A foreign body penetrating into the intraconal orbital compartment poses a surgical challenge because of its deep location behind the globe and near the optic nerve. We present a case of an air gun pellet lodged into the orbital apex, which was removed via superolateral orbitotomy through coronal incision. This additional craniofacial technique is a safe procedure to access the lateral aspect of the intraconal compartment in the unusual event of having to remove an orbital foreign body.

Fluorescence-guided resection with 5-aminolevulinic acid has been shown to be useful in the resection of certain brain tumors other than high grade gliomas, facilitating the intraoperative differentiation of neoplastic tissue. The technique enables the surgeon to ensure that no tumor fragments remain, thereby achieving higher rates of complete resection. Tihan first described pilomyxoid astrocytomas in 1999. They are currently classified as grade II astrocytoma according to the WHO classification system and, because of their tendency to recur and their dissemination through the cerebrospinal fluid pathways, they are considered to be more aggressive than pilocytic astrocytoma. As a result, management of these tumors must be more aggressive, always aiming for complete macroscopic resection whenever possible. In this article, we present a case of pilomyxoid astrocytoma of the third ventricle in which the use of fluorescence-guided resection with 5-ALA facilitated complete resection. Imaging tests performed after five years revealed no signs of recurrence and no adjuvant radiotherapy or chemotherapy was required. This article also comprises a review of the literature concerning the characteristics and management of this tumor, which was recently considered to be a different histopathological entity.

Gout is a common metabolic disorder typically diagnosed in peripheral joints. Tophaceous deposits in the lumbar spine is a very rare condition with very few cases reported in the literature. We present a case of tophaceous gout that originated in the lumbar spine in a patient with normal uric acid blood levels. The following case report concerns a 52-year-old patient with low back pain, left sciatica and numbness in the left leg. Serum uric acid levels were within normal range. MRI and bone scan images suggested an inflammatory-infectious process focussed at L4. After an L4-L5 decompressive laminectomy, histological examination revealed tissue infiltrated with mature plasma cells with negatively birefringent crystals using polarised light consistent with urate deposits.

The main objective of the study is to obtain knowledge about the organisation of care for severe head trauma as well as the initial management of these patients in Neurosurgical Departments in Spain.

Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protection-aspiration device (Maskpirator) is described.

Craniosynostosis is a rare condition and requires a personalised surgical approach, which is why we consider the use of 3D printed models beneficial in the surgical planning of this procedure.

Arterial neurovascular compression is hypothesised to be the main cause of primary trigeminal neuralgia. Although it is the most common cause, other pathologies, such as tumours in the cerebellopontine angle, can cause trigeminal pain. We report a case of a 44-year-old female patient with right trigeminal neuralgia without satisfactory response to medical treatment. Cerebral MRI showed no structural injuries. During microvascular decompression of the trigeminal nerve, endostosis of the internal aspect of the petrous bone was found to compress the trigeminal nerve. The pain disappeared completely in the early postsurgical period, after the complete drilling of the endostosis and microvascular decompression. The patient remains asymptomatic one year later. Endostosis of the petrous bone is a rare cause of trigeminal neuralgia. A proper review of preoperative studies would enable the definitive surgical approach to be optimised.

Lumbosacral and coccygeal skin covered appendages are a rare malformation, considered human-tails.

To compare the identification capability of traumatic axonal injury (TAI) by different sequences on conventional magnetic resonance (MR) studies in traumatic brain injury (TBI) patients.

To describe and analyse predictive and prognostic factors of overall survival (OS) in high-grade gliomas at our institution.

The use of antithrombotic medication (antiplatelet and/or anticoagulant therapy) is widespread. Currently, the management of neurosurgical patients receiving this type of therapy continues to be a problem of special importance. Patients receiving antithrombotic treatment may need neurosurgical care because of bleeding secondary to such treatment, non-haemorrhagic neurosurgical lesions requiring urgent attention, or simply elective neurosurgical procedures. In addition, the consequences of reintroducing early (bleeding or rebleeding) or late (thrombotic or thromboembolic) anticoagulation can be devastating. In this paper we present the antithrombotic treatment consensus protocol during the perioperative and periprocedural period, both in emergent surgery and in elective neurosurgical procedures.

Diving accidents is one of the leading causes of spinal cord injury after falls and car accidents. The objective of this study was to determine the epidemiological and clinical characteristics of these patients in our setting to better prevent these injuries.

Schwannomas are nerve sheath tumours that originate in Schwann cells. They are usually solitary and sporadic and manifest on peripheral, spinal or cranial nerves. Intracranial schwannomas tend to manifest on the eighth cranial nerve, particularly in patients with neurofibromatosis type2. Anterior skull-base schwannomas represent less than 1% of all intracranial schwannomas. They are more frequent in young people and are typically benign. These tumours represent a diagnostic challenge due to their rarity and difficult differential diagnosis, and numerous theories have been postulated concerning their origin and development. In this article, we present the case of a 13-year-old male with a single anterior cranial-base tumour not associated with neurofibromatosis who presented with headache, papilloedema, eye pain and loss of visual acuity. Complete resection of the tumour was performed, which was histopathologically diagnosed as a schwannoma. The patient made a complete clinical recovery with abatement of all symptoms. We conducted a review of the literature and found 66 cases worldwide with this diagnosis. We describe the most relevant epidemiological and clinical characteristics of this kind of tumour and its relation with the recently discovered and similar olfactory schwannoma.

To describe the rationale, pros and cons, and complications of the anterior-lateral extrapleural retroperitoneal approach for unstable (TLICS>4) thoracolumbar fractures.

To analyse the radiological outcomes in the long term of unstable thoraco-lumbar fractures.

The ventricle peritoneal (VP) shunt is commonly used in the treatment of hydrocephalus. It is a relatively simple and effective technique, but around 70% of the patients with a VP shunt have a complication in their lifetime. Most of these complications are due to infection or mechanical dysfunction. The thoracic complications are rare. The present case is one of the small number of them found in the literature, describing hydrothorax as a complication of a VP shunt without catheter migration and without ascites. The case is presented of a 2 year-old girl with VP shunt. The patient was diagnosed with pleural effusion compatible with hydrothorax. After finding beta-2-transferrin in the pleural fluid, it was it was shown to be from cerebrospinal fluid. Cranial CT showed the catheter in a proper position, and the Xray and ultrasound showed the catheter correctly positioned in the peritoneum.

To report perioperative complications in fully endoscopic lumbar discectomy (FELD).

Chordoma is a rare, slow-growing tumour arising from remnants of the notochord. It is most often located in the base of the skull and the sacrococcygeal region, being located in the cervical region in only 6% of cases. A rare case is presented of a left para-spinal chordoma, of which less than 10 cases have been reported in literature. It was located at C2-C4 level in a young male with no personal history of interest. Radiographic findings suggested that this was a slow-growing tumour, of cystic dominance, which eroded the bone structures and encompassed the left vertebral artery. Surgical excision was performed, and in the analysis of the surgical piece, cell proliferation was observed, with a stromal myxoid-chondroid appearance, epithelioid and physaliphorous (PAS+) cells, all of them compatible with chordoma.

Chronic pain is one of the most prevalent pathologies in the world. Treatment with neurostimulators is carried out in the most extreme cases and requires a large investment of resources. In these times of COVID-19 pandemic, we present a comprehensive solution for monitoring this kind of patient, this solution includes the development of a mobile application and a support center for remote monitoring (SCRM).