Neurocirugia最新文献

{"title":"HIDROCEFALIA Y TRASTORNOS DEL LCR (PÓSTERES)","authors":"","doi":"10.1016/S1130-1473(24)00051-4","DOIUrl":"https://doi.org/10.1016/S1130-1473(24)00051-4","url":null,"abstract":"","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 ","pages":"Pages S221-S237"},"PeriodicalIF":0.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141241366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CIRUGÍA FUNCIONAL Y ESTEREOTÁXICA (COMUNICACIONES ORALES)","authors":"","doi":"10.1016/S1130-1473(24)00039-3","DOIUrl":"https://doi.org/10.1016/S1130-1473(24)00039-3","url":null,"abstract":"","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 ","pages":"Pages S125-S136"},"PeriodicalIF":0.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposición de la oliva bulbar mediante los abordajes far lateral y retrosigmoideo bajo. Análisis comparativo de la superficie expuesta y ángulo de ataque","authors":"Pau Capilla-Guasch ,&nbsp;Vicent Quilis-Quesada ,&nbsp;Félix Pastor-Escartín ,&nbsp;Diego Tabarés Palacín ,&nbsp;Juan Pablo Valencia Salazar ,&nbsp;José M. González-Darder","doi":"10.1016/j.neucir.2023.08.001","DOIUrl":"10.1016/j.neucir.2023.08.001","url":null,"abstract":"<div><h3>Objectives</h3><p>Throughout neurosurgical history, the treatment of intrinsic lesions located in the brainstem has been subject of much controversy. The brainstem is the anatomical structure of the central nervous system (CNS) that presents the highest concentration of nuclei and fibers, and its simple manipulation can lead to significant morbidity and mortality. Once one of the safe entry points at the medulla oblongata has been established, we wanted to evaluate the safest approach to the olivary body (the most used safe entry zone on the anterolateral surface of the medulla oblongata). The proposed objective was to evaluate the working channel from the surface of each of the far lateral and retrosigmoid approaches to the olivary body: distances, angles of attack and channel content.</p></div><div><h3>Material and methods</h3><p>To complete this work, a total of 10 heads injected with red/blue silicone were used. A total of 40 approaches were made in the 10 heads used (20 retrosigmoid and 20 far lateral). After completing the anatomical study and obtaining the data referring to all the approaches performed, it was decided to expand the sample of this research study by using 30 high-definition magnetic resonance imaging of anonymous patients without cranial or cerebral pathology. The reference points used were the same ones defined in the anatomical study. After defining the working channels in each of the approaches, the working distances, angle of attack, exposed surface, and the number of neurovascular structures present in the central trajectory were analyzed.</p></div><div><h3>Results</h3><p>The distances to the cranial and medial region of the olivary body were 52.71 mm (SD 3.59) from the retrosigmoid approach and 27.94 mm (SD 3.99) from the far lateral; to the most basal region of the olivary body, the distances were 49.93 (SD 3.72) from the retrosigmoid approach and 18.1 mm (SD 2.5) from the far lateral. The angle of attack to the caudal region was 19.44° (SD 1.3) for the retrosigmoid approach and 50.97° (SD 8.01) for the far lateral approach; the angle of attack to the cranial region was 20.3° (SD 1.22) for the retrosigmoid and 39.9° (SD 5.12) for the far lateral. Regarding neurovascular structures, the probability of finding an arterial structure is higher for the far lateral, whereas a neural structure will be more likely from a retrosigmoid approach.</p></div><div><h3>Conclusions</h3><p>As conclusions of this work, we can say that far lateral approach presents more favorable conditions for the microsurgical treatment of intrinsic bulbar and bulbomedullary lesions approached through the caudal half of the olivary body. In those cases of bulbar and pontine-bulbar lesions approached through the cranial half of the olivary body, the retrosigmoid approach can be considered for selected cases.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 3","pages":"Pages 152-163"},"PeriodicalIF":0.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135515721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracerebral hemorrhage after deep brain stimulation surgery guided with microelectrode recording: analysis of 297 procedures","authors":"Beatriz Dos Santos ,&nbsp;Rui Vaz ,&nbsp;Ana Cristina Braga ,&nbsp;Manuel Rito ,&nbsp;Diana Lucas ,&nbsp;Clara Chamadoira","doi":"10.1016/j.neucir.2023.09.002","DOIUrl":"https://doi.org/10.1016/j.neucir.2023.09.002","url":null,"abstract":"<div><h3>Objectives</h3><p>Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) in patients submitted to deep brain stimulation (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique.</p></div><div><h3>Methods</h3><p>We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, and number of MER trajectories.</p></div><div><h3>Results</h3><p>There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH <em>per</em> lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension.