[Unilateral thalamotomy with high intensity focal ultrasound in patients with refractory essential tremor: a comparative study between patients under and over 70 years of age]. / Talamotomía unilateral con ultrasonidos focales de alta intensidad en pacientes con temblor esencial refractario: un estudio comparativo entre pacientes menores y mayores de 70 años.

INTRODUCTION: High intensity focal ultrasound (HIFU) thalamotomy is a novel treatment for refractory tremor. This study aims to compare the reduction in tremor intensity and adverse effects of treatment between patients younger and older than 70 years of age. PATIENTS AND METHODS: All the patients with refractory essential tremor treated with HIFU between March 2021 and March 2023 were included consecutively. Various demographic and clinical variables were analysed, including age and the items on the Clinical Rating Scale for Tremor (CRST). Cerebral vascular pathology was quantified using the Fazekas scale. Outcomes and adverse effects were compared between the patients aged 70 years or younger, and those older than 70 years. RESULTS: Ninety patients were included, and 50 of them were over 70 years old. Prior to treatment, the CRST A + B score was 20.4 ± 5.7 among those under 70 years of age, and 23.3 ± 5.1 in those older (p = 0.013). At six months after treatment, the mean was 3.8 ± 5.1 and 4.8 ± 4.5, respectively (p = 0.314). We found no significant differences in the CRST C score (2.8 ± 4.1 and 3.5 ± 4.8, p = 0.442). There were also no significant differences between the patients with vascular pathology (Fazekas = 1) and those without (4.6 ± 7.3 and 4.3 ± 4, p = 0.832). There were no differences in the presence of adverse effects between the groups based on age and vascular pathology. CONCLUSIONS: Contrary to traditional opinion, older patients do not have a poorer response or a higher rate of adverse effects after HIFU treatment.

TITLE: Talamotomía unilateral con ultrasonidos focales de alta intensidad en pacientes con temblor esencial refractario: un estudio comparativo entre pacientes menores y mayores de 70 años.Introducción. La talamotomía con ultrasonidos focales de alta intensidad (HIFU) es un tratamiento novedoso para el temblor refractario. El objetivo de este estudio es comparar la reducción en la intensidad del temblor y los efectos adversos del tratamiento entre pacientes menores y mayores de 70 años. Pacientes y métodos. Se incluyó consecutivamente a todos los pacientes con temblor esencial refractario tratados con HIFU entre marzo de 2021 y marzo de 2023. Se analizaron diferentes variables demográficas y clínicas, incluyendo la edad y los apartados de la Clinical Rating Scale for Tremor (CRST). Se cuantificó la patología vascular cerebral mediante la escala de Fazekas. Se compararon los resultados y los efectos adversos entre los grupos de edad de 70 años o menos y de más de 70 años. Resultados. Se incluyó a 90 pacientes, 50 de ellos de más de 70 años. Previamente al tratamiento, la CRST A + B era de 20,4 ± 5,7 en los menores de 70 años y de 23,3 ± 5,1 en los mayores (p = 0,013). A los seis meses tras el tratamiento, la media fue de 3,8 ± 5,1 y 4,8 ± 4,5, respectivamente (p = 0,314). No hallamos diferencias significativas en la CRST C (2,8 ± 4,1 y 3,5 ± 4,8, p = 0,442). Tampoco hubo diferencias significativas entre pacientes con patología vascular (Fazekas = 1) y sin ella (4,6 ± 7,3 y 4,3 ± 4, p = 0,832). No hubo diferencias en la presencia de efectos adversos entre los grupos de edad y de patología vascular. Conclusiones. En contra de lo tradicionalmente concebido, los pacientes de mayor edad no tienen una peor respuesta ni una mayor tasa de efectos adversos tras el tratamiento con HIFU.

[Nuclear paralysis of the oculomotor nerve within the context of traumatic brain injury]. / Paralisis nuclear del III par craneal en el contexto de un traumatismo craneoencefalico.

TITLE: Paralisis nuclear del III par craneal en el contexto de un traumatismo craneoencefalico.

