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array:22 [ "pii" => "S113014730470439X" "issn" => "11301473" "doi" => "10.1016/S1130-1473(04)70439-X" "estado" => "S300" "fechaPublicacion" => "2004-01-01" "aid" => "70439" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "2004" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 2004;15:525-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3568 "formatos" => array:3 [ "EPUB" => 22 "HTML" => 1278 "PDF" => 2268 ] ] "itemSiguiente" => array:18 [ "pii" => "S1130147304704406" "issn" => "11301473" "doi" => "10.1016/S1130-1473(04)70440-6" "estado" => "S300" "fechaPublicacion" => "2004-01-01" "aid" => "70440" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 2004;15:543-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4354 "formatos" => array:3 [ "EPUB" => 24 "HTML" => 1455 "PDF" => 2875 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Empiema epidural espinal. Análisis de 14 casos" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "543" "paginaFinal" => "551" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Spinal epidural empyema. Analysis of 14 cases" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Gelabert-González, J. González-García, J.M. Fernández-Villa, A. GarcíaAllut, R. Martínez-Rumbo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Gelabert-González" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "González-García" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Fernández-Villa" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "GarcíaAllut" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Martínez-Rumbo" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147304704406?idApp=UINPBA00004B" "url" => "/11301473/0000001500000006/v1_201305151229/S1130147304704406/v1_201305151229/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Meningiomas of the basal posterior fossa. Surgical experience in 80 cases" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "525" "paginaFinal" => "542" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R.D. Lobato, P. González, R. Alday, A. Ramos, A. Lagares, J.F. Alen, J.C. Palomino, P. Miranda, A. Perez-Nuñez, I. Arrese" "autores" => array:10 [ 0 => array:3 [ "nombre" => "R.D." "apellidos" => "Lobato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "González" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Alday" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Ramos" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Lagares" ] 5 => array:2 [ "nombre" => "J.F." "apellidos" => "Alen" ] 6 => array:2 [ "nombre" => "J.C." "apellidos" => "Palomino" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Miranda" ] 8 => array:2 [ "nombre" => "A." "apellidos" => "Perez-Nuñez" ] 9 => array:2 [ "nombre" => "I." "apellidos" => "Arrese" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio Neurocirugía, y Sección de Neurorradiología, Hospital 12 de Octubre. Madrid" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Servicio de Neurocirugía. Hospital “12 de Octubre”, Avda Córdoba s/n. 28041 Madrid (Spain)" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Meningiomas basales de la fosa posterior. Experiencia quirúrgica con 80 casos" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-04-24" "fechaAceptado" => "2004-05-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec158598" "palabras" => array:8 [ 0 => "Meningioma" 1 => "Clivus" 2 => "Petrous bone" 3 => "Posterior fossa" 4 => "Cranial nerves" 5 => "Skull base tumor" 6 => "Microsurgery" 7 => "Radiosurgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec158597" "palabras" => array:8 [ 0 => "Meningioma" 1 => "Clivus" 2 => "Petroclival" 3 => "Base craneal" 4 => "Cirugía" 5 => "Nervios craneales" 6 => "Radioterapia" 7 => "Radiocirugía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Despite recent improvements in microsurgical and radiotherapy techniques, treatment of basal posterior fossa meningiomas still carries an elevated risk of morbidity. We present our results in a series of patients with this type of tumor and review the recent literature looking for the results obtained with different approaches and the new tendencies and algorithms proposed for managing these challenging lesions.</p> <span class="elsevierStyleSectionTitle">Material and Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We analyzed retrospectively the clinical presentation and outcome of 80 patients consecutively operated between 1979 and 2003 for basal posterior fossa meningioma (foramen magnum tumors excluded). All patients had preoperative CT scans and the majority MRI studies. A total of 114 operations were performed including two-stage operations, reoperation for recurrence, CSF diversión, and XII-VII anastomosis. The most commonly used approaches were lateral suboccipital retrosigmoid, subtemporal-transtentorial, frontotemporal pterional and supra-infratentorial presigmoid. Thirteen patients received postoperative radiotherapy.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were 59 (73.7%) women and 21 men (mean age = 51.5 years; range = 18–78 yrs). Most common presenting symptoms were cranial nerve dys-function, gait disturbances and intracranial hypertension. The mean duration of symptoms was 2.9 years. 