3D-Printed Endoport vs. Open Surgery for Evacuation of Deep Intracerebral Hemorrhage.

BACKGROUND: Large-sized clinical trials have failed to show an overall benefit of surgery over medical treatment in managing spontaneous intracerebral hemorrhages (ICH); less invasive techniques have shown to decrease brain injury caused by surgical manipulation in the standard open approach improving the clinical outcomes of patients. Thereby, we propose a low-cost 3D-printed endoport for a less invasive ICH evacuation. In this study, the authors compare the clinical outcomes of early surgical evacuation using a 3D-printed endoport vs. a standard open surgery (OS). METHODS: A retrospective analysis was conducted comparing patients who underwent early evacuation of a deep hypertensive ICH through an endoport vs. OS at a single center from August 2017 to March 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were the 90-day post-stroke functional outcome and mortality. RESULTS: A total of 36 patients were included. The two cohorts (18 endoport; 18 OS) showed no statistically significant differences in demographic, clinical, and radiologic characteristics, including median admission hemorrhage volume, Glasgow Coma Scale, and ICH scores. At 90-day post-stroke, 44% of patients in the endoport group and 17% in the OS group had a favorable functional outcome (mRS 0-3) (p = 0.039); moreover, the endoport group showed lower mortality (33% vs. 72%, p = 0.019). CONCLUSIONS: This study suggests that an endoport-assisted ICH evacuation may have better functional outcomes and lower mortality than OS. The proposed device could provide a safe, low-cost alternative for ICH's surgical treatment. More rigorous research is hence needed to assess the potential benefits of this technique.

Direct Endonasal Approach with Partial Upper Posterior Septectomy. A "Rescue Flap" Technique Modification.

Objective Report a modification of the "rescue flap" technique using a direct endonasal approach with a partial superior septectomy for approaching pituitary tumors developed in our institution. Design Prospective study. Setting Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León. Main Outcome Measures Since April 2015, we have performed 19 cases employing a direct endonasal approach with partial superior septectomy. Results and a technical note are described below. Results Nineteen patients were included in this report. Six patients presented transoperatory cerebrospinal fluid (CSF) leak, so a nasoseptal rescue flap was harvested. No patients developed postoperative CSF leak in this group. Two patients were submitted to a second surgical procedure. Nasoseptal flap was harvested without complications. In both patients, the size of the flap was enough to cover the dural defect and avoid CSF leak. Conclusion Direct endonasal approach with a partial posterior septectomy allows enough exposition of the sphenoidal sinus while preserving the nasoseptal septum with the possibility of a successful rescue flap when needed.

A modified protocol using half-dose gadolinium in dynamic 3-Tesla magnetic resonance imaging for detection of ACTH-secreting pituitary tumors.

UNLABELLED: ACTH-secreting tumors represent 10% of functioning pituitary adenomas, and most of them are microadenomas. It is generally accepted that only half of these tumors are correctly identified with current magnetic resonance imaging (MRI) techniques. The objective of the paper is to report a method for detecting suspected ACTH-secreting pituitary tumors undetectable by conventional dynamic MRI using dynamic 3-Tesla MRI (3T MRI) and half-dose gadopentetate dimeglumine (0.05 mmol/Kg). Eight patients were included (5 men and 3 women) with a mean age of 29.12 years. Each of them had a confirmed diagnosis of Cushing disease and a negative dynamic MRI for microadenoma using full-dose gadopentetate dimeglumine. A second MRI was then performed using only half the usual dose of contrast material. Images from the second MRI where compared with the first study. Microadenomas were detected in 100% of the patients using a half dose of the contrast. All were recognized on the basis of the presence of a hypointense nodular lesion surrounded by normal contrast-enhanced tissue. Six patients were submitted to surgery, and the results were confirmed by immunohistochemistry in all of them. The remaining subject had a sinus sample catheterization coincident with the MRI results. CONCLUSION: A half dose of dynamic resonance imaging contrast material increases the sensitivity of MRI detection of ACTH-secreting pituitary tumors.

[Comparison of metoprolol vs clonazepam as a first treatment choice among patients with neurocardiogenic syncope]. / Comparación de metoprolol versus clonazepam como tratamiento de primera intención en pacientes con síncope neurocardiogénico.

