[Controversy in the management of WHO grade II gliomas in eloquent brain areas: recent literature review]. / Controversias en el tratamiento de los gliomas OMS grado II localizados en áreas elocuentes: revisión de la bibliografía reciente.

Recent studies have shown that diffuse grade II gliomas (GGII) located in eloquent brain areas represent over 80% of all GGII. The optimal management of these tumours is still controversial. It has long been considered that surgery is not an option for GGII within eloquent areas, due to the high risk of inducing postoperative sequelae in patients with normal neurological explorations. However, the safety of these surgeries has significantly improved in recent years due to the rapid development of techniques enabling a precise mapping of brain functions. Noninvasive functional neuroimaging techniques have been recently developed, enabling cortical mapping of the entire brain prior to surgical procedures. Such precise data provide a preoperative estimation of the location of eloquent areas in relation to the tumour, which is essential for surgical planning and preoperative assessment of morbidity for various surgical approaches. The intraoperative electrical stimulation (IES) mapping technique consists in the application of a bipolar electrode on the brain tissue, enabling an accurate location of brain functions. This provides unique assistance in GGII resection, as it generates a discrete and transient "virtual" lesion within the eloquent tissue. Tumour removal is then tailored according to functional boundaries in order to optimise the quality of resection and to minimise the risk of postoperative sequelae, preserving quality of life. For patients with a GGII in an eloquent area, the possibility of an early resection should be evaluated by a multidisciplinary neuro-oncology team specialising in the management of such tumours.

Deep brain stimulation and treatment-resistant obsessive-compulsive disorder: A systematic review. / La estimulación cerebral profunda en el trastorno obsesivo-compulsivo refractario al tratamiento: una revisión sistemática.

INTRODUCTION: At least 10% of patients with Obsessive-compulsive Disorder (OCD) are refractory to psychopharmacological treatment. The emergence of new technologies for the modulation of altered neuronal activity in Neurosurgery, deep brain stimulation (DBS), has enabled its use in severe and refractory OCD cases. The objective of this article is to review the current scientific evidence on the effectiveness and applicability of this technique to refractory OCD. METHOD: We systematically reviewed the literature to identify the main characteristics of deep brain stimulation, its use and applicability as treatment for obsessive-compulsive disorder. Therefore, we reviewed PubMed/Medline, Embase and PsycINFO databases, combining the key-words 'Deep brain stimulation', 'DBS' and 'Obsessive-compulsive disorder' 'OCS'. The articles were selected by two of the authors independently, based on the abstracts, and if they described any of the main characteristics of the therapy referring to OCD: applicability; mechanism of action; brain therapeutic targets; efficacy; side-effects; co-therapies. All the information was subsequently extracted and analysed. RESULTS: The critical analysis of the evidence shows that the use of DBS in treatment-resistant OCD is providing satisfactory results regarding efficacy, with assumable side-effects. However, there is insufficient evidence to support the use of any single brain target over another. Patient selection has to be done following analyses of risks/benefits, being advisable to individualize the decision of continuing with concomitant psychopharmacological and psychological treatments. CONCLUSIONS: The use of DBS is still considered to be in the field of research, although it is increasingly used in refractory-OCD, producing in the majority of studies significant improvements in symptomatology, and in functionality and quality of life. It is essential to implement random and controlled studies regarding its long-term efficacy, cost-risk analyses and cost/benefit.

[Efficacy and safety of intraoperative electrical stimulation mapping for resection of WHO grade ii and iii gliomas within eloquent areas]. / Eficacia y seguridad del mapeo por estimulación eléctrica intraoperatoria para la extirpación de gliomas OMS grado ii y iii en áreas cerebrales elocuentes.

BACKGROUND AND OBJECTIVE: Despite the growing use of intraoperative electrical stimulation (IES) mapping for the resection of WHO grade ii and iii gliomas (GGII and GGIII) in eloquent areas, few studies have compared 2 series with and without IES. The present study compares 2 series of patients operated with and without IES at the same institution, analyzing the extent of resection, neurological morbidity, epilepsy prognosis and quality of life. PATIENTS AND METHODS: The surgical results in 2 series of patients with GGII and GGIII within eloquent were compared. Period A (2004-2009): 17 patients operated without IES. Period B (2009-2010): 19 patients operated with IES. RESULTS: The extent of tumor resection was 54.7% in group A and 79.9% in group B (P=.006). Six months after surgery, neurological morbidity was present in 8 patients of group A and one patient of group B (P=.015; odds ratio [OR] 16, 95% confidence interval [95% CI] 1.7-148.3). Two patients of group A with refractory epilepsy, and 8 patients of group B improved epilepsy control (P=.05; OR 42, 95% CI 2.1-825.7). Nine patients of group A and 18 patients of group B returned to the same socio-professional situation as before surgery (P=.015; OR 16, 95% CI 1.7-148.4). CONCLUSIONS: The comparison of IES mapping surgery to conventional surgery revealed that the former enables to: increase in 25.2% the extent of tumor resection, decrease in 48.1% the risk of permanent sequelae, improve epilepsy control and preserve quality of life.