[Cerebellar mutism]. / Mutismo cerebeloso.

Mutismo cerebeloso.

[Bilateral cerebellopontine arachnoid cyst]. / Quiste aracnoideo bilateral del angulo pontocerebeloso.

INTRODUCTION: Bilateral cerebellopontine arachnoid cysts are very rare, and only three cases have been previously reported. CASE REPORT: A 14-year-old previously healthy girl presented to our outpatient clinic with a 6-weeks history of frontal headache. They typically would start in the occipital region and then radiate bifrontally. The neurological examination was unremarkable. Magnetic resonance imaging revealed an extra-axial bilateral lesion in bilateral cerebellopontine angle, larger on left side. The lesions were homogeneously hypointenese on T1-weighted imaging and hyperintense on T2-weighted imaging without evidence of contrast enhancement and without evidence of restriction on diffusion-weighted imaging. No surgical treatment was indicated. CONCLUSIONS: Bilateral arachnoid cysts of the cerebellopontine angle are very infrequent and the main indication for surgery is the existence of clinical symptoms or neurological deficit coincident with the locations of the cysts.

TITLE: Quiste aracnoideo bilateral del angulo pontocerebeloso.Introduccion. Los quistes aracnoideos bilaterales del angulo pontocerebeloso son excepcionales, y unicamente existen tres casos publicados en la bibliografia. Caso clinico. Niña de 14 años, previamente sana, que acude a consultas por presentar cefalea bifrontal de seis semanas de evolucion. La exploracion clinica era normal y la resonancia magnetica craneal mostraba dos lesiones extraaxiales localizadas en ambos angulos pontocerebelosos, siendo ligeramente mayor la izquierda. Las lesiones se comportaban como homogeneamente intensas en T1 e hiperintensas en T2, no captaban contraste y no existia restriccion en las secuencias de difusion. No se indico tratamiento quirurgico. Conclusiones. Los quistes aracnoideos bilaterales situados en el angulo pontocerebeloso son excepcionales. La principal indicacion para el tratamiento quirurgico es la presencia de sintomas o signos neurologicos coincidentes con la localizacion de los quistes.

Primary central nervous system lymphoma.

INTRODUCTION: Primary central nervous system lymphoma is a rare subtype of extranodal non-Hodgkin lymphoma that accounts for 4% of central nervous system tumours. PATIENTS AND METHODS: Retrospective review of 24 patients diagnosed with primary central nervous system lymphoma between 1990 and 2010. All patients were diagnosed using magnetic resonance imaging and the diagnosis was confirmed surgically. RESULTS: Of the 24 patients analysed, all except 4 were immunocompetent. Median age at diagnosis was 59.3 years (range 13-79) and the sex ratio (male to female) was 1:1.1. Cognitive decline (in 33.4%) and headache (in 25%) were the most common complaints. Diagnosis was performed In 13 cases (54%) following craniotomy and in the other 11 cases (46%) after stereotactic biopsy. Breakdown by pathology was as follows: 22 cases of B-cell lymphoma (91.6%), 1 case of anaplastic large-cell lymphoma, and 1 case of T-cell lymphoma. Mean survival time was 12.8 months with an overall 1-year survival rate of 37.5%. CONCLUSIONS: Primary central nervous system lymphoma often presents in the sixth decade with cognitive decline, headache, and focal neurological deficits. A single intracranial lesion was present in 75% of the patients (18 cases), and the remaining 25% (6 cases) had between 2 and 4 lesions. Preoperative clinical status was the most important factor determining prognosis.

[Intracranial gangliogliomas. A review of a series of 20 patients]. / Gangliogliomas intracraneales. Revisión de una serie de 20 pacientes.

