarding is the main objective, with numerous strategies involving single resection, staged resections, postoperative radiosurgery, or single radiosurgery. The retrosigmoid approach remains the primary pathway for surgical access to the cerebellopontine angle (CPA). The use of an endoscope has great advantages. It contributes to the visualization and resection of residual tumor and also reduces the need for cerebellar retraction. The authors present a fully endoscopic resection of a large-sized vestibular schwannoma with facial nerve preservation. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21106

Cerebral spinal fluid (CSF) leak is a significant complication in pituitary surgery, increasing both patient morbidity and mortality. In a recent publication, Campero et al. observed worse postoperative prognosis and increased risk of intraoperative CSF leak in patients with reduced sellar barrier thickness. The objective of this study was to analyze the association between sellar barrier thickness and intraoperative CSF leak in older individuals. A retrospective review was conducted of 44 transsphenoidal surgery resections for pituitary adenomas, 24 microscopic and 20 purely endoscopic procedures. Presence of intraoperative CSF fistula was significantly greater in patients with weak sellar barrier (thickness under 1 mm), compared to strong sellar barrier (52.94% vs 3.70% p 0.0001, respectively). Application of this novel concept may help improve surgical technique selection as well as predict risk of intraoperative CSF leak and need for eventual use of flaps for reconstruction.

Intracranial hemangiopericytoma (HPC) is a rare central nervous system tumor characterized by its low incidence, high rate of local recurrence and risk of metastasis. The main objectives of this paper are two: to show the results in the treatment of HPC in our institution in the last 20years and to make a review of the literature on this topic.Retrospective review that includes patients diagnosed with intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) that have undergone surgery from 1997 to 2017. It includes patients that had nuclear expression of STAT-6 (detected by immunohistochemistry) and gradeII/III histopathological diagnosis (defined by the World Health Organization in 2016). We collected demographic data, tumor characteristics, treatment and survival of these patients.A total of 19 patients fulfilled inclusion criteria. The median follow up was 96 months (12-230). The mortality rate was 21% (n=4). 57.9% of patients presented at least one tumor recurrence (n=11) (recurrences of 6%, 67% y 90% at 1, 5 and 10years). Five patients presented extracranial metastasis. Patients with tumors6cm had greater survival (P.05).A series of patients undergoing SFT/HPC were presented according to the new WHO criteria. Size is a predictor of survival. Currently there are no validated criteria for surgical resection in this pathology. A classification with surgical guidance would be useful.

Introducción: La colocación de un shunt ventrículo-peritoneal, a pesar de considerarse un procedimiento de baja complejidad, puede devenir en una serie de complicaciones. Nuestro equipo quirúrgico desarrolló e implementó a partir de junio de 2016 un nuevo protocolo. El objetivo del presente trabajo es: describir e ilustrar paso a paso la técnica quirúrgica utilizada y demostrar que el uso del “nuevo protocolo” disminuye significativamente las complicaciones asociadas al procedimiento. Material y métodos: Desde junio de 2014 a noviembre de 2017 se intervinieron 184 pacientes en relación a sistemas de derivación de LCR. Se realizó un estudio retrospectivo que incluyó los pacientes con colocación primaria de shunt ventrículo-peritoneal (n=114). El seguimiento promedio fue de 14,2 meses (rango 6-38). Para el análisis estadístico se dividió a la muestra en 2 grupos: “protocolo previo” (n=59) y “nuevo protocolo” (n=55). Para describir la técnica quirúrgica se utilizó el archivo fotográfico y los partes quirúrgicos. Resultados: Se describió la técnica quirúrgica en 7 fases. La cantidad de pacientes con alguna complicación fue significativamente menor luego de implementar el “nuevo protocolo” (20% versus 39% respectivamente; p=0,04). En el grupo “nuevo protocolo” no se registró infección alguna asociada a shunt. Conclusión: Se presentó e ilustró, de manera clara y detallada, la técnica de colocación de shunt ventrículo-peritoneal en 7 fases. Esta técnica, junto a una serie de normas, constituyen un “nuevo protocolo”. La aplicación de éste disminuyó significativamente las complicaciones asociadas al procedimiento. La tasa de infección “cero” no es una utopía.