Reconstruction of depressed skull fracture in school patients. Technique description.

OBJECTIVE: Depressed skull fractures are the result of trauma injuries. They are present in approximately 3% of patients who arrive to an emergency room with skull trauma. The main objective of surgical repair in depressed fractures is correction of cosmetic deformity and the prevention of infections. MATERIAL AND METHODS: A retrospective and transversal study was performed by our department between April 2016 and May 2017. Sixteen patients that underwent a craniotomy for skull trauma with depressed fracture were included in the study. The diagnosis was made by simple cranial CT scan alongside a three-dimensional reconstruction. RESULTS: Of the sixteen patients included, 5 were females (31.2%) and 11 males (68.8%). Twelve of the cases were an exposed fracture. In 7 cases, the fracture was located at parietal bone; 5 were located at frontal bone and 4 at the temporal bone. The average Glasgow coma score in the sample was 13. There were no complications nor deaths. CONCLUSIONS: The remodeling and repositioning of the autologous bone graft allow an adequate cosmetic result and it also avoids the placement of implants without increasing the costs and additional risks.

OBJETIVO: las fracturas de cráneo deprimidas son el resultado de lesiones traumáticas. Se encuentran en aproximadamente el 3% de los pacientes que se presentan en salas de emergencia con traumatismo craneal. El objetivo principal de la reparación quirúrgica en fracturas deprimidas es la corrección de la deformidad cosmética y la prevención de infecciones. PACIENTES Y MÉTODOS: se realizó un estudio retrospectivo y transversal en nuestro departamento entre abril de 2016 y mayo de 2017. Se incluyeron 16 pacientes que se sometieron a una craneotomía por traumatismo craneal y fractura deprimida. El diagnóstico se realizó mediante tomografía computarizada craneal simple con reconstrucción 3D. RESULTADOS: se incluyeron 16 pacientes, 5 casos femeninos (31,2%) y 11 masculinos (68,8%). En 12 casos se observó fractura expuesta. En 7 casos la fractura se localizó en el hueso parietal; 5 casos en el hueso frontal y 4 casos en hueso temporal. El puntaje promedio en la Escala de Coma de Glasgow fue 13. No hubo complicaciones o muertes. CONCLUSIONES: la remodelación y el reposicionamiento del injerto óseo autólogo permite un resultado cosmético adecuado evitando la colocación de implantes sin aumentar los costos y riesgos adicionales.

Associated factors for Tracheostomy in adults with severe traumatic brain injury. Score proposal.

BACKGROUND: In patients with severe traumatic brain injury (TBI), there is a lack of consensus about the need and time to perform a tracheostomy. Nowadays, the decision is individualized to each case. It is considered that patients that will need a tracheostomy profit by performing it earlier. PATIENTS AND METHODS: An observational and prospective study was performed. One hundred and twenty patients in a period of 18 months between 2016 and 2018, older than 18 years, with severe TBI at the first 24 h of trauma were analyzed. Clinical, biochemical, and radiological findings at admission were measured; patients were followed up until discharge. The statistical analysis was made with Student's t-test, χ2, and prevalence risk ratio. RESULTS: Ten associated factors were grouped according to the prevalence risk ratio. The principal factors were CRASH score, IMPACT score, SAPS II score, APACHE II score, age, revised trauma score, Glasgow Coma Scale, subdural hematoma, uni or bilateral abnormal pupil reactivity, and collapse of basal cisterns. CONCLUSIONS: We conclude that there are multiple factors associated with the need for tracheostomy in adult patients with severe TBI and it is possible to predict according to our findings from admission which patients will profit by this procedure.

ANTECEDENTES: No existe aún consenso respecto de la necesidad y el tiempo de realización de traqueostomía en el paciente con trauma craneoencefálico (TCE) grave. En la actualidad, la decisión se individualiza en cada caso. Se considera que los pacientes que requieren traqueostomía tendrán mayor beneficio si se realiza de forma temprana. MÉTODO: Se llevó a cabo un estudio observacional y prospectivo, en un periodo de 18 meses entre 2016 y 2018, con 120 pacientes mayores de 18 años con diagnóstico de TCE grave, en las primeras 24 horas del trauma. Se evaluaron datos clínicos, bioquímicos y radiológicos al ingreso, y se siguió hasta el alta hospitalaria. Se analizan las variables con las prueba t de Student y ji al cuadrado, y también la tasa de riesgo de prevalencia. RESULTADOS: Los factores de riesgo asociados con la necesidad de traqueostomía en el paciente con TCE grave fueron los resultados en las escalas CRASH, IMPACT, SAPS II y APACHE II, la edad, la puntuación de la Revised Trauma Score y de la Escala de Glasgow al ingreso, la presencia y el volumen de hematoma subdural, la respuesta pupilar anormal unilateral o bilateral, y el colapso parcial o total de las cisternas basales. CONCLUSIONES: Existen numerosos factores de riesgo asociados con la necesidad de traqueostomía en los pacientes adultos con TCE grave, y es posible predecir desde el momento del ingreso qué pacientes se beneficiarán de la realización de una traqueostomía.