70% of the tumors were over 3<span class="elsevierStyleHsp" style=""></span>cm in size. Fifty patients (62.5%) had a complete resection, 22 (27.5%) subtotal resection (> 90% tumor volume removed), and 8 (10%) only partial resection. Postoperative complications included hematoma, CSF leak, and infection. Fifty four (67.5%) patients developed new or increased cranial nerve déficits and 12.5% somatomotor, somatosensory or cerebellar déficits immediately after surgery with subsequent improvement in most cases. Following initial surgery 67 patients made a good recovery, 10 developed variable degrees of disability and 3 died. Eleven patients died later in the course for tumor recurrence with or without reoperation, malignant meningioma or unrelated causes. There were 9 recurrences in the subgroup of patients having complete resection initially (mean follow-up = 8.6 years). The majority of patients having initial subtotal or partial resections have been managed without reoperation during a mean follow-up period of 6.5 years (radiosurgery and/or observation).</p> <span class="elsevierStyleSectionTitle">Discussion and Conclusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Current microsurgical and radiotherapy techniques allow either a cure or an acceptable control of basal posterior fossa meningiomas. In patients with tumor invasión of the cavernous sinus, extracranial extensión, violation of the arachnoidal membranes in front of the brainstem, or encasement and infiltration of major arteries, a subtotal excisión seems preferable followed by observation and/ or radiosurgical treatment. Apart from the patients age and the clinical presentation (symptomatic or not), the size and secondary extensions of the tumor must be taken into account for planning treatment in the individual patient.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A pesar de la técnica microquirúrgica y la disponibilidad de la radioterapia estereotáxica, el tratamiento de los meningiomas de la base craneal todavía conlleva un riesgo elevado de morbilidad. Se presenta una serie de pacientes con meningiomas básales de la fosa posterior y se revisa la literatura para establecer una comparación de los resultados obtenidos con diferentes tipos de abordaje terapéutico y detectar las nuevas tendencias para el manejo de estos tumores.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analizaron de modo retrospectivo la presentación y evolución clínica de 80 pacientes operados consecutivamente entre 1979 y 2003 por vía intradural de meningiomas localizados en la base de la fosa posterior (excluidos los del foramen magno). Se practicó TAC craneal en todos los casos y RM en la mayoría. Se realizaron 114 intervenciones, incluyendo operación en dos estadios, reoperación por recurrencia, derivaciones de LCR y anastomosis VII-XII. Los abordajes más empleados fueron el lateral suboccipital retrosigmoideo, subtemporal-transtentorial, frontotemporal pterional y supra-infratentorial presigmoideo retrolaberíntico. 13 pacientes recibieron además tratamiento radioterápico.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se trataron 59 mujeres (73.7%) y 21 hombres (edad media = 51.5 años; rango = 18–78). Los síntomas más frecuentes de presentación (duración media de la historia = 2,9 años) fueron alteraciones de los pares craneales, cefaleas y alteraciones de la marcha. 70% de los tumores tenían un diámetro mayor superior a 3<span class="elsevierStyleHsp" style=""></span>cm. La extirpación fue completa en 50 casos (62.5%), subtotal (resección > 90% del volumen tumoral) en 22 (27.5%) y parcial en 8 (10%). Las complicaciones postoperatorias incluyeron hematoma, fístula LCR, e infección. 54 (67.5%) pacientes desarrollaron incremento, o nueva afectación de pares craneales y un 12.5% déficits de vías largas o cerebelo que mejoraron posteriormente en la gran mayoría. Tras la primera operación 67 pacientes hicieron una buena recuperación, 10 desarrollaron diferentes grados de incapacidad y 3 fallecieron. Once pacientes fallecieron tardíamente durante el curso por recurrencia tumoral con o sin reoperación, meningioma maligno, o causas no relacionadas. Se registraron 9 recurrencias tras resección inicial aparentemente completa (seguimiento medio = 8.6 años). La mayoría de los pacientes con resección subtotal y parcial se han manejado sin reoperación durante un periodo medio de 6.5 años (radiocirugía y/u observación).</p> <span class="elsevierStyleSectionTitle">Discusión y Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La técnica microquirúrgica y la radioterapia estereotáxica permiten un control aceptable de estos meningiomas. En los pacientes con invasión del seno cavernoso, extensión extracraneal, transgresión del plano aracnoideo en relación con el tronco cerebral, o adherencia a arterias cerebrales y sus perforantes, la extirpación subtotal parece preferible. En la planificación del tratamiento, se deben considerar además la edad del paciente, la presentación clínica (lesión sintomática o no sintomática), así como el tamaño y la extensión del tumor.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Lobato, R.D.; González, P.; Alday, R.; Ramos, A.; Lagares, A.; Alen, J.F.; Palomino, J.C.; Miranda, P.; Perez-Nuñez, A.; Arrese, L: Meningiomas of the basal posterior fossa. Surgical experience in 80 cases. Neurocirugía 2004; 15: 525–542</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:80 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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