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Del Pino-Camposeco J, Villanueva-Castro E, Canela-Calderon O, Ponce-Gómez JA, Salazar Felix NA, Arriada-Mendicoa JN. Mature Spinal Teratoma: A Case Report. Cureus 2024; 16:e53785. [PMID: 38465043 PMCID: PMC10923608 DOI: 10.7759/cureus.53785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
We presented an unusual case of a teratoma in a 76-year-old female who began four years ago with paresthesias and hypoesthesias in the sacral and gluteal regions. She denied weakness or gait instability. The magnetic resonance imaging showed an intradural lesion within the cauda equina at levels L2-L3. We decided to perform a posterior midline approach to the lumbar region to expose L2-L3 levels. After doing the L2-L3 laminectomy and the durotomy, we found a solid lesion surrounded by nerve roots with heterogeneous content. Through the meticulous separation of the nerve roots surrounding the lesion, we punctioned it, observing the exit of melanocytic material. Histopathological findings showed germinal neoplasia without immature neuroepithelium or malignant component; therefore, the diagnosis of mature teratoma was made. The patient was discharged without any aggregate neurological deficit. At the six-month follow-up visit, the patient continued with paresthesia in the gluteal region without motor weakness and reported minimal gait improvement.
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Affiliation(s)
- Jorge Del Pino-Camposeco
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Obet Canela-Calderon
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Noe Alejandro Salazar Felix
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Súarez, Mexico City, MEX
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Del Pino-Camposeco J, Villanueva-Castro E, Deustúa-Hernández D, Canela-Calderón OJ, Martínez-de la Maza E, Arriada-Mendicoa JN, Ponce-Gómez JA. Resection of Thoracic Plasmacytoma and Corpectomy Through the Anterolateral Thoracic Approach: A Case Report. Cureus 2023; 15:e50627. [PMID: 38226126 PMCID: PMC10789388 DOI: 10.7759/cureus.50627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
This case report details the case of a 57-year-old male who initially manifested low back pain radiating from the lumbar region to the left leg. Progressive symptoms included paresthesia on the plantar surfaces of both feet and gait instability attributed to weakness in the pelvic limbs. Computed tomography imaging revealed osteolytic lesions in the T9, T10, and T11 vertebral bodies, resulting in compression of the spinal cord. Subsequent contrast-enhanced magnetic resonance imaging validated these findings, confirming the presence of an extradural tumor. In accordance with the Spinal Instability Neoplastic Score (SINS), the case was categorized as indicative of potential spinal instability. Consequently, a surgical intervention was performed to excise the lesion. Thus, the role of SINS played a pivotal role in guiding the decision-making process for the chosen treatment modality.
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Affiliation(s)
- Jorge Del Pino-Camposeco
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Obet Jair Canela-Calderón
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Ernesto Martínez-de la Maza
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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3
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Ramírez-Aragón S, Del Pino-Camposeco J, Villanueva-Castro E, Canela-Calderon O, Arriada-Mendicoa JN, Ponce-Gómez JA. A Postoperative Complication of Takotsubo Syndrome in the Spinal Surgery: A Case Report. Cureus 2023; 15:e51034. [PMID: 38264385 PMCID: PMC10805121 DOI: 10.7759/cureus.51034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
We present the case of a 32-year-old woman with a diagnosis of lumbar root syndrome and spondylolisthesis, which is why she underwent surgery. Anterior discectomy and intersomatic box placement plus posterior fixation were performed with percutaneous transpedicular screws in L5-S1. At 24 hours of the procedure, the patient presents sustained hypotension, adding sudden and intense chest pain with neck irradiation, dyspnea, and diaphoresis, as well as electrocardiographic abnormalities and elevation of cardiac enzymes suggestive of an acute coronary syndrome, subsequently evidence of basal hypokinesis in the echocardiogram. After providing hemodynamic support and analgesic management, the symptoms were resolved, and the electrocardiogram (ECG) and cardiac enzymes were normalized, allowing an adequate postoperative evolution.