</p></div><div><h3>Conclusions</h3><p>MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 2","pages":"Pages 79-86"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140042447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ependimomas de fosa posterior de tipo lateral en la edad pediátrica","authors":"Pablo Miranda-Lloret,&nbsp;Estela Plaza-Ramírez,&nbsp;Juan Antonio Simal-Julián,&nbsp;Giovanni Pancucci,&nbsp;Adela Cañete,&nbsp;Alejandro Montoya-Filardi,&nbsp;Gemma Llavador","doi":"10.1016/j.neucir.2023.10.002","DOIUrl":"10.1016/j.neucir.2023.10.002","url":null,"abstract":"<div><h3>Background and aims</h3><p>Lateral-type posterior fossa ependymomas are a well-defined subtype of tumors both clinically and pathologically, with a poor prognosis. Their incidence is low and surgical management is challenging. The objective of the present work is to review our series of lateral-tye posterior fossa ependymomas and compare our results with those of previous series.</p></div><div><h3>Materials and methods</h3><p>Among 30 cases of ependymoma operated in our pediatric department in the last 10 years, we identified seven cases of lateral-type posterior fossa ependymomas. We then performed a retrospective, descriptive study.</p></div><div><h3>Results</h3><p>Mean age of our patients was 3.75 years. Six cases presented with hydrocephalus. Mean tumor volume at diagnosis was 61<!--> <!-->cc. A complete resection was achieved in six cases and a near-total resection in one patient. Five patients transiently required a gastrostomy and a tracheostomy. Mean follow-up was 58 months. One case progressed along this period and eventually died. Four cases of hydrocephalus required a ventriculoperitoneal CSF shunt and two were managed with a third ventriculostomy. At last follow-up four patients carried a normal life and two displayed a mild restriction according to Lansky's scale.</p></div><div><h3>Conclusions</h3><p>The aim of surgical treatment in lateral-type posterior fossa ependymomas is complete resection. Neurological deficits associated to lower cranial nerve dysfunction are common but transient. Deeper genetic characterization of these tumors may identify risk factors that guide stratification of adjuvant therapies.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 2","pages":"Pages 87-94"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136127372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fistula espontánea de LCR como manifestación de la hipertensión intracraneal idiopática","authors":"Samsara López Hernández ,&nbsp;Carlos Alberto Rodríguez Arias ,&nbsp;Jaime Santos Pérez ,&nbsp;Mario Martínez-Galdámez ,&nbsp;Adrián Fernández García ,&nbsp;Herbert Daniel Jiménez Zapata","doi":"10.1016/j.neucir.2023.02.001","DOIUrl":"10.1016/j.neucir.2023.02.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Spontaneous cerebrospinal fluid (CSF) fistula, of unknown origin, is a rare condition whose etiology is increasingly related to idiopathic intracranial hypertension (IIH). This study tries to raise awareness that they should not be considered as two different processes, but that fistulas can be a form of debut, requiring a study and subsequent treatment. Repair techniques are described, as well as the study of IIH.</p></div><div><h3>Results</h3><p>We treated eight patients, five women and three men, aged between 46 and 72 years, with a diagnosis of spontaneous CSF fistula, four nasal and four otics who underwent surgical treatment. After repair, a diagnostic study was performed for IIH by MRI and angio-MRI, presenting in all cases a transverse venous sinus stenosis. The intracranial pressure values obtained by lumbar puncture showed values of 20<!--> <!-->mmHg or higher. All patients were diagnosed with IIH. The one-year follow-up did not reveal any recurrence of the fistulas, maintaining a control of the IIH.</p></div><div><h3>Conclusion</h3><p>Despite their low frequency of both cranial CSF fistula and IIH, an association of both conditions should be considered by continuing the study and surveillance of these patients after fistula closure.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 2","pages":"Pages 57-63"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129652285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes after selective shunt during carotid endarterectomy: A propensity score matching analysis","authors":"Juliana Pereira-Macedo ,&nbsp;Luís Afonso Fialho Duarte-Gamas ,&nbsp;António Henrique Pereira-Neves ,&nbsp;José Paulo Alves Vieira de Andrade ,&nbsp;João Manuel Palmeira Rocha-Neves","doi":"10.1016/j.neucir.2023.07.006","DOIUrl":"10.1016/j.neucir.2023.07.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Carotid cross-clamping during carotid endarterectomy might lead to intraoperative neurologic deficits, increasing stroke/death risk. If deficits are detected, carotid shunting has been recommended to reduce the risk of stroke. However, shunting may sustain a specific chance of embolic events and subsequently incurring harm. Current evidence is still questionable regarding its clear benefit. The aim is to determine whether a policy of selective shunt impacts the complication rate following an endarterectomy.</p></div><div><h3>Material and methods</h3><p>From January 2013 to May 2021, all patients undergoing carotid endarterectomy under regional anesthesia with intraoperative neurologic alteration were retrieved. Patients submitted to selective shunt were compared to a non-shunt group. A 1:1 propensity score matching (PSM) was performed. Differences between the groups and clinical outcomes were calculated, resorting to univariate analysis.