Search

Tolosa-Hunt syndrome consist of. unilateral or periorbital headache, paresis of the III, IV, and/or VI cranial nerve ipsilateral to the headache, and image evidence of pathology in the cavernous sinus or superior orbital fissure. We present the case of a 76 YO woman who developed Tolosa-Hunt syndrome posteriorly to the application of Sinovac vaccine against Covid-19.

Introduction: Degeneration of the cervical spine (CDSD) prevalence is nearly 90% by the 7th decade. This is the first research that compares the outcomes between the Anterior Approach (AA) and Posterior Approach (PA) to cervical myelopathy (CM) in the elderly. Materials and Methods: A retrospective observational study of electronic health records at the Hospital Central Sur de Alta Especialidad (HCSAE), PEMEX from January 2010 to May 2020 with patients older than 60 years submitted to cervical surgery. For the analysis we elaborated two groups according to the surgical approach: AA vs PA; we analyzed the trans-operative behavior, the immediate outcome, and after 3 months, 6 months, and 1 year. Results: As a total of 145 patients, the prevalence of CM in elderly was the 63.8% with a median age of 69 (64 - 75) years. We found statistical differences in strength outcome only in the P3m (p = 0.011), for sensitivity we found major prevalence of affection in the PA group. We didn’t report a significant difference in the Neck Disability Index (NDI) at all measures, but the PA presented a major incapacity. The Nurick scale results were significant in all stages (p . Discussion: Patients show significant improvements in outcome measures with either anterior or posterior surgery. Both approaches are highly efficacious in preventing neurologic deterioration and in most cases improve neurological function with appropriate postoperative management like rehabilitation, pain management, and psychological support. Conclusion: The patients submitted to surgical medullary decompression presented a favorable outcome despite the age and the higher prevalence of comorbidities; whereby we favor the surgical treatment in all patients in a case-to-case selection to generate a positive impact on functional outcomes.

Paraclinoid aneurysms take importance due to the technical difficulty due to anatomical relationships, which is why different approaches have been sought for their proper management. This is a female patient with a finding of a paraclinoid aneurysm and treatment using an endonasal approach with adequate angiographic support. Knowledge of the anatomy and surgical skill are required for the management of these lesions, assisted by angiographic controls for successful treatment. The endoscopic endonasal approach is adequate if the anatomy allows it and the basic hospital infrastructure is available to obtain high success rates.Los aneurismas paraclinoideos cobran importancia debido a la dificultad técnica por sus relaciones anatómicas, por lo que se han buscado diferentes abordajes para su adecuado manejo. Se presenta el caso de una paciente con un aneurisma paraclinoideo y tratamiento mediante abordaje endonasal con apoyo angiográfico adecuado. Se requieren conocimientos de la anatomía y habilidad quirúrgica para el manejo de estas lesiones, así como asistencia de controles angiográficos para el éxito del tratamiento. El abordaje endonasal endoscópico es adecuado en caso de que la anatomía lo permita y se tenga la infraestructura hospitalaria básica para obtener un alto índice de éxitos.

Background: Chordomas are malignant tumors that arise from the remnants of the notochord. Complete en bloc radical resection with postoperative radiation therapy is currently considered the gold standard. Here, we performed a 360-staged approach to manage a C3-C4 chordoma that involved the right vertebral artery. Case Description: A 40-year-old woman presented with a C3-C4 chordoma that invaded the right vertebral artery. She responded well to a circumferential approach including resection and stabilization. Conclusion: A 40-year-old woman with a C3-C4 spinal chordoma was optimally managed with a combined anterior/posterior surgical approach including decompression/fusion.

Objective To know the clinical presentation and affected vessels as well as evaluate the carotid Doppler ultrasound (CDU) vs. diagnostic cerebral angiography (DCA) both due to the percentage of significant stenosis (>50%), and the presence of carotid ulcers in Mexican population. Patients and Methods In Mexico City, from January 2018 to January 2020, was realized a retrospective analysis in a third-level hospital, which qualitative variables were studied. In the case of the percentage of stenosis, the existence -or not- of significant stenosis was considered. The sensitivity, specificity, negative predictive value and positive predictive value of ultrasound vs. angiography for significant stenosis and for the detection of ulcers was also calculated. Results A total of 30 patients were analyzed, 18 men and 12 women with an age range between 47 and 89 years and an average age of 71 years. The arterial locations most frequently reported by ultrasound and angiography were graphed, as well as the mean percentage of stenosis. Regarding the evaluation of the Doppler ultrasound as a diagnostic test, 78% of sensitivity and a 53% of specificity for the percentage of stenosis, so it was greater than or equal to 50%; and a sensitivity of 0% and specificity of 90% for the detection of ulcers. Conclusions The value of ultrasound as a diagnostic test compared to gold standard, contrasts with the result that was reported in the reading. We consider that the intentional search for carotid ulcers in patients who have already presented medical history compatible with carotid disease should be more exhaustive, based on studies with greater sensitivity, although they could be more invasive or more expensive.