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Affiliation(s)
- Sergio Ramírez-Aragón
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Jorge Del Pino-Camposeco
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Obet Canela-Calderon
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Villanueva-Castro E, Meraz-Soto JM, Hernández-Dehesa IA, Tena-Suck ML, Hernández-Reséndiz R, Mateo-Nouel EDJ, Ponce-Gómez JA, Arriada-Mendicoa JN. Spinal Ependymomas: An Updated WHO Classification and a Narrative Review. Cureus 2023; 15:e49086. [PMID: 38125233 PMCID: PMC10731541 DOI: 10.7759/cureus.49086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Ependymomas are neuroepithelial tumors that develop from ependymal cells found in the brain parenchyma and can spread to any part of the spinal cord. Three to six percent of all malignancies affecting the central nervous system (CNS) are ependymomas. Even the most talented surgeons are challenged by spinal cord ependymomas; as a result, research into this clinical phenomenon should continue. Since 1979, the World Health Organization (WHO) has published a classification and grading system for CNS malignancies to ensure consistent diagnostic standards worldwide. The WHO prepared an update on these tumors, paying particular attention to molecular techniques to categorize the therapeutic management of each patient with greater accuracy and clarity. We thoroughly reviewed the literature on the epidemiology, etiology, diagnosis, and treatment of spinal ependymomas since there has not been a recent review of these tumors. This included modifications to the 2021 WHO Classification of Tumors of the Central Nervous System.
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Affiliation(s)
- Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Marcos Meraz-Soto
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Martha Lilia Tena-Suck
- Department of Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Edgardo de Jesus Mateo-Nouel
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Tejada-Pineda MF, Hoyo-Ulloa I, Ortega-Porcayo LA, Baquera-Heredia JJ, Zárate-García JP, Romano-Feinholz S, Ponce-Gómez JA, Jiménez SM. Cytomegalovirus (CMV)-Driven Transformation: An Uncommon Cause of a Central Nervous System Pseudotumor. Cureus 2023; 15:e44188. [PMID: 37767259 PMCID: PMC10520896 DOI: 10.7759/cureus.44188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Cytomegalovirus (CMV) is an opportunistic virus that can cause life-threatening neurological diseases in immunocompromised individuals, particularly those with HIV/AIDS. In this case report, a patient presenting with left gait lateralization was found to have a ring-enhancing cerebral mass lesion that was attributed to CMV. To date, only eight similar cases have been documented. When evaluating patients with HIV/AIDS who have cerebral mass lesions, clinicians should keep CMV as a possible cause because prompt antiviral therapy may improve clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Juan Antonio Ponce-Gómez
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", Mexico City, MEX
- Neurological Surgery, ABC Medical Center, Mexico City, MEX
| | - Sergio M Jiménez
- Radiosurgery Unit, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", Mexico City, MEX
- Neurological Surgery - Radiosurgery, ABC Medical Center, Mexico City, MEX
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del Pino-Camposeco J, Villanueva-Castro E, Ponce-Gómez JA, Ramírez-Aragón S, Hernández-Hernández A, Arriada-Mendicoa JN. Foix-Alajouanine Syndrome: A Case Report. Cureus 2023; 15:e36696. [PMID: 37113340 PMCID: PMC10128097 DOI: 10.7759/cureus.36696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/28/2023] Open
Abstract
Foix-Alajouanine syndrome is a rare form of presentation of an arteriovenous malformation of the spinal cord that causes myelopathy in the thoracic and lumbar medullary segments. We present the case of a 46-year-old female who suffered from weakness in the lower limbs with sensation loss, low back pain, urinary incontinence, and constipation. The magnetic resonance image T2 sequence of the thoracic spine from T6 to T11 revealed abnormally hypointense signals in the posterior epidural region caused by larger arteries. A spinal digital subtraction angiography was useful to diagnose a right perimedullary fistula with venous drainage, which was satisfactorily embolized. The key to suspecting this diagnosis is the presence of dilated vessels in the posterior epidural space, which are evident in T2 and short tau inversion recovery (STIR)-weighted sequences. Physicians often misdiagnose Foix-Alajouanine syndrome, resulting in potential delays in care. Neurosurgeons can use surgery or endovascular embolization to treat this condition.
