A Case of Dentatotomy for Pain and Spasticity and Systematic Review.

BACKGROUND: Surgical interventions for spasticity aim to improve motor function and pain in cases that are refractory to medical treatment. Ablation of the cerebellar dentate nucleus (dentatotomy) may be a useful alternative. CASE REPORT: A 55-year-old male patient with spasticity, secondary to a traumatic cervical spinal cord injury with quadriparesis, had bilateral lumbar DREZotomy with an improvement that lasted for 6 years. Ten years after the DREZotomy, a progressive increased spasticity manifested as spastic diplegia (Ashworth 4) and spontaneous muscle painful spasms (Penn 4), as well as spasticity in the upper extremities, predominantly on the right side (Ashworth 3). A right radio frequency dentatotomy was performed with intraoperative electrophysiological monitoring. Spasticity scales were applied at the following times: preoperative and at 1 and 8 months after surgery. During the first month, the patient presented a clear decrease in spasticity ipsilateral to the side of lesioning (Ashworth 1) and of painful spasms in the lower extremities (Penn 1). After 8 months, spasticity ipsilateral to the injury decreased even more to Ashworth (0), but a progressive increase in muscle spasms of lower extremities was observed (Penn 2). CONCLUSION: Stereotactic dentatotomy may be an effective surgical alternative for management of spasticity associated with painful spasms in selected patients.

Prognostic factors of unilateral prelemniscal radiations radiofrequency lesions: A surgical technique for the treatment of Parkinson's disease motor symptoms.

OBJECTIVE: A group of patients with Parkinson's disease (PD) were managed with unilateral prelemniscal radiation radiofrequency lesions (U-Raprl). The current study aims to evaluate prognostic factors that could influence clinical response. METHODS: Patients previously diagnosed with PD managed with U-Raprl were included in the study, classifying them into two groups according to their percentage of clinical response ( 1.5), Age (p < 0.0001, ∆ = 2.38), Evolution (p < 0.0001, ∆ = 2.38), and post-operative UPDRS (p < 0.01, ∆ = 1.38). The qualitative analysis of the distribution regarding the responder group shows that those patients with an age under 58 years, an evolution fewer than 7 years, and a preoperative HYS score smaller than 2, showed a response ≥ 50% according to the UPDRS-III in all cases. CONCLUSION: U-Raprl is a highly effective procedure with a 5-year persistence of improvement. The most relevant prognostic factors to consider for a clinical response according to UPDRS-III greater than 50% are age under 58 years, less than 7 years of PD evolution, and HYS less or equal to 3.

Co-release of glutamate and GABA from single, identified mossy fibre giant boutons.

Several laboratories have provided immunohistochemical, molecular biological and electrophysiological evidence that the glutamatergic granule cells of the dentate gyrus can transiently express a GABAergic phenotype during development. Electrophysiological recordings on hippocampal slices obtained during this period have shown that stimulation of the mossy fibres (MFs) provokes simultaneous monosynaptic GABA(A) and glutamate receptor-mediated responses in their target cells,which have the pharmacological and physiological characteristics of MF neurotransmission. This evidence, although strongly supporting the hypothesis that MFs co-release glutamate and GABA, is indirect, as the extracellular stimulation used in slice experiments could activate fibres other than MFs. In this study, we show that selective stimulation of single, identified MF boutons (MFBs) attached to the apical dendrites of dissociated pyramidal cells of developing rats produced synaptic currents mediated by either glutamate receptors only or by both glutamate and GABA(A) receptors. By contrast, stimulation of MFBs of adult rats produced exclusively glutamate receptor-mediated responses. All responses evoked by stimulation of MFBs underwent strong frequency-dependent potentiation and were depressed by the activation of presynaptic metabotropic glutamate receptors. On the other hand, synaptic responses evoked by stimulation of interneuronal boutons located on the soma or on the basal dendrites of the same pyramidal cells were exclusively mediated by GABA(A) receptors, underwent frequency-dependent depression and were unaffected by mGluR agonists.We here demonstrate that the simultaneous glutamatergic and GABAergic responses evoked by MF stimulation in pyramidal cells of CA3 during development have a common origin in the giant MFBs.