Background: Before the introduction of high-resolution MR, few disc fragments were misdiagnosed as meningiomas. Case Description: A 63-year-old female presented with a 6-month history of mild to moderate pain in the left arm, weakness 4/5 in the left arm C5-C6 distribution, and a loss of the left biceps reflex response. Although the MR study was read as showing a C5-C6 level probable spinal meningioma, this proved to be a sequestrated disc fragment at surgery. Conclusion: Rarely, cervical disc herniations may be misdiagnosed on MR studies as spinal meningiomas.

Introduction: Meningiomas are the most common primary central nervous system (CNS) tumors, with an incidence of 8.14 per 100,000 habitants. They represent 30% of all adult primary brain tumor diagnoses in the United States in contrast to Latin America with 50%. In Mexico, there are no epidemiological trends of meningiomas or other CNS tumors. Simpson resection grade and WHO grade are the prognostic factors with the greatest effect. In this paper, we describe the correlation between the survival free of disease and the gross total resection with its histological type according to Simpson’s grading scale. Materials and methods: A descriptive, analytical, retrospective, case-control study was conducted in two public third -level hospitals and three second- level hospitals in two cities of Mexico, (Mexico City and Guadalajara, Jalisco in a period of 10 years (2010-2020). An analysis of measures of central tendency was performed for age, sex, location, histological type, and postsurgical Simpson grade.Results: 26 patients of 179 had recurrence. Among the total recurrences, 15.4% were Simpson 1, 69.2%Simpson 2, and 15.4%Simpson 3. The survival for Simpson 1 was 142.0 months, Simpson 2 90.32 months, and Simpson 3 69.13 months. According to the histological type, the meningiomas with the lowest survival were the microcystic ones with 60 months, followed by the atypical ones with 90.4 months, and the psammomatous ones with 99.8 months. Conclusion: Surgical resection and the histological type are factors that affect progression free -survival. The Mexican population presents characteristics similar to those described in world literature.Importance of the study: This is the first study of its kind in the Mexican population and lays the foundations for future studies in the Latin American population.

Resumen Introduccion Existen diferentes tecnicas para reconstruccion del musculo temporal (MT) en el abordaje pterional (AP) con el objetivo de evitar y disminuir la atrofia, hasta el momento ninguna ha logrado evitarla en su totalidad. La administracion de bupivacaina genera regeneracion de fibras musculares. Aun no existe en la literatura medica estudios que evaluen el tiempo de manipulacion del MT y que den uso a la bupivacaina para el tratamiento de la atrofia despues de un abordaje pterional, el presente estudio pretende describir los efectos de estas variables. Pacientes y metodos Estudio longitudinal, incluyendo pacientes de 18-80 anos y sometidos a abordaje pterional en los anos 2016-2017. Evaluamos los efectos de la manipulacion del MT y la administracion de bupivacaina al 0,5% sobre el trofismo y la funcion del MT. Resultados Veintinueve pacientes fueron sometidos a AP; 16(55,17%) contaron con criterios para infiltracion con bupivacina al 0,5%. Se encontro una correlacion negativa entre los tiempos de manipulacion y el trofismo, no estadisticamente significativo (p>0,05). Se evaluo los indices de disfuncion de Helkimo y Fonseca prequirurgicos y posquirurgicos encontrandose un incremento estadisticamente significativo en la disfuncion (p En pacientes infiltrados con bupivacaina al 0,5% se observo una diferencia media del espesor de MT de 0,275±1,18 mm, en contraste con los no infiltrados de 2,39±1,30mm (t[27] = -5,118, p=0,0001). Conclusiones La manipulacion del MT durante el abordaje pterional, condiciona un impacto sobre la calidad de vida de acuerdo con los indices de disfuncion, debido a la atrofia. Esta investigacion presenta que la administracion de bupivacaina al 0,5% durante la cirugia ofrece una disminucion en la atrofia del MT.

