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        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">One in every thousand intracranial meningiomas metastatize extracranially&#46; Lung and intraabdominal organs are most frequently affected&#46; Only 7&#37; involve vertebrae and just a dozen cases have been reported in the literature&#46; To our knowledge&#44; this is the first description of a total en bloc spondylectomy through a posterior approach for the treatment of an intraosseous metastatic meningioma to the eleventh dorsal vertebra&#46;</p> <span class="elsevierStyleSectionTitle">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In March 1996&#44; a 37 year-old male underwent surgical resection for a left occipital intraventricular benign meningioma &#40;WHO I&#41;&#46; He was reoperated in February 2002 due to local recurrence&#46; By the end on 2003 he developed progressively invalidating dorsolumbar pain&#46; MRI studies revealed a T11 intraosseous mass&#46; In March 2004&#44; a percutaneous biopsy and vertebroplasty were performed&#46; The pathological specimen was identified as adenocarcinoma and he initiated chemotherapy&#46; Advice from a second pathologist was seeked&#44; who suggested the diagnosis of intraosseous meningioma&#46; Workup studies failed to reveal any primary tumor&#46; In May 2004 the patient was admitted to our department and a new transpedicular biopsy confirmed the diagnosis&#46; In June 2004 he underwent T11 total en bloc spondylectomy &#40;Tomita&#39;s procedure&#41;&#44; fusion with bone and calcium substitute-filled stackable carbon-fiber cages&#44; and T9 to L1 transpedicular screw fixation&#46; No postoperative complications ocurred and he is&#44; so far&#44; free from primary and secondary disease&#46; Definite pathology&#58; benign meningioma &#40;WHO I&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distant metastases from intracranial meningiomas are rare entities&#44; arising from benign lesions in&#44; at least&#44; 60&#37; of cases&#46; Enam et al proposed a specific pathological score to differentiate benign&#44; atypic and malignant meningiomas&#46; Such score correlates with the chance of metastatizing&#58; more than 40&#37; in malignant meningiomas compared to 3&#46;8&#37; of brain tumors overall&#46; The ability to metastatize seems to be linked to vascular or lifatic invasiveness&#46; Metastases ocurr more frequently in angioblastic&#44; papillary and meningothelial variants&#46; Hematogenous &#40;especially venous&#59; Batson&#39;s perivertebral plexus&#41;&#44; linfatic and cerebrospinal fluid are the main routes involved in the spreading of the tumor&#46; Craniotomy itself may also play a role&#44; for the majority of patients have been previously operated on repeatedly&#46; The interval between the onset of the intracranial disease and the appearance of the metastasis varies from months to many years&#46; The value of transpedicular biopsy is widely recognized &#40;efficacy over 80&#37;&#41; and the suitability of the specimen for pathological examination improves when wide inner caliber trephines are used&#46; In the case presented we applied the oncologic concept of vertebral en bloc resection&#46; We believe this case represents a paradigmatic indication of this technique because it respects the concepts of radical resection and spinal stability&#44; and offers an opportunity for the curation of the disease&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las met&#225;stasis distantes de meningioma intracraneal ocurren en uno de cada mil meningiomas&#46; La mayor parte afectan a pulm&#243;n u &#243;rganos intraabdominales&#46; S&#243;lo un 7&#37; aparecen en v&#233;rtebras&#46; Se han publicado en torno a una docena de casos&#46; Presentamos la primera descripci&#243;n hasta la fecha de una vertebrectom&#237;a completa por v&#237;a posterior para tratar una met&#225;stasis intra&#243;sea de meningioma benigno en el cuerpo de T11&#46;</p> <span