BACKGROUND AND OBJECTIVES:Giant epidermoid cysts involving the middle cranial and posterior fossae can adhere to neurovascular structures and are challenging to manage. The minimally invasive posterolateral transcavernous transtentorial approach (MIPLATTA) offers an alternative route for resection while minimizing surgical morbidity. METHODS:A retrospective analysis was conducted on a consecutive series of patients with histopathologically confirmed giant epidermoid cysts who underwent resection using the MIPLATTA between 2019 and 2023. Patients with lesions extending supra- and infratentorially who had pre- and postoperative imaging for volumetric analysis and a minimum follow-up of 6 months were included. Surgical outcomes were assessed based on the extent of resection, complications, and functional recovery using the modified Rankin Scale. RESULTS:Ten patients were included (mean age, 42 years). All 10 cysts were located in the prepontine region and cerebellopontine angle, and 5 extended into the middle fossa. Six patients had gross total resection, and 4 had subtotal resection because of adherence of the cyst to critical structures. The mean (range) operative time was 10.8 (6-13) hours. At the 6-month follow-up, 3 patients had cranial nerve deficits, 3 had hydrocephalus, 1 had a cerebrospinal fluid fistula, and 2 had chemical meningitis. Functional outcome assessments showed modified Rankin Scale score ≤2 in all patients. CONCLUSION:The MIPLATTA provided a versatile surgical corridor for resecting giant transtentorial epidermoid cysts. It enabled extensive lesion exposure while preserving neurovascular structures and offered favorable surgical outcomes with acceptable morbidity. Further studies are warranted to compare MIPLATTA efficacy with that of conventional approaches.
Background:Concurrent trigeminal neuralgia (TN) and hemifacial spasm (HFS) arising from two separate offending vessels, each compressing a distinct cranial nerve, is an uncommon and markedly disabling presentation of neurovascular compression syndrome. Unlike cases in which a single artery accounts for both syndromes, this dual-vessel configuration demands individual identification and decompression of each conflict through a shared operative corridor. Case Description:A 71-year-old man presented with a 13-year history of pharmacologically refractory left V1-V3 TN (Barrow Neurological Institute [BNI] grade IV) and left HFS only partially controlled with quarterly botulinum toxin injections; pre-operative facial motor function was intact (House-Brackmann grade I). Fast Imaging Employing Steady-state Acquisition (FIESTA)-sequence magnetic resonance imaging identified a dolichoectatic basilar artery compressing the left trigeminal nerve and a separate conflict between the left anterior inferior cerebellar artery (AICA) and the facial nerve. Through a left retrosigmoid approach, both conflicts were addressed with independent Teflon pledget interposition secured with fibrin sealant. Lateral spread response (LSR) monitoring served as a continuous electrophysiological marker, with LSR abolition confirming adequate decompression following AICA mobilization. Conclusion:At 6-month follow-up, the patient maintained complete pain freedom (BNI I), sustained HFS resolution, and intact facial function (House-Brackmann I), having discontinued all anticonvulsant therapy and botulinum toxin injections. This case illustrates that dual microvascular decompression via the retrosigmoid approach can safely address concurrent TN and HFS caused by two anatomically distinct vessels, and reinforces intraoperative LSR monitoring as a reliable endpoint for decompression adequacy.
Traumatic dental injuries (TDIs) are the fifth most prevalent condition worldwide. Proper diagnosis and emergency management are essential for ensuring a favourable outcome and prognosis. Although other international guidelines provide recommendations for the emergency management of TDI, specific clinical situations are not always addressed. To provide the dental health team and patients with recommendations based on the best scientific evidence available for the outpatient emergency management of people suffering from TDI. The Chilean Ministry of Health formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Universidad de La Frontera, supported the guideline-development process, including evidence synthesis. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks. The panel agreed on 15 recommendations for outpatient management of TDIs, such as fractures, luxations and avulsions in primary and permanent dentition. Conditional recommendations for permanent teeth included performing partial pulpotomy with calcium hydroxide or bioceramic in complicated crown fractures, stabilizing with a rigid splint in cervical root fracture, performing digital repositioning and splinting in lateral and extrusive luxation for more than 48 h, performing dental reimplantation in avulsed teeth with extended extra-oral time > 1 h, not treating the root surface and prescribe antibiotics in avulsed teeth. Conditional recommendations for primary teeth included performing just the extraction of the mobile fragment in complicated crown-root fractures and not splint in teeth with subluxation, lateral or extrusive luxation. Conditional recommendations for the use of mouthwash with 0.12% chlorhexidine twice a day for a period of 7–14 days in people with TDIs and against prescribing antibiotics in people with crown fracture, intra-alveolar root fracture or tooth luxation associated with trauma.
This report describes the case of a 97-year-old male patient, completely dependent on his activities of daily living (ECOG 3), with a 6-month-old tumor lesion in the anterior area of the chest. Skin biopsy informs a trichilemmal carcinoma. The patient received 5 weekly radiotherapy sessions of 7 Gy each (35 Gy total), with partial tumor response. It is intended to apply new sessions of radiotherapy to the affected area. The case is presented due to the low prevalenceand the dermoscopy findings of this type of carcinoma associated with a partial response to radiotherapy, a treatment rarely reported as first-line for this pathology.
The diagnosis of hereditary ataxias caused by repeat expansions continue to present unique methodological challenges, especially for developing countries where genomic medicine services are not well established. The purpose of this work is to present a cohort of patients who presented with adult-onset ataxia of suspected genetic etiology, but had remained undiagnosed until now. They were analyzed for a set of repeat expansions including the genes causing the more recently identified types, SCA27BandRFC1-related CANVAS. Patients with a possible diagnosis of hereditary cerebellar ataxia with adult onset underwent genetic testing to detect a set of repeat expansions known to cause autosomal dominant ataxia. In selected cases, a complete vestibular function evaluation and brain magnetic resonance imaging was acquired. In 17 of the 56 studied cases (including 11 of 43 index cases) we established a genetic diagnosis, which demonstrates that this is a promising approach to adult-onset ataxias in a population that remains underrepresented in worldwide genomic studies. We identified 9 individuals with SCA27B and 7 with CANVAS, highlighting the epidemiological relevance of these newly recognized etiologies, an information useful for planning the allocation of resources towards improving the access to genomic medicine in in our region.