Bibliometric Analysis of Mexican Publications on Stereotactic and Functional Neurosurgery From 1949 to 2021.

Background: Stereotactic and functional neurosurgery (SFN) is a rapidly evolving field and some emerging countries, especially Mexico, have made significant contributions to this discipline. A bibliometric analysis has never been performed in Latin America, and this would be particularly important to show the areas that remain poorly studied, and design research strategies for the future. Methods: Scopus was queried using keywords pertaining to functional neurosurgery, restricting the affiliation country to Mexico, and considering documents published after 1949. Added to the initial search, a complementary literature exploration by author, considering the publications of the most productive neurosurgeons, was performed. A descriptive statistical analysis was carried out. Results: From 5,109 articles, only 371 were eligible. Scientific production has gradually increased with time. Epilepsy (31%) and movement disorders (27.4%) were the most studied neurological conditions, whereas the other 41.6% corresponded to pain, behavior disorders, spinal cord injuries, neuromodulation, stereotactic biopsies, and SFN history. Level of evidence was predominantly level V (59.1%). Publication output is highly skewed to Mexico City, which represents 78.4% of national production. Relative to factors associated with impact of research, publications in English had more citations (28.5 mean citations per paper), and journals with an impact factor greater than one had more than 10 mean citations per paper. Conclusions: Mexico has experienced an increase in the productivity of SFN literature, addressing the most prevalent issues in the country (epilepsy and motor disorders). However, it is necessary to report studies with a higher level of evidence, as well as to decentralize the research collaborating with national institutions outside Mexico City. On the other hand, it is imperative to promote scientific production in English and in high-impact indexed journals to increase the visibility of our production. We would like to call upon our colleagues in other countries to reproduce our methodology, in order to determine the factors associated with the impact and productivity on SFN research.

Evolution and Revolution of Imaging Technologies in Neurosurgery.

We understand only a small fraction of the events happening in our brains; therefore, despite all the progress made thus far, a whole array of questions remains. Nonetheless, neurosurgeons invented new tools to circumvent the challenges that had plagued their predecessors. With the manufacturing boom of the 20th century, technological innovations blossomed enabling the neuroscientific community to study and operate upon the living brain in finer detail and with greater precision while avoiding harm to the nervous system. The purpose of this chronological review is to 1) raise awareness among future neurosurgeons about the latest advances in the field, 2) become familiar with innovations such as augmented reality (AR) that should be included in education given their ready applicability in surgical training, and 3) be comfortable with customizing these technologies to real-life cases like in the case of mixed reality.

Women in Neurosurgery: First Neurosurgeon in Latin America and Current Mexican Leaders.

BACKGROUND: History has taught us that Mexican culture has been largely supported by women, despite gender prejudice from the society. Neurosurgery has not been the exception. Therefore, we investigated the challenges and influence of female neurosurgeons in Mexico. METHODS: We conducted a review of the literature and an analysis of the internal database of the Mexican Society of Neurological Surgery focusing on 3 topics: 1) the historical presence of women and gender inequality in Mexico; 2) the life and legacy of the woman who became the first neurosurgeon in Mexico and in Latin America; and 3) the participation of women in neurosurgery in the past 3 decades. RESULTS: In Latin America, the first woman in neurosurgery was María Cristina García-Sancho, who completed her neurosurgical training in 1951. Currently, women represent 6.2% of the total members of the Mexican Society of Neurological Surgery (MSNS). This percentage is still low, although data collected in this study suggest that it might increase in the next few years because 16.7% of Board Directors of the MSNS are women, the next elected president is a female neurosurgeon, and 14.5% of neurosurgery residents are women. CONCLUSIONS: Although a steady increase has occurred of women in neurosurgery in Mexico, there is still work to do, especially to overcome the barriers related to the old assumptions of the cultural and social roles of women.

