Pneumocephalus and CSF leak secondary to skull base fracture by pyrotechnical object: case report

Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)

Presigmoid transpetrous approach (partial petrosectomy) combined with subtemporal transtentorial approach for petroclival meningioma

Introduction: Petroclival meningiomas constitute 3 to 10% of meningiomas of the posterior fossa, they originate in the petroclival fissure, in the upper part of the clivus, petrosal apex, and medial to the trigeminal nerve. Resection of these tumors is a neurosurgical challenge. The combined partial petrosectomy approach associated with a sub-temporal approach is a technique described by various authors; however, its performance is considered highly complex. We report the case of a petroclival meningioma operated successfully in our hospital using a combined presigmoid and subtemporal transtentorial transpetrosal approach. Clinical case: 33-year-old female patient with a clinical picture of headache, nausea, and gait disturbance. Brain magnetic resonance imaging showed a large right petroclival tumor (4.2x3.9x3.8cm) that displaced the brainstem and secondary hydrocephalus. The hydrocephalus was treated with a ventricular peritoneal shunt. Then, the tumor was resected using a combined presigmoid and subtemporal transpetrosal approach, a technique that allowed adequate exposure of the tumor, achieving complete resection, without intraoperative complications. Postoperative evolution was favorable, with no sequelae. Conclusion: The combined presigmoid and transtentorial subtemporal transpetrous approach for petroclival meningiomas is an effective and feasible technique to perform in our environment. The support of technology such as Neuronavigation, the ultrasonic aspirator, intraoperative monitoring, and adequate experience in skull base surgery are fundamental factors for the success of this surgery. Keywords: Meningioma, Skull Base Neoplasms, Craniotomy, Neurosurgical Procedures. (Source: MeSH NLM)

Impact of the COVID-19 pandemic on patients with rupture of intracranial aneurysm at the Dos de Mayo National Hospital in Lima Peru

Objective: To evaluate the impact on the outcome of patients with a ruptured aneurysm, who are admitted to the Dos de Mayo National Hospital in the context of the COVID-19 pandemic. Methods: 42 operated for ruptured aneurysms were included in the context of the COVID-19 pandemic between March 1 and December 31, 2020 (group A), and a control group of 44 patients operated on between March 1 and December 31, 2019 (group B). Upon admission, the poor neurological status defined by the WFNS> 3, the Fisher IV high-grade tomographic status with intracerebral hematoma or acute hydrocephalus, which required external ventricular drainage (EVD), and the presence of vasospasm were evaluated. The Modified Rankin Scale was evaluated at discharge. Statistical analysis was performed to compare both groups. Results: The rates of poor neurological presentation and complications during the presurgical evolution (intracerebral hemorrhage and acute hydrocephalus that required EVD) were higher in group A (p = 0.002 and p <0.05, respectively). The delay in the admission of the patient to the emergency room to receive treatment was 7.5 days in group A and 4.95 days for group B. All these factors contributed to a lower possibility of recovery in group A, which was correlated with higher Values on the Modified Rankin Scale at discharge for this group (p = 0.04). Conclusion: We did not find national reports on ruptured aneurysms treated in the context of the pandemic, this being one of the first studies that demonstrate the impact of the COVID-19 pandemic in patients with ruptured intracranial aneurysm. The population should be educated on how to act in case of specific symptoms such as sudden intense headache, neurological deficit, or acute chest pain, which should receive timely care, immediate referral, and priority of treatment in referral hospitals in order to reduce morbidity and mortality of complex neurological pathologies. Keywords: Intracranial Aneurysm, Aneurysm, Ruptured, Cerebral Hemorrhage, Pandemics, COVID-19. (Source: MeSH NLM)

Orbital schwannoma, a rare entity. case report

Introduction: Orbital schwannoma is a rare pathology, which constitutes approximately 1 to 6.5% of orbital tumors, and can originate from the ophthalmic branch of the 5th cranial nerve or from perioptic sympathetic nerves. Its diagnosis is made by magnetic resonance imaging (MRI) with contrast. The first-line treatment is surgery, and total resection provides a good prognosis. The time of illness is used to evaluate the visual prognosis in these patients. Clinical Case: A 12-year-old woman, with a 9-year illness, characterized by a progressive decrease in right visual acuity until reaching amaurosis. Brain MRI with contrast shows an isointense tumor on T1, adhered to the medial aspect of the optic nerve sheath, which captures contrast, slightly hyperintense on T2. Total resection of the lesion is performed, and the diagnosis of schwannoma is confirmed by pathological anatomy. A month after surgery, the patient had slightly recovered her vision, without presenting other complications. Conclusion: Orbital schwannoma is a rare pathology that must be treated surgically as soon as possible to achieve a better visual prognosis for the patient. Keywords: Neurilemmoma, Optic Nerve, Orbital Neoplasms, Cranial Nerves, (source: MeSH NLM)

Neurological Severity Classification System (CSN-System) in adults with BTI, Hospital Cayetano Heredia, Lima - Peru, 2020. Preliminary study.