Objective To determine the epidemiology of the localization and histological type of meningiomas in the Mexican population and the distribution of the different histological patterns and their relationship to tumor localization and patient demographics. Methods A retrospective analysis was performed in 5 hospitals in Mexico from 2009 to 2019. For qualitative variables, mean values were compared using Pearson χ2 test for the correlation between location and histological pattern as well as the clinical presentation and the patient’s sex. Student t test was performed for age and its correlation with location and histology. Results Analysis of 179 patients revealed significant differences in histopathological pattern, patient sex, and tumor location. No significant differences were found for age or clinical presentation in association with any specific histological pattern. Conclusions There was a correlation between the histology of the 15 histopathological varieties of meningiomas and the predilection site of appearance as well as certain demographic aspects, such as sex. This study lays the foundation for future studies in Mexico on the differentiation and typing of meningiomas regardless of the histological grade to which they belong, as the exact behavior of these tumors, including grade I tumors, remains unknown to date.

Background: Thrombosis of the internal jugular vein (IJV) is extremely rare, being central catheterization the most common cause. We present a case of a patient with an unusual appearance of neurological symptoms as a consequence of thrombosis of the IJV secondary to miliary tuberculosis. Case Description: A 30-year-old woman with disseminated tuberculosis, with multiple lymphadenopathy, axillary, cervical, mesenteric, retroperitoneal, and inguinal, presented with clinical evidence of intracranial hypertension. A diagnostic cerebral angiography was performed, which revealed an occluded left internal jugular and venous stasis in the entire cerebral venous system. The patient was treated with low-molecular-weight heparin, with which she had an adequate evolution. Conclusion: Tuberculosis is capable of generating a state of hypercoagulability, in addition to a mechanical compression effect due to cervical lymphadenopathy. We report an unusual clinical presentation, with intracranial involvement due to IJV thrombosis secondary to miliary tuberculosis. So far, there are no cases with a similar presentation described above.

Background: Choroid plexus papillomas (CPPs) are benign extra-axial tumors that originate from the choroid plexus; these tumors rarely have metastases, being at the spinal level the location with few reported cases. Case Description: We report the case of a 48-year-old man with a history of atypical fourth ventricular CPP and gross total resection (GTR) in 2008. In 2015, he presented with radicular pain, decreased strength, and paresthesia in the left leg. Magnetic resonance imaging revealed a well-defined intradural ovoid lesion in the vertebral canal at the level of the L3-L4 intersomatic space. Subtotal resection of the tumor was performed. The patient recovered well, with relief of pain and no neurological deficit. A literature research few cases of CPP metastasis in adults. We describe here a fifth-decade male patient with a lumbar neoplasm, which according to the histopathologic characteristics and location is the first case of an atypical papilloma implant of the choroid plexus at this spinal level. Conclusion: GTR of primary lesions and associated implants remains the gold standard for surgical treatment of CPP. Radiotherapy, stereotactic radiosurgery, and chemotherapy are adjuvant therapies for CPP but there is no definitive protocol for the management of implants. Proper follow-up of these patients is essential since spinal drop can appear many years after the initial presentation of CPP.

Background Double Crush Syndrome (DCS) is a clinical condition that involves multiple compression sites along a single peripheral nerve. The present study aims to describe the epidemiology of DCS and surgical results. Methods A retrospective observational analytic study included patients with clinical diagnosis of cervical radiculopathy and carpal tunnel syndrome who underwent surgery between January 2009 and January 2019. General demographic characteristics were noted, and 3 groups were distinguished: spinal surgery, carpal tunnel release, and bimodal decompression (BD); statistical differences were analyzed between them. Results The sample comprised 32 patients. DCS prevalence was 10.29%. Mean age at presentation was 59.25 ± 10.98 years. There was female predominance (75%). Paresthesia was the main symptom (65.6%). Post-surgical results of BD showed significant improvement in sensory nerve conduction velocity, motor nerve conduction velocity (both P = 0.008), and disability on Douleur Neuropathique 4 questions, Neck Disability Index, and Boston Carpal Tunnel Questionnaire (P = 0.001, 0.004, 0.008, respectively). Conclusions Diagnosis and management of DCS are a challenge. It is necessary to determine the site with maximal compression and risk of complications to decide on treatment. If first-line surgery is adequate, proximal and distal symptomatology can be improved. To maximize success, we recommend BD, according to the present results.