Lumbar dermoid cysts: 3 illustrative cases and a total review of the literature of the last two decades.

Spinal dermoid cysts are relatively infrequent tumors generally associated with a benign course. Here we describe three cases and analyzed the 109 cases of lumbar dermal cysts described in the literature in the last 20 years. We report a pediatric patient with a dermoid cyst posterior to a lumbar surgery for myelomeningocele repair with bad evolution; and two adult patients with the affection of the motor and autonomic function with good surgical outcomes. In approximately half of the reviewed cases, it was reported at least one complication. In fact, two cases had a fatal outcome. We discuss relevant characteristics of these lesions and those aspects probably associated with complications and bad outcomes.

Neurological Functional Surgery in Mexico: From Pre-Columbian Cranial Surgery to Functional Neurosurgery in the 21st Century.

From the predominance of the pre-Columbian cultures to the present, an interest has existed in Mexico in brain structure and function, in both normal and pathological conditions. This interest has resulted in both medical and surgical attempts to treat some neurological conditions. Eighty years ago, with the influence of American and European neurosurgeons, modern Mexican neurosurgery emerged. Since then, it has progressively grown and diversified into several high specialties. At present, functional neurosurgery in Mexico constitutes, similar to that in other countries, a recognized surgical subspecialty that provides valuable information to treat brain dysfunctions such as movement disorders, pain, epilepsy, and other conditions. In the present report, we have briefly described the main historical aspects of the emergence and development of functional neurosurgery in Mexico.

An Affordable and Feasible Technique for Minimally Invasive Tubular Lumbar Discectomy.

BACKGROUND: The benefits of minimally invasive spine surgery are attainable only if hospitals have the financial resources to acquire essential equipment. We present a surgical approach readily available to countries where unacceptably expensive materials are the main limitation for use of minimally invasive spine surgery. METHODS: This retrospective study included 30 patients who underwent minimally invasive spine surgery using syringes as dilators and retractors for posterior lumbar approaches. Inclusion criteria were lumbar radicular/back pain, degenerative disc, spondylolysis, unilateral approach, and maximum of 2 affected spine levels. Demographic characteristics, affected radicular level, diagnosis, type and length of surgery, hospital length of stay, MacNab criteria, complications, and resumption of daily activities were analyzed. RESULTS: Of 30 patients, 17 (56.6%) presented with S1 radicular pain. Pain was mainly due to posterolateral hernia (70%; n = 21) requiring 1-level discectomy. In 6 patients (20%), discectomy and an interspinous process device were required. One patient (3.33%) underwent 2-level discectomy. All surgeries were performed using syringes as dilators and retractors. Maximum syringe diameter used was 2 cm (20-mL syringes) in 29 patients (96.6%) and 3 cm (60-mL syringe) in 1 patient. Average length of surgery was 1.5 hours, and average hospital stay was 1.8 days. Based on MacNab criteria, excellent, good, and fair outcomes were achieved in 25 patients (83%), 3 patients (10%), and 2 patients (6.7%). Complications were observed in 5 patients (16.7%). CONCLUSIONS: This is a safe and feasible technique with excellent results obtained at low cost and is becoming an attractive surgical option in developing countries.

Differential frequency-dependent antidromic resonance of the Schaffer collaterals and mossy fibers.