INTRODUCTION: A ganglioglioma is a type of primary central nervous system low grade tumour composed of mixed populations of glial and neuroepithelial elements. They accounts for 0.4 to 2% of all intracranial tumours and appear more commonly in children and young adults. Seizures, which are the most important symptom in these tumours, improve significantly after surgical excision. METHODS: Between 1995 and 2008, 20 patients with (12 adults and 8 children) with intracranial ganglioglioma were treated at our hospital. Clinical information obtained by chart review included sex, age at onset of symptoms, clinical history, results of neurological examination, tumour location, CT and MRI appearance, surgical results and follow-up. All patients underwent tumour resection and the extent of surgery was determined from the surgical reports and postoperative imaging studies. RESULTS: The median age of patients was 26.4 years (range, 1-75 years), and the female to male ratio was 1.5:1. Except in one case, all patients had seizures with a median duration before diagnosis of 7.4 years (range 1-29). Seventeen tumours were located in the temporal lobe (9 right and 8 left). Macroscopically complete excision was performed in 17 patients and subtotal in the remaining 3. There were 4 cases of recurrence treated by surgery and radiotherapy being added in one case. The mean follow up was 8.5 years (range 22 months-14 years) and disease free survival at 5 years was 85% and an overall survival of 95%. CONCLUSIONS: The seizures, which are the most frequent symptoms, significantly improved after surgical removal. Surgery is the first choice of therapy in these tumours, and in the presence of subtotal resection or tumour recurrence the best indication for treatment is repeat surgery. Radiotherapy should be reserved only for malignant forms.

[Filum terminale ependymomas. Analysis of a serie of 20 consecutive cases]. / Ependimomas del filum terminal. Análisis de 20 casos consecutivos.

OBJECTIVE: to analyze the clinical, radiological and surgical outcome of a series of filum terminale ependymomas. Patients and methods. This retrospective study involved 20 patients with 21 ependymomas of the filum terminale encountered during a 21 year period (1988- 2008). All patients were diagnosed using MRI and surgically treated. RESULTS: the male: female ratio was 1:1.5, and the mean age at diagnosis was 44.8 years (range 15-64). First symptom included radicular pain (12 cases) and lumbar pain in the other 8 cases, with average symptom duration of 8.7 years (range 0-6-32). All patients underwent open biopsy, seventeen tumours received gross-total resection and 4 received subtotal resection. Histologically, 20 tumours were myxopapillary ependymomas (grade I) and 1 case a grade II ependymoma. The mean follow-up period was 8 years (range 1-18 years). CONCLUSIONS: filum terminale ependimomas are slow growing tumours of the cauda equina with a high incidence in young adults. The most common presentation is with low back pain long time evolution. Although ependymomas of the filum terminale are thought to be benign, local recurrence is not uncommon.

[Chronic subdural hematoma associated with arachnoid cyst. Report of 12 cases]. / Hematoma subdural crónico asociado a quiste aracnoideo. Presentación de 12 casos.

INTRODUCTION: We designed this study to investigate the clinical, neurological, and radiological outcome of patients with chronic subdural hematoma related to an intracranial arachnoid cysts. PATIENTS AND METHODS: Medical records of 12 cases of patients with arachnoids cyst complicated with chronic subdural hematoma were retrospectively reviewed. RESULTS: Between January 1984 and April 2008, 12 patients (0.9%) of 1.253 cases of chronic subdural hematoma surgically treated in our hospital had associated arachnoid cyst. Arachnoid cysts were located in the middle fossa (10 cases) and convexity (2 cases). The most frequent symptom was headache (6 cases), followed by seizures (3 cases). Eleven patients underwent burr hole and drainage; the oldest patient was treated conservatively. CONCLUSIONS: Patients with AC, especially when these are located in temporal fossa, appear to harbour a life-long risk of contracting subdural hematoma. Hematoma evacuation is adequate at first operation and if arachnoid cyst is symptomatic or preoperative symptoms persist, additional arachnoid cyst surgery should be considered.

[Spontaneous resolution of a lumbar disc herniation]. / Resolución espontánea de hernia de disco lumbar.

Lumbar disc herniation is a common cause of lower leg radiculopathy and the most effective methods of treatment remain in question. Both surgical and nonsurgical treatments may provide a successful outcome in appropriately selected patients. The spontaneous resolution of herniated lumbar discs is a well-established phenomenon. The authors present a case of spontaneous regression of a herniated lumbar nucleus pulpous in a patient with radiculopathy.