[Clinical and radiological results of non-fusion by static interspinous spacer]. / Resultados clínicos y radiológicos de la no fusión por espaciador interespinoso estático.

BACKGROUND: The aim of this paper is to demonstrate the clinical and radiological results of non-fusion in patients with degenerative disc disease and lumbar by placing static interspinous spacer. METHODS: A retrospective study was made in the period between January 2010 and January 2013, 130 patients were treated by placing static interspinous spacer. Patients were divided into: Group 1 (treated for diagnosis of degenerative lumbar spinal stenosis), and group 2 (those diagnosed with lumbar disc herniation). It is improving pain by visual analog scale (VAS), functional improvement based on the Oswestry scale (ODI) and radiological outcome at 6,12 and 24 months was evaluated. RESULTS: 57 female patients and 73 male were included. The most affected segments were L4 - L5 and L5 - S1. In Group 1, there was improvement in pain (VAS) at 6 months to 2 points which was maintained through 12 months and 24 months was found in 4 points. Functional improvement (ODI) at 6 and 12 months remained 13 points and 24 points and 21 months in group 2: VAS 2.7, 3, 3.5 and ODI 15 respectively at 6 and 12 months; at 24 months was found in 20 points. There were no fatal complications in 1.5% in both groups. Regarding radiological changes increased the diameter foraminal which was held at the 6, 12 and 24 month follow-up. CONCLUSIONS: The interspinous device is an effective alternative treatment for lumbar degenerative disc disease and because it was associated with significantly improved lumbar pain and return to work activity.

Introducción: el objetivo de este trabajo es demostrar los resultados clínicos y radiológicos de la no fusión en los pacientes con enfermedad degenerativa lumbar y discal mediante la colocación de espaciador interespinoso estático. Métodos: estudio retrospectivo, de enero de 2010 a enero de 2013, con 130 pacientes tratados mediante colocación de espaciador interespinoso estático. Los pacientes se dividieron en: grupo 1 (tratados por diagnóstico de canal lumbar estrecho degenerativo) y grupo 2 (pacientes con diagnóstico de hernia discal lumbar). Se evaluó la mejoría de dolor mediante escala visual análoga (VAS), mejoría funcional con base en la escala de Oswestry (ODI) y resultado radiológico a los 6, 12 y 24 meses. Resultados: se incluyeron 57 pacientes del sexo femenino y 73 masculinos. Los segmentos más afectados fueron L4 - L5 y L5 - S1. En el grupo 1 hubo mejoría del dolor a los 6 meses a 2 puntos, la cual se mantuvo hasta los 12 meses; mientras que a los 24 meses se encontró en 4 puntos. La mejoría funcional (ODI) a los 6 y 12 meses se mantuvo el 13 puntos y a los 24 meses en 21 puntos. Mientras que en el grupo 2: VAS de 2.7, 3, 3.5 respectivamente y ODI de 15 a los 6 y 12 meses; a los 24 meses se encontró en 20 puntos. Hubo complicaciones no mortales en 1.5% en ambos grupos. En cuanto a los cambios radiológicos, se demostró un aumento en el diámetro foraminal el cual se mantuvo a los 6, 12 y 24 meses de seguimiento. Conclusiones: el dispositivo interespinoso es una alternativa de tratamiento eficaz para la enfermedad degenerativa lumbar y la enfermedad discal, ya que se asoció con mejora significativa de dolor lumbar y reincorporación a actividad laboral.

Manejo de la enfermedad aneurismática múltiple. Experiencia en un Hospital de Especialidades.

Objective: To establish the frequency and results in patients carriers with multiple aneurysms (MA) treated by microsurgery and/or neurological endovascular therapy (NET) in the Hospital of Specialties on The National Medical Center La Raza. Method: It is an ambispective, descriptive and longitudinal study that includes patients carriers of MA treated in the National Medical Center La Raza from March the 1st of 2009 to April the 30th of 2014. Results: 62 patients carriers of 151 aneurysms were treated. According to the type of treatment, 30 patients (49%) were included in the surgical group (GQ), 25 (40%) in the endovascular group (GE) and 7 (11%) in the combinated group (GC). The number of aneurysms was distributed this way: 69 (46%) in the GQ, 61 (40%) in the GE and 21 (14%) in the GC. At GQ, it was not possible to exclude all their aneurysms on 21% of the patients, while it was feasible in only 27%. In all GE patients (40%) the exclusion of all aneurysms was achieved. The GC, meaning surgical cases that were not completed by NET, formed 11% of the cases. At GQ there was a rate of 6% of complications, meanwhile at GE it was 0.5%.