To better understand information transfer along the hippocampal pathways and its plasticity, here we studied the antidromic responses of the dentate gyrus (DG) and CA3 to activation of the mossy fibers and Schaffer collaterals, respectively, in hippocampal slices from naïve and epileptic rats. We applied trains of 600 electrical stimuli at functionally meaningful frequencies (θ, ß/γ and γ). The responses of the DG to θ frequency trains underwent rapid potentiation that lasted about 400 stimuli, after which they progressively returned to control value. At ß/γ and γ frequencies, however, the initial potentiation was followed by a strong frequency-dependent depression within the first 50 stimuli. In kindled animals, the initial potentiation was stronger than in control preparations and the resonant phase at θ frequency lasted longer. In contrast, CA3 responses were exponentially depressed at all frequencies, but depression was significantly less intense at θ frequency in epileptic preparations. Failure of fibers to fire action potentials could account for some of the aforementioned characteristics, but waveforms of the intracellular action potentials also changed as the field responses did, i.e., half-duration and time-to-peak increased in both structures along the stimulation trains. Noteworthy, block of glutamate and GABA ionotropic receptors prevented resonance and reduced the depression of antidromic responses to ß/γ and γ stimulation recorded in the DG, but not in CA3. We show that the different behavior in the information transfer along these pathways depends on the frequency at which action potentials are generated, excitability history and anatomical features, including myelination and tortuosity. In addition, the mossy fibers are endowed with ionotropic receptors and terminal active properties conferring them their sui generis non-passive antidromic responses.

Granule cells born in the adult rat hippocampus can regulate the expression of GABAergic markers.

The granule cells (GCs) of the dentate gyrus transiently express markers of the GABAergic phenotype early during development. However, GCs are generated throughout life, posing the question of whether the newborn neurons in the adult rodent recapitulate the development of the neurotransmitter phenotype of GCs generated during embryonic and early postnatal development. In this work we asked whether newborn GCs transiently express a GABAergic phenotype during their development in the adult rat. Using retroviral infection, we labeled dividing cells in the dorsal hippocampus with GFP, identified them as granule cells, and determined their expression of GABAergic markers at different developmental stages. We found that GFP-positive cells express Prox-1 and calbindin, identifying them as GCs. GABA or GAD(67) was expressed in 13% of GFP-positive cells at 7 dpi, in 16% at 10 dpi and in 20% at 15 dpi. At 30 dpi, however, no GFP-positive cell somata containing GABAergic markers were detected, but their mossy fiber boutons did contain GAD(67). Interestingly, developing GCs detected with doublecortin and PSA-NCAM in non-injected adult rats, did not express GABAergic markers, suggesting that retroviral injection/infection stimulates their transient expression. However, in non-injected rats, a number of mossy fiber boutons of newborn granule cells detected with PSA-NCAM did express GAD(67). Our findings reveal that developing GCs born in the adult are able to transiently up-regulate the expression of GABAergic markers to be detected in their soma in response to insults, while they constitutively express GAD(67) in their mossy fibers.

Dissociation of CA3 pyramidal cells with attached, functional, identified mossy fiber and interneuronal boutons for studying glutamatergic and GABAergic synaptic transmission.

Pyramidal cells of CA3 area receive glutamatergic signals from the mossy fibers (MFs), perforant path and collaterals of other pyramidal cells, as well as GABAergic inputs from interneurons. In hippocampal slices, an extracellular stimulation electrode is often used to activate the MFs, with the disadvantage of possibly activating fibers other than MFs. We set-up a preparation that allows the analysis of the glutamatergic input from identified, giant MF boutons as well as of GABAergic inputs from boutons of interneurons on single CA3 pyramidal cells. Mossy fiber boutons were labeled by exposing hippocampal slices to a zinc-reactive fluorescent dye, or by injecting a fluorescent dye in the granule cell layer and allowing its transport along the MFs to their terminals in CA3 area. After conducting an enzyme-free, mechanical dissociation of CA3 area, we obtained pyramidal cells containing fluorescent, giant MF boutons attached to their apical dendrites, as well as boutons of interneuronal origin. Whole cell recordings were then performed, whereby synaptic responses could be evoked by selective stimulation of the identified boutons. The synaptic currents evoked by stimulation of MF boutons, unlike those evoked by stimulation of interneuronal boutons, underwent strong frequency potentiation and were depressed by activation of metabotropic glutamate receptors, which are characteristics of transmission of MF origin. Combination of fluorophores can be used to label different tracts/boutons allowing the study of the different characteristics of neurotransmitter release from a variety of sources on single target cells.