Consenso sobre guías de tratamiento de gliomas de bajo grado elaborado por el grupo de tumores de la SENEC / Low grade gliomas guide-lines elaborated by the tumor section of Spanish Society of Neurosurgery

Los gliomas de bajo grado (Low Grade Gliomas, LGG) del adulto son tumores que se originan a partir de las células gliales del cerebro y cuyo manejo implica gran controversia a día de hoy, comenzando desde el diagnóstico, hasta el tratamiento y seguimiento posterior de estos pacientes. Es por ello que el grupo de tumores de la Sociedad Española de Neurocirugía (GT-SENEC) ha llevado a cabo una reunión de consenso, en la que se han debatido las cuestiones neuroquirúrgicas más relevantes, llegando a recomendaciones basadas en la mejor evidencia científica. Con el fin de obtener el máximo beneficio a estos tratamientos se debe hacer una valoración individualizada de cada paciente por un equipo multidisciplinar, constituido por aquellas especialidades involucradas tanto en el diagnóstico como en el tratamiento. El objetivo de este trabajo es elaborar unas recomendaciones de tratamiento para los pacientes con LGG, para lo cual un experto en cada campo ha descrito lo más relevante de dicha área basado tanto en su experiencia como en la literatura. Se han desarrollado los apartados más relevantes en el manejo de los LGG basados en la mejor evidencia publicada. A pesar de que existe controversia en algunos aspectos del manejo de los LGG, cada vez hay más datos para poder hacer recomendaciones de tratamiento consensuadas. El neurocirujano debe conocer las distintas opciones de tratamientos, sus indicaciones y riesgos para poder participar activamente en la toma de decisiones y poder ofrecer un tratamiento neuroquirúrgico oportuno a cada situación (AU)

Adult low-grade gliomas (Low Grade Gliomas, LGG) are tumors that originate from the glial cells of the brain and whose management involves great controversy, starting from the diagnosis, to the treatment and subsequent follow-up. For this reason, the Tumor Group of the Spanish Society of Neurosurgery (GT-SENEC) has held a consensus meeting, in which the most relevant neurosurgical issues have been discussed, reaching recommendations based on the best scientific evidence. In order to obtain the maximum benefit from these treatments, an individualized assessment of each patient should be made by a multidisciplinary team. Experts in each LGG treatment field have briefly described it based in their experience and the reviewed of the literature. Each area has been summarized and focused on the best published evidence. LGG have been surrounded by treatment controversy, although during the last years more accurate data has been published in order to reach treatment consensus. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case (AU)

Low grade gliomas guide-lines elaborated by the tumor section of Spanish Society of Neurosurgery.

Adult low-grade gliomas (Low Grade Gliomas, LGG) are tumors that originate from the glial cells of the brain and whose management involves great controversy, starting from the diagnosis, to the treatment and subsequent follow-up. For this reason, the Tumor Group of the Spanish Society of Neurosurgery (GT-SENEC) has held a consensus meeting, in which the most relevant neurosurgical issues have been discussed, reaching recommendations based on the best scientific evidence. In order to obtain the maximum benefit from these treatments, an individualised assessment of each patient should be made by a multidisciplinary team. Experts in each LGG treatment field have briefly described it based in their experience and the reviewed of the literature. Each area has been summarized and focused on the best published evidence. LGG have been surrounded by treatment controversy, although during the last years more accurate data has been published in order to reach treatment consensus. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case.

Effects of Myofascial Release on Pressure Pain Thresholds in Patients With Neck Pain: A Single-Blind Randomized Controlled Trial.

OBJECTIVE: This study aimed to investigate the efficacy of myofascial release therapy (MRT) for improving pressure pain thresholds (PPTs) and pain in patients with mechanical neck pain. DESIGN: Forty-one participants with neck pain were randomly allocated to either a MRT group (five sessions) or a physical therapy (PT) group (ten sessions) for 2 wks. The multimodal PT program included ultrasound therapy (US), transcutaneous electric nerve stimulation, and massage. Visual analog scale (VAS) and PPTs in suboccipital and upper trapezius muscles were measured at baseline, at the end of treatment, and at 1 month follow-up. RESULTS: At the end of treatment, significant mean differences in VAS (-0.99, 95% confidence interval [CI] = -1.82 to -0.16), in both left (0.28, 95% CI = 0.06 to 0.50) and right (0.40, 95% CI = 0.16 to 0.63) suboccipital PPTs and in the right trapezius PPT (0.38, 95% CI = 0.07 to 0.69) were observed. At 1-month follow-up, significant mean differences were found for VAS (-1.85, 95% CI = -2.76 to -0.94) and both left (0.46, 95% CI = 0.12 to 0.80) and right (0.38, 95% CI = 0.06 to 0.69) suboccipital PPTs. CONCLUSIONS: This study provides evidence that MRT could be better than a multimodal PT program for short-term improvement of pain and PPTs in patients with neck pain.

