Utilidad de la monitorización de la presión intracraneal en pacientes con sospecha de hipertensión intracraneal benigna / Usefulness of intracranial pressure continuous monitoring in pseudotumor cerebri

Objetivo: Evaluar la utilidad del análisis del registro de presión intracraneal (PIC) en el diagnóstico de la hipertensión intracraneal benigna (HIB). Material y métodos: Diez pacientes con sospecha clínica de HIB en los que no se cumplen por completo los criterios diagnósticos. Se recogen los datos demográficos, clínicos y radiológicos, así como los datos de monitorización de la PIC y las complicaciones relacionadas con el procedimiento. Se evalúan resultados clínicos a los 6meses de la intervención. Resultados: Todos los pacientes fueron mujeres jóvenes. La PIC media no fue superior a los 250 mmH2O en 5 de los 8 pacientes con registros patológicos. El análisis morfológico del trazado evidencia ondas A en un porcentaje elevado de pacientes (62,5%), correlacionándose en general con PIC media más elevada, aunque esta situación no se correspondió de forma sistemática con presencia de papiledema. Las ondas B de alta amplitud estuvieron presentes en todos los registros. La amplitud del registro fue superior a 5mmHg en la mayoría de los casos considerados patológicos. Todos los pacientes tratados conforme a los criterios de monitorización de PIC experimentaron mejoría tras la intervención. No hubo complicaciones relacionadas con el procedimiento de monitorización. Conclusiones: Los datos clínicos y de exploración son en ocasiones insuficientes para establecer el diagnóstico de HIB, especialmente en los casos en que el paciente ha sido tratado médica o quirúrgicamente con anterioridad. La monitorización de la PIC es un método seguro y fiable, útil en el diagnóstico de esta entidad. Es imprescindible un análisis morfológico del trazado, ya que la PIC media es un dato de escasa utilidad, en tanto que la presencia de ondas A y B de alta amplitud se relaciona con una buena respuesta a la derivación. La amplitud del trazado expresa la complianza cerebral y es un dato relacionado también con respuesta a la derivación

Objectives. To analyse the usefulness of intracranial pressure (ICP) monitoring in pseudotumor cerebri (PTC). Material and methods: Ten patients with suspected PTC, but having incomplete criteria for the syndrome, on whom ICP monitoring was performed. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and related complications. Results were evaluated 6months after surgery. Results: In relation to demographics, all patients were young females. Mean ICP was less than 250 mmH2O in 5 of 8 patients with pathological monitoring. Most patients (62.5%) showed A waves; these were related with higher mean ICP, but not always with papilloedema. All recordings showed high amplitude B waves. Most pathological recordings showed wave amplitudes superior to 5 mmHg. There were no complications related to the monitoring technique. Conclusions: Clinical and lumbar opening pressure data are not enough to establish PTC diagnosis correctly, especially if patient has been treated previously. Monitoring using ICP is a valuable, safe tool, and very useful in this syndrome. Mean ICP could be normal even with pathological recordings. Morphological analysis is necessary to establish diagnosis. A and B waves are highly related to shunt response. Wave amplitude is related to brain compliance and to shunt response as well

Utilidad de la monitorización de la presión intracraneal en pacientes con ventriculomegalia marcada de larga evolución / Usefulness of continuous intracranial pressure monitoring in long-standing overt ventriculomegaly in adults

Objetivo: Evaluar la utilidad del análisis del registro de la presión intracraneal (PIC) en el manejo de pacientes con marcada ventriculomegalia de larga evolución. Material y métodos: Veintidós pacientes con ventriculomegalia radiológica y clínica neurológica. Se recogen los datos demográficos, clínicos y radiológicos, así como los datos de monitorización de PIC y las complicaciones relacionadas con el procedimiento. Se evalúan resultados clínicos a los 6 meses de la intervención. Resultados: Las edades oscilaron entre los 20 y los 70 años, con una media de 44 años. El síntoma de consulta más frecuente fue la cefalea. Los índices de Evans oscilaron entre 0,35 y 0,66, con una media de 0,47. El 55% asociaban estenosis de acueducto de Silvio. La PIC media fue superior a 12 mmHg en solo el 9% de los pacientes, en tanto que el análisis morfológico de los trazados catalogó al 64% de los mismos como patológicos. El análisis morfológico del trazado evidencia ondas A premeseta en 7 pacientes y ondas B en 20 pacientes (14 de ellos con ondas B de alta amplitud). Se consideraron patológicos y por tanto candidatos a cirugía a 14 pacientes, de los que 12 aceptaron la intervención (derivación de líquido cefalorraquídeo o ventriculostomía). El 70% de ellos habían experimentado mejoría a los 6 meses. No hubo complicaciones relacionadas con la monitorización. Conclusiones: La monitorización de la PIC es un método seguro y fiable, útil en el manejo de esta entidad, que permite seleccionar los pacientes candidatos a cirugía. Es imprescindible un análisis morfológico del trazado, ya que la PIC media es un dato de escasa utilidad, en tanto que la presencia de ondas A y B de alta amplitud se relaciona con una buena respuesta al shunt

