Background and Importance Brainstem lesions may be unresectable or unapproachable. Regardless, the histopathological diagnosis is fundamental to determine the most appropriate treatment. We present our experience with transfrontal stereotactic biopsy technique for brainstem lesions as a safe and effective surgical route even when contralateral transhemispheric approach is required for preservation of eloquent tissue. Clinical Presentation Twenty-five patients underwent surgery by transfrontal approach. Medical records were reviewed for establishing the number of patients who had postoperative histopathological diagnosis and postoperative complications. Twenty-four patients (18 adults and 7 children) had histopathological diagnosis. There were 18 astrocytomas documented, of which 12 were high grade and 6 low grade. The other diagnoses included viral encephalitis, post–renal transplant lymphoproliferative disorder, nonspecific chronic inflammation, Langerhans cell histiocytosis, and two metastases. No case was hindered by cerebrospinal fluid loss or ventricular entry. Complications included a case of mesencephalic hemorrhage with upper limb monoparesis and a case of a partially compromised third cranial nerve in another patient without associated bleeding. Conclusion Stereotactic biopsy of brainstem lesions by transfrontal ipsilateral or transfrontal transhemispheric contralateral approaches is a safe and effective surgical approach in achieving a histopathological diagnosis in both pediatric and adult populations.

Fuentes de financiamiento del estudio: Ninguna. Conflicto de interés: Ninguno.

Purpose: To synthesize the evidence on the outcomes of visual function, hypopituitarism, ophthalmoplegia, and tumor growth/recurrence in patients with pituitary apoplexy (PA) treated either surgically or conservatively. Methods: The MEDLINE, Scopus, Web of Science, Ovid, and Cochrane databases were systematically searched. The inclusion criteria were studies of adult human beings with PA, who underwent surgery or were treated conservatively for the management of their pathology and evaluated any of the described outcomes. Studies published in English and Spanish were considered, and there was no restriction regarding the date of publication. Odds ratios were estimated for each study and treatment effects were calculated through random effects models. Results: The literature search yielded 18 studies published between 1993 and 2022, enrolling a total of 886 patients: 533 treated with surgery and 353 conservative. Patient with more severe symptoms underwent surgery. The recovery rates in visual field, endocrine function, and ophthalmoplegia, were, for overall surgery 76%, 23% and 81% respectively; early surgery 79%, 0% and 81% respectively; late surgery 73%, 0% and 70% respectively; and conservative management 79%, 23% and 90% respectively. Pooled analysis favored early surgery versus conservative management in ophthalmoplegia recovery with statistical significance OR 2.78 (CI 95% 1.09, 7.09 p = 0.03). Conclusion: Both treatment modalities may be capable to improve or completely recover deficits in the respective appropriate cases. Further reports with greater statistical power are needed comparing equivalently treatment modalities to estimate better their effects on the studied outcomes.

Introducción: En la pared torácica anterior pueden presentarse masas musculares supernumerarias, estas suelen ubicarse profundas a la piel, por delante del músculo pectoral mayor y de su fascia. Sus fibras pueden cursar paralelas u oblicuas al esternón, presentarse uni o bilateralmente a un lado de éste y con morfología muy variada que se presta a múltiples clasificaciones. Adquieren importancia clínica, especialmente en radiología, porque pueden prestarse a errores en el diagnóstico de algunos tipos de patología mamaria. Material y métodos: Revisión bibliográfica de los variados tipos de masas musculares que pueden presentarse en la pared torácica anterior y reporte de un caso en cadáver masculino de nacionalidad colombiana, de etnia mestiza, disecado por estudiantes de medicina en la sala de disección del Departamento de Morfología de la Universidad del Valle, en Cali, Colombia. Resultados: En el lado derecho de la pared torácica anterior del cadáver se encontró una masa muscular que describía un trayecto vertical, paralelo al borde derecho del esternón, la cual medía, considerando en conjunto todos los fascículos musculares, aproximadamente 7 cm de largo y 2,9 cm de ancho. Conclusion: Dada la ubicación del músculo en la parte anterior de la pared torácica, en relación con el músculo pectoral mayor y la mama, puede tratarse de una variación del llamado “músculo esternal”, del cual pueden derivarse algunas implicaciones radiológicas, quirúrgicas y clínicas, por lo que se considera importante que el personal de la salud conozca la anatomía y la epidemiología de esta variación anatómica para evitar diagnósticos errados.

Objective A frequent challenge for the neurosurgeon when treating a patient with cranioencephalic trauma is to determine whether the patient has a vascular lesion, when to suspect it, and what studies to request. In this context, the objective of the present study was to identify the variables on cranial computed tomography (CT) scans that predict vascular injury in digital subtraction angiography in patients with cranioencephalic trauma. Methods We conducted a cross-sectional study of patients with cranioencephalic trauma admitted to the Hospital Universitario del Valle between June 2016 and June 2019. Subjects with available simple CT images of the skull and digital subtraction angiography were included. Results A total of 138 subjects who met the inclusion criteria were identified. The average age was 32 years, 82% were men, and the most frequent mechanism of injury was firearm wound (59%). The variables associated with vascular injury were fracture of the base of the temporal skull and sphenoid fracture. Conclusion The presence of fractures of the base of the temporal skull and sphenoid fractures is associated with vascular injury in patients with cranioencephalic trauma.