</p></div><div><h3>Results</h3><p><span>Ninety-eight patients were selected, from which 23 were operated on using a shunt. After PSM, 22 non-shunt patients were compared to 22 matched shunted patients. Concerning demographics and comorbidities, both groups were comparable to pre and post-PSM, except for chronic heart failure, which was more prevalent in shunted patients (26.1%, </span><em>P</em> <!-->=<!--> <!-->0.036) in pre-PSM analysis. Regarding 30-day stroke and score Clavien–Dindo<!--> <!-->≥<!--> <!-->2, no significant association was found (<em>P</em> <!-->=<!--> <!-->0.730, <em>P</em> <!-->=<!--> <!-->0.635 and <em>P</em> <!-->=<!--> <!-->0.942, <em>P</em> <!-->=<!--> <!-->0.472, correspondingly, for pre and post-PSM).</p></div><div><h3>Conclusions</h3><p>In this cohort, resorting to shunting did not demonstrate an advantage regarding 30-day stroke or a Clavien–Dindo<!--> <!-->≥<!--> <!-->2 rates. Nevertheless, additional more extensive studies are mandatory to achieve precise results concerning the accurate utility of carotid shunting in this subset of patients under regional anesthesia.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 2","pages":"Pages 71-78"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136055073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eficacia de las infiltraciones epidurales en el abordaje del dolor y la discapacidad por radiculopatía lumbosacra aguda y subaguda","authors":"Jose Manuel Rabanal LLevot ,&nbsp;Amaia Muñoz Alonso ,&nbsp;Alberto Taborga Echevarría ,&nbsp;Jose Angel Martínez Agueros ,&nbsp;Sergio Maldonado Vega","doi":"10.1016/j.neucir.2023.07.004","DOIUrl":"10.1016/j.neucir.2023.07.004","url":null,"abstract":"<div><h3>Backgrund and objective</h3><p>Epidural infiltrations are used for treatment of low back pain and sciatica. linked to lumbar radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work.</p></div><div><h3>Methods</h3><p>Is a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal).</p></div><div><h3>Results</h3><p>Ninety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47<!--> <!-->±<!--> <!-->11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48<!--> <!-->±<!--> <!-->1.5 basal; 6.2<!--> <!-->±<!--> <!-->0,9 at 15 days; 6.3<!--> <!-->±<!--> <!-->1.2 at one month; 6.15<!--> <!-->±<!--> <!-->1.3 at 3 months, <em>P</em>&lt;.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections.</p></div><div><h3>Conclusions</h3><p>Epidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 2","pages":"Pages 64-70"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135348825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nuevo nomenclátor estandarizado de Neurocirugía: criterios e indicadores cuantitativos y cualitativos de baremación de actos médicos","authors":"Ángel Horcajadas Almansa ,&nbsp;Luis Ley Urzaiz ,&nbsp;Roberto Garcia Leal ,&nbsp;Francisco González Llanos ,&nbsp;Mónica Lara Almunia ,&nbsp;Ruben Martinez Laez ,&nbsp;Jose M. Torres Campa ,&nbsp;Idoia Zaspe Cenoz ,&nbsp;Jesús Lafuente Baraza","doi":"10.1016/j.neucir.2023.10.001","DOIUrl":"10.1016/j.neucir.2023.10.001","url":null,"abstract":"<div><h3>Purpose</h3><p>Update the list of medical acts in the specialty of neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales.</p></div><div><h3>Material and method</h3><p>The elaboration of the new nomenclator was divided into three phases: (1) identification and selection of medical acts, (2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and (3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC.</p></div><div><h3>Results</h3><p>The new nomenclator has 255 medical acts grouped into four groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. Forty-two procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined.</p></div><div><h3>Conclusions</h3><p>This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimize geographic variability in all healthcare settings.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 2","pages":"Pages 95-112"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type I atlanto-occipital dislocation complicated by non-communicating hydrocephalus – A case report","authors":"Maciej Kaspera,&nbsp;Marcin Niedbała,&nbsp;Igor Jastrzębski,&nbsp;Wojciech Kaspera","doi":"10.1016/j.neucir.2023.02.002","DOIUrl":"https://doi.org/10.1016/j.neucir.2023.02.002","url":null,"abstract":"<div><p>Hydrocephalus<span><span>, an extremely rare complication of craniocervical junction injuries, is postulated to result from compression of the fourth ventricular cerebrospinal fluid (CSF) outlets by fractured and displaced bone fragments, a swollen upper spinal cord or adhesions formed after a </span>traumatic subarachnoid haemorrhage<span><span>. We present the case of a 21-year-old woman for whom an injury to the cervical spine complicated by a type I atlanto-occipital dislocation contributed to the development of non-communicating hydrocephalus. The hydrocephalus was probably a consequence of impaired </span>CSF circulation at the fourth ventricular outlets (the foramina of Luschka and Magendie), caused by post-haemorrhagic adhesions formed after severe injury to the craniocervical junction.</span></span></p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"35 1","pages":"Pages 45-50"},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139100394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}