Introduction Postsurgical Lumbar facet joint syndrome (PLFJS) is a clinical entity characterized by acute or chronic lumbar pain which can irradiate to the lower extremities but never with a dermatomal pattern in postsurgical patients of lumbar surgery. The diagnosis and treatment are with a Diagnostic Facet Block (DFB). This study describes the outcome of patients undergoing DFB after lumbar surgery and compares the results with patients without surgery. Methods An analytic and longitudinal study with patients over 18 years old between January 2018 and January 2020. For the comparative analysis, we performed two groups: non-surgical lumbar facet joint syndrome (NSLFJS) and PLFJS. Results The general prevalence of PLFJS in our population was 12.5%. The results after DBF showed a significant decrease in the Oswestry percentage and pain according to the Visual Analog Scale(VAS) for the NSLFJS and PLFJS groups between the 3 surgical stages (pre-DFB, post-DFB at 6 weeks and post-DFB at 6 months), but no significant differences between the 2 groups. Discussion The VAS and Oswestry reported a significant improvement in both groups of patients. The innervation of the lumbar facet joints causes pain, this is secondary to the pathological neural activity of facet arthritis that arises because of chronic postsurgical inflammation or chronic degenerative changes. Conclusion The origin of the LFJS is the arthrosis of the facet, originated by postsurgical or degenerative changes. DFB is effectivefor decreasing pain of facet joint origin in patients with previous lumbar surgery.

Highlights • Intracranial malignant peripheral nerve sheath tumors are an extremely rare pathology with a high morbidity and mortality. • The most frequently affected cranial nerves in decreasing order of frequency are the trigeminal, vestibulocochlear and facial, being glossopharyngeal, vagus and spinal nerves extremely rare affected. • This manuscript is the first in English-written literature to expose the case of an adult female patient with NF1 who presented a MPNST involving the glossopharyngeal, vagus and spinal left nerves with intracranial-extracranial extension and systemic metastases. • Treatment strategies for this particular pathology are still unclear due to the low frequency of the disease and a lack of number of cases, making them a challenge for the neurosurgeon., Introduction Intracranial malignant peripheral nerve sheath tumors are an extremely rare pathology with a high morbidity and mortality. Epidemiological, clinical and prognostic data are scarce and with little certainty in the literature. The aim of this paper is to report for first time in English literature, the case of a patient with type 1 neurofibromatosis, who presented a malignant peripheral nerve sheath tumor that involved the left glossopharyngeal, vagus and spinal nerves with intracranial and extracranial extension through jugular foramen and systemic metastases. Presentation of case A 37 years-old female patient with malnutrition and Villaret́s syndrome. It was confirmed by brain magnetic resonance imaging and PET-CT the presence of a neoplasic lesion which was radiologically compatible with malignant peripheral nerve sheath tumor with systemic metastases. Partial surgical resection was performed; the patient postoperative course was without significant clinical improvement but with added peripheral facial palsy. The patient did not accept adjuvant management because of personal reasons. Discussion and conclusion Behavior therapy is unclear due to the low frequency of the disease and the lack of case series, representing a challenge for the physician in its approach and a poor prognosis for the patient.

Introduction Brown tumors are non-neoplastic, expansive bone lesions that occur only in the setting of hyperparathyroidism. The most usual localization of brown tumors is in mandible, ribs and large bones. In cervical spine, to date, there are only 11 cases reported. The aim of this work is to report the case of a patient with Wegener´s granulomatosis with secondary end stage renal failure who developed a brown tumor in C4 vertebra. Presentation of case A 25-year-old woman with an history of 2 months of worsening cervicalgia without history of trauma. She complained about progressive neck pain with irradiation to both shoulders and right arm paresthesias, spontaneous fracture or brown spinal cord tumor were suspected. She presented cervical spine instability, was managed with corpectomy of C4 and biopsy. Discussion The initial suspicion of this disease must be since the first clinician contact of the patient and with the past medical history of end stage renal failure plus recent neurologic manifestations. The aim of neurosurgical management of these patients is to promote spinal stability and release spinal cord and nerve roots to eliminate risk of neurological deficits. Conclusion The importance of the prompt diagnosis of the brown tumor is to establish a multidisciplinary management to prevent progression, neurologic complications and sequelae despite its benign behavior.

