Introducción: Los Craneofaringiomas son tumores embrionarios que se originan en la parte anterosuperior de la hipófisis, conun frecuente crecimiento supraselar. El crecimiento supraselar puede involucrar o no el hipotálamo anterior, medio o posterioren dependencia del sentido del vector de crecimiento anteroposterior. Método: Se operaron 40 pacientes en el Hospital Hermanos Ameijeiras donde se realizó un abordaje endonasal endoscópico extendido transplanum transtuberculum transmedio selar; trans-selar o trans-doso selar, en dependencia de la clasificación de Kassam; se determinó el compartamiento clínico pre y postoperatorio aplicando la clasificación de Elliot y colaboradores. Resultados: Se observó una mejoría del estatus visual, no así del estatus pituitario ni hipotalámico, sin embargo, se logró una estabilización de los mismos. El acceso quirúrgico y el grado de resección tumoral fueron excelentes, con resección total en el 92,5% y la complicación más frecuente fue la diabetes insípida.

Introducción: Los cordomas del clivus son neoplasias de lento crecimiento, originadas de restos de la notocorda, que invaden el hueso y tienen alto índice de recurrencia. Objetivo: Caracterizar el comportamiento de esta entidad en nuestro centro en cuanto a los aspectos clínicos, radiológicos, terapéuticos y evolutivos. Método: Se realizó un estudio descriptivo retrospectivo en el período comprendido entre enero de 2010 a diciembre de 2015. La muestra fue de 10 pacientes, 6 masculinos y 4 femeninos, con una edad promedio de 55 años. Se realizó en todos los casos un abordaje endonasal endoscópico extendido al clivus, seguido de radioterapia de intensidad modulada (IMRT) hipofraccionada o 3D conformada Resultados: Las alteraciones clínicas más frecuentes fueron: la cefalea y la diplopía. Predominaron los cordomas clásicos al final de la sexta década de vida y en el sexo masculino. Se logró una resección completa de la lesión en el 80% de los casos y un control de la enfermedad a los 4 años en el 90%. Existieron aceptables complicaciones y un fallecido que presentó fístula del líquido cefalorraquídeo y meningitis. Conclusiones: El abordaje endonasal endoscópico extendido al clivus constituye una opción quirúrgica excelente y prometedora, lográndose una resección quirúrgica radical de la lesión con aceptables complicaciones.

Introduction The paranasal sinuses mucoceles are benign expansive cystic lesions that occur rarely in the sphenoid sinus and contain mucous material enclosed by cylindrical pseudostratified epithelium. Objective To report one case of sphenoid sinus mucocele that occurred with headache and was submitted to surgical treatment through endonasal endoscopy approach. Case Report 59-year-old male patient with history of increasing frontoorbital, bilateral, fluctuating headache and exophthalmos. There was no other associated clinical abnormality. Computed Tomography (CT) and Magnetic Resonance Image (MRI) scans confirmed an expansive mass of sphenoid sinus, suggesting mucocele. The patient was submitted to endonasal endoscopic surgery with posterior ethmoidotomy, large sphenoidotomy, and marsupialization of the lesion. Conclusion Mucoceles of the sphenoid sinus are a very rare condition with variable clinical and radiological presentation. Surgical treatment is absolutely indicated and early treatment avoids visual damage that can be permanent. Endonasal endoscopic approach with drainage and marsupialization of sphenoid sinus, using a transnasal corridor, is a safe and effective treatment modality.

Background The COMPLETE trial showed that routine and complete Percutaneous Coronary Intervention (PCI) of non-infarct related artery (non-IRA) lesions in STEMI was associated with a significant reduction in the rates of death or new myocardial infarction. However, whether this benefit is related to improved myocardial salvage and left ventricular (LV) function is unknown. Methods We prospectively included 465 patients with first STEMI reperfused by primary PCI. Late gadolinium-enhanced Cardiac Magnetic Resonance (CMR) was obtained during admission to measure the area at risk (AAR), IRA-infarct size (IS) as % LV mass, and myocardial salvage index (MSI) as % of AAR. The study was repeated in 392 of them at 6 months follow-up to compute LV volumes and ejection fraction (EF). Results Patients with three-vessel disease had larger IS than those with two or single vessel disease (25.4±14.5% vs 19.0±13.1% vs 19.0±12.8% LV mass respectively, p<0.05), despite no differences in AAR (33±11% LV mass for all). Accordingly, MSI decreased progressively for one, two or three-vessel disease (42.4±31.4 vs 41.5±30.6 vs 25.1±31.3% AAR respectively, p<0.01). The number of myocardial segments with microvascular obstruction (MVO) was also higher for three-vessel disease (1.9±1.9) than for two (1.1±1.7) or single-vessel disease (1.2±1.8), p<0.05. Mean follow-up EF also decreased progressively with the number of vessels involved (50.7±9.4, 49.1±11.4 and, 44.4±11.2% respectively, p<0.01). A total of 183 patients had multivessel disease. Among them, those with complete revascularization (n=51) had larger MSI (46.4±35.2 vs 34.5±29.3% AAR, p<0.04) and were less likely to have MVO phenomenon (28.6 vs 49.2%, p<0.05). However, no significant differences in the change in EF was observed between both groups (ΔEF:+4.4±6.2 vs +4.3±6.2%, p=0.985 for the interaction). Conclusion The presence and extent of multivessel disease influence myocardial salvage and MVO following primary PCI in STEMI. Improvement in myocardial salvage in the IRA territory and a reduction in microvascular obstruction may mediate the beneficial effects of complete revascularization. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundaciό La Marato TV3 2015303132, FIS PI15/00531. Partially funded with FEDER funds.