Análisis de los factores que influyen en el resultado final del traumatismo craneal moderado / Analysis of the factors influencing the final outcome of moderate head injury

Introducción: El traumatismo craneoencefálico (TCE) es un fenómeno muy frecuente, asociado a elevadas tasas de morbilidad. Objetivo: Describir una serie amplia de pacientes adultos, mayores de 14 años, que sufren TCE moderado atendidos en el Hospital Universitario de Getafe, entre los años 2005 y 2015, estudiar el perfil epidemiológico y analizar el diagnóstico y el tratamiento efectuados, así como establecer los principales factores pronósticos que influyen en el resultado final. Método: Se ha realizado un estudio retrospectivo, de revisión de historias clínicas y entrevistas telefónicas. Resultados: Se ha estudiado un total de 66 pacientes que sufren TCE moderado. El TCE moderado es más frecuente en varones, y el mecanismo causante más común es el accidente de tráfico. Conclusiones: El presente estudio establece la necesidad de ingreso hospitalario, ya sea en planta de Neurocirugía o en la Unidad de Cuidados Intensivos (UCI), en función de la situación clínica del paciente y de los hallazgos radiológicos encontrados en la Tomografía Computarizada (TC). Las variables que han resultado determinantes de la evolución adversa en el paciente que sufre trauma craneal moderado son los hallazgos patológicos en la TC, la existencia de focalidad neurológica, la presencia de deterioro clínico, la edad avanzada, los hallazgos en la TC de control, y los atropellos, caídas e impactos directos como mecanismos causantes. Existe diferencia de pronóstico entre pacientes con puntuación de 11 y 12, con una evolución más parecida al del paciente que sufre trauma leve, y los que obtienen 9 y 10 puntos, con un pronóstico más similar al del trauma grave.

Introduction: Head injuries are very frequent and associated with high morbidity rates. This paper describes a large series of patients, all ≥14 years old, who suffered moderate head injuries and were treated at the University Hospital of Getafe, between 2005 and 2015 (n = 66). Our aims were (1) to examine patients' epidemiological profile; (2) to describe the best diagnostic and therapeutic measures performed; and (3) to identify the main determinants of final outcome. Methods: This was a combined retrospective and prospective study, consisting first of a review of medical records, followed by telephone interviews of eligible patients to determine final outcomes. Results: Sixty-six patients with moderate head injuries were studied. In this series, most patients were males, and the most common causative mechanism was a traffic accident. The needs for hospital admission, admission into the Neurosurgery service, and admission to Intensive Care Unit (ICU) were determined by patients' clinical presentation and radiological findings. Risk factors for a poor final neurological outcome were the presence of neurological defects during the initial clinical examination, findings on brain computerized tomography (CT), and patient age. The Glasgow Coma Scale was poor at predicting the final outcome in these patients with moderate head injuries, incapable of distinguishing between patients with a score of 11 or 12, more similar to mild trauma, and those with scores of 9 or 10 points, more similar to severe head trauma. Conclusions: In this series of adolescent and adult patients with moderate head injuries, the best predictors of final outcome were the initial presence/absence of neurological defects and CT findings, and patient age. The Glasgow Coma Scale was less useful.

Factores pronósticos del traumatismo craneoencefálico grave / Prognostic factors for severe head injury

Introducción: El traumatismo craneoencefálico (TCE) es un fenómeno frecuente, asociado a elevadas tasas de morbilidad. Clásicamente se ha prestado más atención al traumatismo craneal grave o severo, dada la trascendencia del problema sanitario. Objetivo: Describir una serie de pacientes mayores de 14 años, que sufrieron TCE grave atendidos en el Hospital Universitario de Getafe entre los años 1993 y 2015 (n = 86), estudiar el perfil epidemiológico de presentación, y analizar el diagnóstico y tratamiento efectuados, así como establecer los principales factores pronósticos que influyen en el resultado final. Método: Se ha realizado un estudio retrospectivo, de revisión de historias clínicas y entrevistas en Consultas Externas. Resultados: El TCE grave es más frecuente en varones, y el mecanismo causante más común en nuestro medio es el accidente de tráfico. En este estudio, las variables que han resultado más determinantes de la evolución adversa en el paciente que sufre trauma craneal grave son la edad, el tamaño y la reactividad pupilar, la peor puntuación obtenida por el paciente en la escala de Glasgow para el Coma y las lesiones encontradas en la Tomografía Computarizada (TC) de cráneo. Conclusiones: Las lesiones en el trauma craneal grave se pueden categorizar en nueve patrones patológicos de acuerdo con la información aportada por la TC. Estos patrones presentan un perfil anatómico, clínico y una significación pronóstica bien definidos, asociándose a su vez a un patrón de comportamiento de la PIC característico. Los hematomas extra-axiales puros son las lesiones que presentan mejor pronóstico, siendo la lesión axonal difusa asociada a hinchazón cerebral y las contusiones múltiples bilaterales las que conllevan peor evolución. La Escala de Rimel se ajusta correctamente a la severidad del traumatismo craneal. La Escala de Glasgow para el Coma se relaciona bien con el pronóstico final del paciente con trauma craneal grave.