Recomendaciones sobre el uso de ácido 5-aminolevulínico en la cirugía de los gliomas malignos. Documento de consenso / Recommendations on the use of 5-amino-levulinic acid in surgery of malignant gliomas. Consensus document. The Neuro-oncology Working Group of the Spanish Neurosurgical Society (SENEC)

Cuando hablamos de pacientes con gliomas de alto grado se encuentra, entre otros factores con interés pronóstico, la radicalidad de la cirugía efectuada. Las limitaciones para su ejecución se deben bien a la extensión del tumor o bien a su localización, en un área elocuente. En un intento de conseguir este objetivo hemos desarrollado en los últimos tiempos diversos métodos que nos permiten maximizar la resección del tumor, intentando siempre causar la menor morbilidad posible. Uno de estos es el empleo del ácido 5-aminolevulínico (5-ALA) y el desarrollo de la cirugía guiada con fluorescencia a partir de su uso. No obstante, para su correcta utilización requiere conocer ante qué producto estamos, la forma de administración, las precauciones a que estamos obligados y cómo poder sacarle el máximo rendimiento. Miembros del Grupo de Trabajo de Neurooncología (GTNO) de la Sociedad Española de Neurocirugía (SENEC) han elaborado esta guía o documento de consenso con el objetivo de homogeneizar y facilitar la toma de decisiones en la utilización del 5-ALA para la cirugía tumoral encefálica guiada con fluorescencia, y en particular en la resección de los gliomas de alto grado (AU)

Among the prognostic factors when it comes to patients with high-grade gliomas, we find the radicality of the surgery performed. The limitations of this factor are caused by either the extension of the tumour or its location in an eloquent area. To achieve this goal, in the last few years we have developed several methods that allow us to maximise tumour resection, while always trying to cause the least possible co-morbidity. One of these methods includes the use of 5-amino-levulinic acid (5-ALA) and the development of fluorescence guided surgery. However, optimal performance requires knowledge of the product employed, the mode of administration and precautions to consider. Members of the neuro-oncology work group of the Spanish Neurosurgical Society (SENEC) have prepared this guideline or consensus document for anyone who wishes to become familiar with the use of 5-ALA fluorescence-guided surgery in the management of high-grade gliomas. For those who already utilise this technique, this document can be useful for consultation purposes (AU)

[Recommendations on the use of 5-amino-levulinic acid in surgery of malignant gliomas. Consensus document. The Neuro-oncology Working Group of the Spanish Neurosurgical Society (SENEC)]. / Recomendaciones sobre el uso de ácido 5-aminolevulínico en la cirugía de los gliomas malignos. Documento de consenso.

Among the prognostic factors when it comes to patients with high-grade gliomas, we find the radicality of the surgery performed. The limitations of this factor are caused by either the extension of the tumour or its location in an eloquent area. To achieve this goal, in the last few years we have developed several methods that allow us to maximise tumour resection, while always trying to cause the least possible co-morbidity. One of these methods includes the use of 5-amino-levulinic acid (5-ALA) and the development of fluorescence guided surgery. However, optimal performance requires knowledge of the product employed, the mode of administration and precautions to consider. Members of the neuro-oncology work group of the Spanish Neurosurgical Society (SENEC) have prepared this guideline or consensus document for anyone who wishes to become familiar with the use of 5-ALA fluorescence-guided surgery in the management of high-grade gliomas. For those who already utilise this technique, this document can be useful for consultation purposes.

Características citomorfológicas e inmunohistoquímicas de cultivos primarios obtenidos a partir de tumores cerebrales / Cyto-morphological and immunohistochemical features of primary cell cultures obtained from human brain tumor

Objetivos: Establecer si los cultivos primarios de tumores cerebrales son válidos como método de estudio 'in vitro' para la extrapolación y aplicación clínica futura de ensayos terapéuticos. Material y método: Se obtuvieron 8 cultivos primarios a partir del material de biopsia de pacientes con tumores cerebrales (2 glioblastomas multiformes, 1 ependimoma, 1 oligodendro-glioma anaplásico y:4 meningiomas). Se valoró la expresión inmunohistoquímica a la proteína ácida glial fibrilar, vimentina, antígeno epitelial de membrana, S-100 y CD57 en el material turnoral parafinado y -en los cultivos primarios correspondientes. Resultados: Se obtuvo una estrecha correlación en la expresión inmunohistoquímica, para cada tumor a los antígenos estudiados, entre el material parafinado y los cultivos primarios (23/24, 95.8 por ciento). únicamente se apreció una disminución en la intensidad de dicha expresión, cuando esta era positiva en el material parafinado.. (7/18, 38.9 por ciento), en el cultivo primario correspondiente, pero en ningún caso con resultados negativos en parafina se evidenció positividad en el cultivo celular (0/6, 0 por ciento). Conclusiones: Las técnicas inmunohistoquímicas son válidas para caracterizar a los elementos celulares de los cultivos primarios obtenidos de tumores cerebrales, permitiéndonos complementar a otros métodos como la citomorfología y validarlos como 'banco de pruebas' para futuros estudios con aplicación clínica y terapéutica (AU)