Highlights • Lower back pain and radiculopathy are demonstrated in up to 85% of patients by a lumbar disc herniation. • No clear consensus has been made regarding classification by measurement of the actual herniated content. • The patient's lumbar disc herniation classifies as an extruded disc. • MIS is the preferred approach for the treatment of lumbar disc herniation regarding the size., Introduction and importance Low back pain and lower limb radiculopathy are some of the most common diagnoses in our neurosurgery department. Giant lumbar intervertebral disc herniation, are not a common find in our daily practice. Management for this kind of pathology is controversial. The quest for the best surgical approach is still a matter of debate. This case report intends to demonstrate the advantages of minimally invasive procedures. Case presentation 40-year-old female, diagnosed with giant lumbar L5-S1 disc herniation with localized lower back electric-type pain, 5/10 intensity in the visual analog scale (VAS) and an Oswestry Disability Index (ODI) score of 76 points, underwent minimally invasive surgery (MIS) with tubular retractor system. 6-month post-op, the patient referred no pain, and an ODI score of 4 points was obtained. Clinical discussion There is no clear classification, regarding the lumbar intervertebral disc herniated content. We didn’t find any clear indications or contraindications regarding the relationship of the size of herniated disc content and surgical approach (MIS vs Open). We perform on average 175 spine cases per year and educational commitment with spine pathology is demonstrated with our spine fellowship since 3 years ago. Conclusion We believe giant extruded regardless of migration, single-level intervertebral disc herniation, could be effectively and safely treated by MIS.

Primary lymphomas of the skull base are rare (1% of lymphomas in adults); they can originate from the cavernous sinus and the parasellar region. Diffuse large B-cell lymphoma is the most common histologic subtype. Currently, the origin of these lymphomas is controversial, and their clinical characteristics are not very specific. There are various treatments for these lesions with a variable response; therefore, the prognosis of these lesions is variable. Clinical case: We present the case of a 52-year-old man who spontaneously presented with diplopia. Physical examination revealed a limitation in adduction of the right eye, right palpebral ptosis, and limitation in the abduction of the left eye. Brain magnetic resonance imaging revealed a well-defined and homogeneous extra-axial lesion at the cavernous sinus level. The patient was biopsied and diagnosed with B-cell lymphoma; received chemotherapy and radiotherapy. In this article, we present a clinical case that considers the characteristics of the diagnosis and is the first B-cell lymphoma at the cavernous sinus level reported in Mexico. Conclusion: Skull base lymphomas have a broad clinical spectrum. Minimally invasive surgery for biopsy purposes is the gold standard for diagnosis, and the treatment with the best results is chemotherapy.

Introduction There are different techniques for the reconstruction of the temporal muscle (TM) in the pterional approach (PA) in order to avoid and reduce atrophy, it has not been able to avoid it in its entirety. The administration of bupivacaine generates regeneration of muscle fibres. There are no studies in the medical literature that evaluate the time of TM manipulation and the use of bupivacaine for the treatment of atrophy after pterional approach, the present investigation aim is to describe the effects of these variables. Patient and methods Longitudinal study, including patients from 18-80 years old with pterional approach at 2016–2017. We evaluated the effects of the TM manipulation times and the administration of 0.5% bupivacaine on the trophism and function of TM. Results Twenty-nine patients underwent a PA; 16(55.17%) count with criteria for 0.5% bupivacain infiltration. We found a negative correlation between manipulation times and trophism, with no statistically significance (p > .05). We evaluated presurgical and postsurgical index of Helkimo and Fonseca's index, finding an increase of disfunction with statistically significance (p In patients who were infiltrated with 0.5% bupivacaine we observed a mean difference in the TM's trophism of 0.275 ± 1.18 mm, in contrast with no infiltrated which was 2.39 ± 1.30 mm (t[27] = −5.118, p = .0001). Conclusions The manipulation of the TM during a pterional approach conditioned an impact on the quality of life according to the disfunction indexes, due to atrophy. This investigation exhibits that de administration of 0.5% bupivacaine during surgery offers a decrease in the TM atrophy.

Gliomas are the most frequent supratentorial intracranial tumors in the pediatric population. Usually, they are intra-axial lesions with a characteristic image pattern, however, there are few reported cases of gliomas with exophytic growth. There are no previous reports in the literature of gliomas with exophytic growth in the Sylvian fissure. Fourteen year-old female patient who started with seizures. In imaging studies, a neoplasic mass with an exophytic portion in the left Sylvian fissure was found. Macroscopically, total resection was performed, definitive diagnosis was anaplastic astrocytoma. She presented recurrence and is currently receiving adjuvant treatment. Supratentorial gliomas with exophytic growth are extremely rare. We report the first case in the pediatric population, and we consider it is important to know its imaging and macroscopic characteristics for its initial management and to take it into account as a differential diagnosis of exophytic lesions.