Objectives: Traumatic Brain Injury (TBI) is the disruption of brain function and architecture. The Glasgow Coma Scale (GCS) is the most widely used TBI severity classification; however, it assesses the functional status of the brain resulting from highly heterogeneous lesions and has little accuracy. The Neurological Severity Classification System (NSC System), a clinical-tomographic instrument designed to overcome lesion heterogeneity, assesses brain function and structure in determining the severity of BTI. Methods: Observational, prospective, and cross-sectional study in adults with BTI from the emergency service of the Cayetano Heredia Hospital, April - August 2020. It included patients aged 18 years or older with acute BTI. The NSC system was compared with the GCS in the BTI classification. Results: Of 29 patients, 82.76% were male and 82.76% were between 18 and 64 years old. The severity of the TBI through the NSC System was very mild 6.70%, mild 17.24%, moderate 51.72%, severe 17.24%, and critical 6.70%. There was an association between the NSC System and the Rotterdam Computed Tomographic Score (RCTS) (p = 0.005), a moderate positive correlation of the NSC System with the RCTS (Rho 0.6773, p = 0.0001), an association between the NSC System and the indication for neurosurgical intervention (p = 0.002), as well as high sensitivity-specificity in the distinction of severity categories with the NSC System, and lower GCS performance. Conclusions: The NSC clinical-tomographic system improves the determination of the severity of BTI in comparison with GCS and provides an excellent relationship with the indication for neurosurgical intervention. Keywords: Brain Injuries, Traumatic, Brain, Glasgow Coma Scale, Functional Status (Source: MeSH NLM)

Double aneurysm clipping of true fetal posterior communicating artery by minipterional approach plus control with sodium fluorescein: a case report

Introduction: True fetal or fetal type posterior communicating artery aneurysms (PComA) are a technical challenge for the neurosurgeon in both endovascular and microsurgical treatment. Microsurgical clipping using minimally invasive approaches is a safe and optimal alternative solution. Clinical case: a 53-year-old patient who presented subarachnoid hemorrhage, Hunt & Hess scale III, Fisher scale III, and Glasgow Coma Scale of 13. Cerebral angioCT showed two saccular aneurysms in the right true fetal PComA. The patient underwent a right interfacial minipterional craniotomy and clipping of the 2 aneurysms, using sodium fluorescein as a guide. Total occlusion of the aneurysms was achieved, maintaining the patency of the fetal PComA. Conclusion: The minipterional approach allows adequate access to the fetal PComA and the aneurysms originating from it. It is essential to review the patency of the adjacent vessels, being the use of intraoperative fluorescein is an essential complement to avoid complications such as cerebral infarction. Keywords: Intracranial Aneurysm, Craniotomy, Fluorescein, Subarachnoid Hemorrhage, Neurosurgeons (Source: MeSH NLM)

Mild cranioencephalic trauma in the child population. Experience at the Baca Ortiz Hospital, Quito-Ecuador, 2016-2019

Introduction: The alteration at the anatomical and/or functional level, both motors, sensory and cognitive, a product of the sudden exchange of mechanical energy caused by an external force on the skull, is what defines a traumatic brain injury (TBI). The permanence or transience of these alterations determines the severity of the TBI, with 70 to 80% of a mild type whose neurological symptoms are of little intensity and duration. Clinical observation in mild TBI includes observing children under 2 years of age with trauma without fracture or admission criteria clinically for 2 to 4 hours and observing children with symptoms or mechanism of fall for 4 to 6 hours not known. The objective of the study is to describe mild TBI at Baca Ortiz Pediatric Hospital, a national children's referral hospital in Ecuador, during the period from January 2016 to December 2019. Methods: Cross-sectional, descriptive, and retrospective study that includes patients diagnosed with mild head trauma evaluated and treated in the Neurosurgery Service of the Baca Ortiz Pediatric Hospital, from January 2016 to December 2019. Results: During the period 2016 to 2019, 105 children with mild TBI were diagnosed and treated, this being more frequent in males (62.85%) and during the preschool stage (51.42%). Of all of them, 82.85% received specialty medical care in the first 6 hours after the trauma. The main etiology was the fall produced at home (66.66%). Conclusions: Mild traumatic brain injury is one of the main reasons for pediatric hospital consultation in our setting. It mostly occurs in male patients of preschool age, because of falls at home. Keywords: Craniocerebral Trauma, Child, Hospitals, Pediatric, Referral and Consultation (Source: MeSH NLM)