Introduction: A giant cerebral aneurysm is one that reaches a size greater than 25 mm in diameter, and whose complications are rupture and a mass effect like a tumor. The complex anatomy of the posterior communicating segment and the size of the aneurysm make it challenging to treat surgically, so the best definitive treatment option for this type of pathology is the Endovascular route, which seeks obliteration and exclusion of the aneurysm.

Clinical case: A 65-year-old female patient with a history of high blood pressure and a religion of being a Jehovah's Witness, was admitted with an illness of 5 months characterized by headache, dizziness, eyelid ptosis, left hemiparesis 4/5, on a Glasgow coma of 15 points. Cerebral angiography showed a giant unruptured aneurysm of the communicating segment of the right internal carotid artery, for which it was embolized with a stent and penumbra coils using the “Jailing” technique, successfully closing the entire aneurysm.

Conclusion: Giant aneurysms are complex lesions, for which Endovascular therapy is a safe and effective alternative with a lower complication rate.

 

 

 

 

Introduction: In epilepsy refractory to medical treatment which presents multiple and bilateral epileptogenic foci such as Lennox Gastaut syndrome (LGS) the surgical alternative is disconnection surgery such as callosotomy. Posterior callosotomy is indicated in cases of atonic seizures with posterior resection, leading to better seizure control especially when resection surgeries of the anterior third or anterior two-thirds of the corpus callosum fail. We present the case of a patient with Lennox Gastaut syndrome who required a posterior callosotomy after a partial anterior callosotomy, finally achieving complete control of atonic seizures.

Clinical case: a 10-year-old male patient with a diagnosis of drug-resistant epilepsy due to Lennox Gastaut syndrome, and a surgical history of a partial callosotomy of the anterior third of the corpus callosum. In March 2021 which achieved only a transient decrease in seizures. The patient had had atonic seizures for 6 years and had been unsuccessfully treated with 5 different anticonvulsant medications such as topiramate clonazepam levetiracetam lamotrigine and valproate. On examination: Awake, alert, moderate to severe psychomotor retardation. Brain MRI was normal. A posterior microsurgical callosotomy was performed without complications. His postoperative clinical evolution was favorable showing an absence of atonic seizures.

Conclusions: Selective posterior callosotomy is an essential tool in controlling seizures in cases of refractory epilepsy in patients with atonic seizures. Our study suggests that posterior callosotomy is likely to be even more effective and safe when resections of different segments of the corpus callosum are combined.

 

 

 

 

 

 

 

 

Introduction: Ancient schwannoma is a rare subtype of spinal schwannomas. It is named for the degenerative changes that it can present. Contrast-enhanced magnetic resonance helps us diagnose, as it can show heterogeneous lesions that capture ring contrast. The treatment is surgical.

Clinical Case: A 67-year-old male patient is presented, with 2 years of the disease characterized by thoracic radicular pain and severe paraparesis in the last 6 months. Contrast-enhanced MRI showed a tumor with heterogeneous uptake, widening the right T2/T3 foramina with right anterior paravertebral extension and severe canal stenosis at the T2 level. A laminectomy plus total resection of the lesion was performed; the pathology study was reported as ancient schwannoma. The evolution was favorable with complete recovery of muscle strength in subsequent months.

Conclusion: Ancient schwannoma is a rare pathology that has peculiar imaging characteristics and whose treatment is surgical.

 

 

 

Introduction: Anaplastic astrocytoma (AA) or grade III is a primary brain tumor, astrocytic, malignant, and diffusely infiltrating. The survival of patients depends on several clinical and treatment factors, being this unknown in our environment. The objective of this study was to determine the survival of patients operated on for grade III astrocytoma and the impact of preoperative and postoperative prognostic factors.

Methods: A retrospective, observational and longitudinal study of 35 patients operated on for astrocytoma grade III at Hospital Guillermo Almenara between 2003 and 2009 was carried out. Data were collected from medical records, operative reports, and telephone interviews. Patients with anaplastic astrocytomas were classified according to prognostic risk group, treatment type, and surgery extent. SPSS 25.0 was used for the analysis.

Results: Of a total of 124 patients with astrocytoma, 28.2% (35/124) had a grade III astrocytoma, with an average survival of 34.8 months. According to the clinical prognosis group, the survival of the low, medium, and high-risk groups was 46.7, 28.1, and 8.5 months, respectively. Regarding the type of treatment, the group with the longest survival was surgery + radiotherapy (39.5 months), followed by surgery + radiotherapy + chemotherapy (29.3 months), and the one with the lowest survival was surgery alone (6.5 months). According to the extension of the surgery, the highest survival was obtained by the total resection group (46.2 months), while the lowest survival was for the partial resection group (13.9 months).

Conclusions: The average survival of patients operated on for grade III astrocytomas in our hospital was 34.8 months, with the best prognostic factors being the "low risk" clinical group, the combined treatment of surgery + radiotherapy, and total resection. Its classification into prognostic risk groups based on pre-surgical clinical data helps us predict survival.

 

 

 

Introduction: Esthesioneuroblastoma, or olfactory neuroblastoma, is a rare malignant neoplasm of the sinonasal tract that originates in the olfactory neuroepithelium with neuroblastic differentiation. It occurs most frequently in the upper nasal cavity. It is a locally aggressive neoplasm and metastasizes both hematogenously and lymphatic. A multimodal approach, which can combine surgery, chemotherapy, and radiotherapy, is essential for the management of these tumors.

Clinical Case: A 56-year-old female patient with an 18-month illness, characterized by loss of smell, shortness of breath, and frontal headache. Brain tomography showed an extensive tumor in the nasopharynx with intracranial involvement and destruction of the anterior skull base. She was diagnosed with Esthesioneuroblastoma by endonasal endoscopic biopsy. A combined approach was planned first by Neurosurgery, through a bifrontal craniotomy in which the resection of the intracranial portion and the reconstruction of the skull base were achieved. Then, Head and Neck Surgery perform the resection of the tumor in the nasal cavity through right lateral rhinotomy. The patient evolved favorably in the postoperative period without presenting neurological deficit, so she was discharged in the following days after the removal of the tracheostomy cannula. She subsequently received adjuvant chemotherapy and radiation therapy.

Conclusion: In an Esthesioneuroblastoma, obtaining an extensive resection, total, if possible, is a very important factor in the prognosis of a patient, so it is recommended to use the combination of several surgical techniques to achieve this goal.