Introduction: Head injury is a very frequent event, associated with high morbidity rates. Classically, more attention has been paid to severe trauma. This paper describes a large series of patients, all ≥14 years old, who suffered severe head injuries and were treated at the University Hospital of Getafe, between 2005 and 2015 (n = 66). Our aims were (1) to examine patients' epidemiological profile; (2) to describe the best diagnostic and therapeutic measures performed; and (3) to identify the main determinants of final outcome. Methods: This was a combined retrospective and prospective study, consisting first of a review of medical records, followed by in-house neurosurgical consultations to determine final outcomes. Results: In this study, the variables that were most determinant of poor outcomes in patients with severe head injuries were patient age, the initial size and reactivity of their pupils, their worst Glasgow Coma Scale score, and lesions found on brain computed tomography (CT). Conclusions: Severe head injuries can be categorized into nine pathological patterns, based upon brain CT findings. Each pattern has a distinct anatomical and clinical profile and well-defined prognostic significance, in turn associated with behavior patterns characteristic of intracranial pressure (ICP). Pure extra-axial hematomas are associated with the best prognosis, with diffuse axonal lesions associated with brain swelling and multiple bilateral contusions the worst. The Rimel Scale accurately adjusts to the severity of head trauma. The Glasgow Coma Scale is a good predictor of ultimate outcomes in patients with severe head injuries.

Rosette-forming glioneuronal tumor of the fourth ventricle. Two cases report and literature review. / Tumor glioneuronal formador de rosetas del IV ventrículo. Presentación de 2casos y revisión de la literatura.

Rosette-forming glioneuronal tumor of the fourth ventricle is a primary central nervous system tumor introduced in the group of glioneuronal tumors in the WHO classification of 2007. Initially it was described around the fourth ventricle, but recently have been published cases in different locations. We present 2cases of this rare tumor, both surgically treated. The first in a 41 year old man with typical symptoms of posterior fossa injury. The second in an 18 year old woman, with incidental finding of posterior fossa injury that was also surgically treated. We present pre- and post-surgical magnetic resonance images, histological pictures of this tumor and we make a review of the literature.

Significant Hemorrhage Rate Reduction after Gamma Knife Radiosurgery in Symptomatic Cavernous Malformations: Long-Term Outcome in 95 Case Series and Literature Review.

BACKGROUND: The natural history of cavernous malformations (CMs) has remained unclear. This lack of knowledge has made treatment decisions difficult. Indeed, the use of stereotactic radiosurgery is nowadays controversial. The purpose of this paper is to throw light on the effectiveness of Gamma Knife radiosurgery (GKRS) therapy. METHODS: The authors reviewed data collected from a prospectively maintained database. A total of 95 patients (57 female and 38 male) underwent GKRS for high-surgical-risk CMs. A total of 76 cavernomas were deeply located (64 lesions in the brainstem and 12 lesions in the thalamus). All of them were located in eloquent regions. The median malformation volume was 1,570 mm3. The median tumor margin dose was 11.87 Gy, and the mean tumor maximum dose was 19.56 Gy. RESULTS: Ninety-five cavernous CMs were managed from 1994 to 2014. All patients had experienced at least 1 symptomatic bleeding incident before treatment (only 1 hemorrhage event in 81%). The median length of follow-up review was 78 months. The pretreatment annual hemorrhage rate was 3.06% compared with 1.4% during the first 3-year latency interval, and 0.16% thereafter (p = 0.004). Four patients developed new location-dependent neurological deficits, and 3 patients had edema-related headache after radiosurgery. All of them presented full recovery. CONCLUSIONS: The best dosage range for preventing bleeding was identified as between 11 and 12 Gy in our series. Although the efficacy of radiosurgery in CMs remains impossible to quantify, a very significant reduction in the bleeding rate occurs after a 3-year latency interval. No permanent neurological morbidity is reported in our series. These results defend the safety of GKRS in surgical high-risk CM from the first bleeding event.

[Casuistry review of patients undergoing surgery for pituitary adenomas in Getafe University Hospital (Spain)]. / Revisión casuística en el hospital universitario de Getafe de pacientes con patología hipofisaria adenomatosa intervenidos quirúrgicamente.

OBJECTIVE: To perform a casuistry review of patients diagnosed with pituitary adenomas (PA) who underwent surgery performed by the same neurosurgeon after 1995. MATERIAL AND METHODS: A descriptive and retrospective study was performed in 98 patients with PA undergoing surgery from 1995-2008. Tumor size and data on functionality, pathology and postprocedural complications were analyzed. The study was divided into two periods: 1995-2002 (first period) and 2003-2008 (second period). RESULTS: A total of 110 surgical interventions (59 in the first period and 51 in the second) were performed for 49 non-hormone-producing PA and 61 hormone-producing PA. There were 85 macroadenomas and 25 microadenomas. Cure was achieved in 31 patients (36%) with macroadenomas and in 21 patients (84%) with microadenomas (P=0.05).The number of complications was significantly higher in the first period [32 patients (54 %)] than in the second period [16 patients (31.3%)] (P<0.05). Cure was achieved in 28 patients (47.4%) in the first period compared with 31 (52.1%) in the second (P=0.1). The mortality rate was 0.9%. CONCLUSIONS: As described in previous studies, the cure rate was significantly higher for microadenomas than for macroadenomas. There was a significant reduction in the incidence of surgical complications and a trend toward an increase in the percentage of overall healing in the second period of the study. These results are probably related to the neurosurgeon's greater experience and surgical skill.