OBJECTIVE: We compared the effects of a metoprolol and clonazepam in patients with neurocardiogenic syncope. METHODS: We compared the effects of a metoprolol and clonazepam in a prospective, randomised trial in 54 patients. Patients were randomly assigned to metoprolol (starting dose 50 mg bid) or clonazepam (starting dose 0.5 mg qd). We assessed a primary combined endpoint of syncope and pre-syncope on a follow-up of 12 months. RESULTS: The primary combined endpoint of syncope and presyncope occurred in the metoprolol group in 3, 4, and 10% of patients at 3, 6, and 12 months respectively. In the clonazepam group it was no recurrence in the first 6 months, and 5% recurrence at 12 months follow-up (nonsignificant differences between groups). Clinical symptoms commonly associated with neurally mediated syncope were decreased similarly in both treatment groups, in the metoprolol group from 5.2+/-2.5 to 1.9+/-2.1 (p < 0.001) and in the clonazepam group from 5.5+/-2.5 to 1.5+/-2.2 (p<0.001). CONCLUSIONS: Pharmacological treatment of neurocardiogenic syncope with metoprolol or clonazepam resulted in similar prevention of syncope and presyncope. Both treatments decreased clinical symptoms but complete symptomatic resolution was rarely observed.

Comparación de metoprolol versus clonazepam como tratamiento de primera intención en pacientes con síncope neurocardiogénico / Comparison of metoprolol vs clonazepam as a first treatment choice among patients with neurocardiogenic syncope

Objetivo: Comparar la eficacia de metoprolol versus clonazepam como tratamiento de primera intención en pacientes con síncope neurocardiogénico. Material y métodos: Se llevó a cabo estudio prospectivo, longitudinal y aleatorizado en el que se evaluó el efecto del metoprolol (50 mg dos veces al día) versus clonazepam (0.5 mg una vez al día) sobre la sintomatología asociada a los tres meses y la recurrencia de síncope a 12 meses. La distribución de los datos fue normal, el análisis estadístico se realizó por métodos paramétricos considerándose significancia estadística una p≤0.05. Resultados: De 54 pacientes, 32 fueron tratados con metoprolol y 22 con clonazepam. No hubo diferencias en las características basales entre ambos grupos. El número de síntomas por paciente se redujo en el grupo de metoprolol de 5.2±2.5 a 1.9±2.1 (p<0.001), y en el grupo de clonazepam de 5.5±2.5 a 1.5±2.2 (p<0.001). La recurrencia de síncope a los 12 meses fue de 10% en el primer grupo y de 5% en el grupo de clonazepam, sin diferencia estadísticamente significativa. Conclusiones: El tratamiento con metoprolol o clonazepam disminuye en forma significativa los síntomas de distonía neurovegetativa asociados y la recurrencia de síncope es similar con ambos tratamientos.

OBJECTIVE: We compared the effects of a metoprolol and clonazepam in patients with neurocardiogenic syncope. METHODS: We compared the effects of a metoprolol and clonazepam in a prospective, randomised trial in 54 patients. Patients were randomly assigned to metoprolol (starting dose 50 mg bid) or clonazepam (starting dose 0.5 mg qd). We assessed a primary combined endpoint of syncope and pre-syncope on a follow-up of 12 months. RESULTS: The primary combined endpoint of syncope and presyncope occurred in the metoprolol group in 3, 4, and 10% of patients at 3, 6, and 12 months respectively. In the clonazepam group it was no recurrence in the first 6 months, and 5% recurrence at 12 months follow-up (nonsignificant differences between groups). Clinical symptoms commonly associated with neurally mediated syncope were decreased similarly in both treatment groups, in the metoprolol group from 5.2+/-2.5 to 1.9+/-2.1 (p < 0.001) and in the clonazepam group from 5.5+/-2.5 to 1.5+/-2.2 (p<0.001). CONCLUSIONS: Pharmacological treatment of neurocardiogenic syncope with metoprolol or clonazepam resulted in similar prevention of syncope and presyncope. Both treatments decreased clinical symptoms but complete symptomatic resolution was rarely observed.