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Ponce-Gómez JA, Ortega-Porcayo LA, Soriano-Barón HE, Sotomayor-González A, Arriada-Mendicoa N, Gómez-Amador JL, Palma-Díaz M, Barges-Coll J. Evolution from microscopic transoral to endoscopic endonasal odontoidectomy. Neurosurg Focus 2015; 37:E15. [PMID: 25270134 DOI: 10.3171/2014.7.focus14301] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation. METHODS Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc-C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up. RESULTS Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series. CONCLUSIONS Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.
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Affiliation(s)
- Juan Antonio Ponce-Gómez
- Departments of Neurological Surgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez," Mexico City, Mexico
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Osuna-Zazuetal MA, Ponce-Gómez JA, Pérez-Neri I. [Neuroprotective mechanisms of cannabinoids in brain ischemia and neurodegenerative disorders]. Invest Clin 2015; 56:188-200. [PMID: 26299059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
One of the most important causes of morbidity and mortality is neurologic dysfunction; its high incidence has led to an intense research of the mechanisms that protect the central nervous system from hypoxia and ischemia. The mayor challenge is to block the biochemical events leading to neuronal death. This may be achieved by neuroprotective mechanisms that avoid the metabolic and immunologic cascades that follow a neurological damage. When it occurs, several pathophysiological events develop including cytokine release, oxidative stress and excitotoxicity. Neuroprotective effects of cannabinoids to all those mechanisms have been reported in animal models of brain ischemia, excitotoxicity, brain trauma and neurodegenerative disorders. Some endocannabinoid analogs are being tested in clinical studies (I-III phase) for acute disorders involving neuronal death (brain trauma and ischemia). The study of the cannabinoid system may allow the discovery of effective neuroprotective drugs for the treatment of neurological disorders.
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Ortega-Porcayo LA, Ponce-Gómez JA, Martínez-Moreno M, Portocarrero-Ortíz L, Tena-Suck ML, Gómez-Amador JL. Primary ectopic frontotemporal craniopharyngioma. Int J Surg Case Rep 2015; 9:57-60. [PMID: 25725331 PMCID: PMC4392184 DOI: 10.1016/j.ijscr.2014.12.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/22/2014] [Accepted: 12/27/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Primary ectopic craniopharyngiomas have only rarely been reported. Craniopharyngiomas involve usually the sellar and suprasellar region, but can be originated from cell remnants of the obliterated craniopharyngeal duct or metaplastic change of andenohypophyseal cells. We present the first case of a primary ectopic frontotemporal craniopharyngioma. PRESENTATION OF CASE A 35-year old woman presented with a one-year history of headache and diplopia. MRI showed a large frontotemporal cystic lesion. Tumor resection was performed with a keyhole endoscopic frontal lateral approach. The pathological features showed an adamantinomatous craniopharyngioma with a cholesterol granuloma reaction. DISCUSSION There have been reported different localizations for primary ectopic craniopharyngioma. Our case presented a lobulated frontotemporal cystic mass formed by a dense eosinophilic proteinaceous material dystrophic calcifications and cholesterol crystals, with epithelial remnants. No tumor regrowth was observed in the magnetic resonance image 27 months postoperatively. CONCLUSION Primary ectopic craniopharyngioma is a rare entity with a pathogenesis that remains uncertain. This is an unusual anatomic location associated with unique clinical findings.
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Affiliation(s)
- Luis Alberto Ortega-Porcayo
- Department of Neurosurgery. National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" Mexico City, Mexico
| | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery. National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" Mexico City, Mexico
| | - Mauricio Martínez-Moreno
- Department of Neurosurgery. National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" Mexico City, Mexico
| | - Lesly Portocarrero-Ortíz
- Department of Neuroendocrinology. National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez", Mexico City, Mexico
| | - Martha Lilia Tena-Suck
- Department of Neuropathology. National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" Mexico City, Mexico
| | - Juan Luis Gómez-Amador
- Department of Neurosurgery. National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez" Mexico City, Mexico.
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