[Invasive management of trigeminal neuralgia. 8 years experience]. / Manejo invasivo de la neuralgia del trigémino. Experiencia de 8 años.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by stereotyped repetitive, unilateral pain, referred as an electric shock, triggered by the stimulation of the rami of the trigeminy nerve. It presents more frequently in women. The aim is to know the efficacy of surgical treatment of TN against pain by means of microvascular decompressive technics (MDT) and balloon percutaneous microcompression (BPM). METHODS: A retrospective study was performed from January 2005 to January 2013, including 73 patients treated for TN. Sixty patients from group 1 (82 %) were treated with MDT, and 13 from group 2 with BPM. We evaluated the presence of pain in patients during the immediate postoperative period, and at 1, 3 and 5 years. RESULTS: 55 female patients and 18 male patients were included. The mean age of presentation for TN was 55 years. In group 1 there was pain remission in the immediate postoperative period in 95% of the cases, in 92% at one year, 91% at 3 years and 88% at 5 years; in group 2 in 85%, 84%, 84% and 70%, respectively. There were no lethal complications in 6.5% in group 1 and in 28% in group 2. CONCLUSIONS: The two therapeutic procedures reduced pain of TN in a long term in most patients. Our results show high and perdurable resolution of the pain with negligible morbimortality.

Introducción: la neuralgia del trigémino (NT) se caracteriza por un dolor estereotipado, repetitivo, unilateral referido como eléctrico, desencadenado por la estimulación de  ramas del nervio trigémino. Se presenta con mayor frecuencia en mujeres, 2:1 con respecto a sexo masculino. El objetivo fue conocer la eficacia del tratamiento quirúrgico de NT contra el dolor mediante las técnicas de descompresión microvascular (DMV) y microcompresión percutánea con balón (MPB). Métodos: estudio retrospectivo, en el periodo entre enero de 2005 y enero de 2013, de 73 pacientes tratados por NT. Los 60 pacientes del grupo 1 fueron tratados con DMV, y los 13 del grupo 2 con MPB. Se evaluó la presencia de dolor de los pacientes en el postoperatorio inmediato y a 1, 3 y 5 años. Resultados: se incluyeron 55 pacientes del sexo femenino y 18 hombres. La edad media de presentación de NT fue a los 55 años de edad. En el grupo 1 hubo remisión del dolor en el postoperatorio inmediato en 95 % de los casos, en 92 % al primer año, 91 % a los 3 años y 88 % a los 5 años y en el grupo 2: 85 %, 84 %, 84% y 70 % respectivamente. Conclusiones: los dos procedimientos terapéuticos redujeron el dolor de NT a largo plazo en la mayoría de los pacientes. Nuestros resultados muestran resolución alta y perdurable del dolor con escasa morbimortalidad.

[Treatment of endovascular aneurysms associated with fenestration of the basilar artery. A case report]. / Tratamiento endovascular de aneurisma asociado a fenestración de la arteria basilar. Reporte de un caso.

The fenestration of the basilar artery is an uncommon anatomical variant that may be associated with saccular aneurysms; however this association is rare. We report the case of a patient who presented with subarachnoid hemorrhage that was successfully treated by coil embolization and review the literature.

[Ventriculo subgaleal shunt in hydrocephalus secondary to intraventricular hemorrhage in prematures]. / Derivación ventrículo-subgaleal en hidrocefalia secundaria a hemorragia intraventricular (HIV) en el prematuro.

BACKGROUND: Intraventricular hemorrhage (IVH) is one of the most serious complications in premature lightweight. While in the decade of 1970-1980 the incidence was 40-50%, now it is at least 20%. But it presents a challenge because of the multiple existing therapies and the results in terms of neurological sequelae. MATERIAL AND METHODS: We performed a retrospective review of 48 patients managed with ventriculo subgaleal shunt and a therapeutic decision based on gestational age, weight, and grade of intraventricular hemorrhage. RESULTS: Of the patients, 29 (60%) of the cases were female and 19 (40%) were male. The average gestation age for placing the subgaleal system was 30 months, with an average weight of 1,511 g, and with an infection rate of 4%. In 44 cases peritoneal system was placed (92%) because four died (8%). No mortality was observed at surgery. CONCLUSIONS: Mortality in the past appeared in 75% of patients, with the realization that derivation of subgaleal irrigation reduces infections besides allowing proper control of hydrocephalus and thus decreases the long-term neurological sequelae.