class="elsevierStyleSectionTitle">Caso cl&#237;nico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Var&#243;n de 37 a&#241;os de edad&#44; intervenido en otro centro en Marzo de 1996 de meningioma benigno intraventricular occipital izquierdo de tipo transicional &#40;OMS tipo I&#41;&#46; Precis&#243; reintervenci&#243;n por recidiva local en Febrero de 2002&#46; A finales de 2003 comenz&#243; con dolor dorsolumbar intenso y el estudio de RM espinal evidenci&#243; una masa intr&#243;sea en T11&#46; En Marzo de 2004 se realiz&#243; biopsia transpedicular y vertebroplastia acr&#237;lica&#46; El resultado histol&#243;gico fue de adenocarcinoma y el paciente comenz&#243; a recibir quimioterapia&#46; Una segunda opini&#243;n sobre las muestras histol&#243;gicas sugiri&#243; el diagn&#243;stico de meningioma&#46; El estudio de extensi&#243;n tumoral no evidenci&#243; otra neoplasia primaria&#46; En Mayo de 2004 ingres&#243; en nuestro servicio donde se repite la biopsia transpedicular que confirma el diagn&#243;stico de meningioma&#46; En Junio de 2004 se realiz&#243; vertebrectom&#237;a T11 completa por v&#237;a posterior&#44; seg&#250;n t&#233;cnica de Tomita&#44; artrodesis intersom&#225;tica con cajas apilables de fibra de carbono rellenas de injerto &#243;seo y sustituto c&#225;lcico&#44; y fijaci&#243;n transpedicular T9 a L1&#46; La evoluci&#243;n postoperatoria fue satisfactoria y&#44; actualmente&#44; se encuentra libre de enfermedad primaria y secundaria&#46; Anatom&#237;a patol&#243;gica definitiva&#58; meningioma benigno &#40;OMS I&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las met&#225;stasis distantes de meningiomas intracraneales son entidades raras que en m&#225;s del 60&#37; de los casos provienen de meningiomas benignos&#46; Enam y cols dise&#241;aron una gradaci&#243;n seg&#250;n par&#225;metros histol&#243;gicos para diferenciar los meningiomas benignos de los at&#237;picos y malignos&#46; Dicha gradaci&#243;n correlaciona con la probabilidad de producir met&#225;stasis distantes&#58; m&#225;s del 40&#37; en los meningiomas malignos frente a una media del 3&#46;8&#37; de todos los tumores cerebrales&#46; La posibilidad de metastatizar parece relacionarse con la capacidad de invasividad vascular o linf&#225;tica&#46; Las met&#225;stasis son m&#225;s frecuentes en las variantes angiobl&#225;stica&#44; papilar y meningotelial&#46; Se describen tres v&#237;as de diseminaci&#243;n&#58; hemat&#243;gena &#40;sobre todo venosa&#59; plexo perivertebral de Batson&#41; linf&#225;tica y por LCR&#46; La craneotom&#237;a podr&#237;a ser otra v&#237;a de diseminaci&#243;n pues la mayor&#237;a de los pacientes han sido previamente multioperados del tumor craneal&#46; El tiempo transcurrido entre el diagn&#243;stico del meningioma intracraneal y la aparici&#243;n de la met&#225;stasis vertebral puede variar entre meses y a&#241;os&#46; La rentabilidad diagn&#243;stica de la biopsia transpedicular es mayor del 80&#37; y mejora cuanto mayor es el di&#225;metro interno de la trefina utilizada&#46; En el caso descrito&#44; aplicamos el concepto oncol&#243;gico de resecci&#243;n en bloque de la v&#233;rtebra afectada&#46; Creemos que se trata de una indicaci&#243;n paradigm&#225;tica de esta t&#233;cnica pues respeta los conceptos de resecci&#243;n radical y estabilidad de la columna&#44; y otorga una oportunidad de curaci&#243;n de la enfermedad&#46;</p>"
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Metastatic meningioma to the eleventh dorsal vertebral body: total en bloc spondylectomy. Case report and review of the literature
Metástasis de meningioma en la undécima vértebra dorsal: vertebrectomía total en bloque. Caso clínico y revisión de la literatura
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E.M.ª Corrales-García*, B. Pérez-Mies**
*. Servicio de Oncología Radioterápica. Hospital Divino Valles. Burgos
**. Servicios de Anatomía Patológica. Hospital General Yagüe. Burgos

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