Objectives: To analyze the usefulness of intracranial pressure (ICP) monitoring in overt long-standing ventriculomegaly patients. Material and methods: There were 22 patients with ventriculomegaly and neurological symptoms. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and complications related to the procedure. Results were evaluated 6 months after surgery. Results: Mean age was 44 years (22-70). Mean Evans index was 0.47 (0.35-0.66). Aqueductal stenosis was present in more than half of the patients (55%). Mean ICP was higher than 12 mmHg in only 9% of patients. Morphological analysis of ICP recordings was abnormal in 64% of patients. 'Pre-plateau' A waves were seen in 7 patients, with B waves seen in 20 patients (high amplitude B waves in 14). Twelve patients were operated on the basis of ICP recordings (CSF shunt or ventriculostomy). Seventy per cent of treated patients had improved at 6 months. There were no complications related to the monitoring technique. Conclusions: ICP monitoring is a valuable, safe tool, very useful in these cases. Selection of surgical candidates on the basis of ICP monitoring seems to be advisable. Mean ICP may be normal even with pathological recordings. Morphological analysis is essential to establish a correct diagnosis. The presence of A and B waves in the recording is highly related to good shunt response

[Usefulness of intracranial pressure continuous monitoring in pseudotumor cerebri]. / Utilidad de la monitorización de la presión intracraneal en pacientes con sospecha de hipertensión intracraneal benigna.

OBJECTIVES: To analyse the usefulness of intracranial pressure (ICP) monitoring in pseudotumor cerebri (PTC). MATERIAL AND METHODS: Ten patients with suspected PTC, but having incomplete criteria for the syndrome, on whom ICP monitoring was performed. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and related complications. Results were evaluated 6 months after surgery. RESULTS: In relation to demographics, all patients were young females. Mean ICP was less than 250 mmH2O in 5 of 8 patients with pathological monitoring. Most patients (62.5%) showed A waves; these were related with higher mean ICP, but not always with papilloedema. All recordings showed high amplitude B waves. Most pathological recordings showed wave amplitudes superior to 5 mmHg. There were no complications related to the monitoring technique. CONCLUSIONS: Clinical and lumbar opening pressure data are not enough to establish PTC diagnosis correctly, especially if patient has been treated previously. Monitoring using ICP is a valuable, safe tool, and very useful in this syndrome. Mean ICP could be normal even with pathological recordings. Morphological analysis is necessary to establish diagnosis. A and B waves are highly related to shunt response. Wave amplitude is related to brain compliance and to shunt response as well.

[Usefulness of continuous intracranial pressure monitoring in long-standing overt ventriculomegaly in adults]. / Utilidad de la monitorización de la presión intracraneal en pacientes con ventriculomegalia marcada de larga evolución.

OBJECTIVES: To analyze the usefulness of intracranial pressure (ICP) monitoring in overt long-standing ventriculomegaly patients. MATERIAL AND METHODS: There were 22 patients with ventriculomegaly and neurological symptoms. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and complications related to the procedure. Results were evaluated 6 months after surgery. RESULTS: Mean age was 44 years (22-70). Mean Evans index was 0.47 (0.35-0.66). Aqueductal stenosis was present in more than half of the patients (55%). Mean ICP was higher than 12 mmHg in only 9% of patients. Morphological analysis of ICP recordings was abnormal in 64% of patients. "Pre-plateau" A waves were seen in 7 patients, with B waves seen in 20 patients (high amplitude B waves in 14). Twelve patients were operated on the basis of ICP recordings (CSF shunt or ventriculostomy). Seventy per cent of treated patients had improved at 6 months. There were no complications related to the monitoring technique. CONCLUSIONS: ICP monitoring is a valuable, safe tool, very useful in these cases. Selection of surgical candidates on the basis of ICP monitoring seems to be advisable. Mean ICP may be normal even with pathological recordings. Morphological analysis is essential to establish a correct diagnosis. The presence of A and B waves in the recording is highly related to good shunt response.

Salvage radiosurgery for selected patients with recurrent malignant gliomas.

PURPOSE: To analyse the survival after salvage radiosurgery and to identify prognostic factors. METHODS: We retrospectively reviewed 87 consecutive patients, with recurrent high-grade glioma, that underwent stereotactic radiosurgery between 1997 and 2010. We evaluated the survival after initial diagnosis and after reirradiation. The prognostic factors were analysed by bivariate and multivariate Cox regression model. RESULTS: The median age was 48 years old. The primary histology included anaplastic astrocytoma (47%) and glioblastoma (53%). A margin dose of 18 Gy was administered in the majority of cases (74%). The median survival after initial diagnosis was 21 months (39 months for anaplastic astrocytoma and 18.5 months for glioblastoma) and after reirradiation it was 10 months (17 months for anaplastic astrocytoma and 7.5 months for glioblastoma). In the bivariate analyses, the prognostic factors significantly associated with survival after reirradiation were age, tumour and treatment volume at recurrence, recursive partitioning analyses classification, Karnofsky performance score, histology, and margin to the planning target volume. Only the last four showed significant association in the multivariate analyses. CONCLUSION: stereotactic radiosurgery is a safe and may be an effective treatment option for selected patients diagnosed with recurrent high-grade glioma. The identified prognostic factors could help individualise the treatment.

Spinal cord astrocytoma: multidisciplinary experience.

BACKGROUND: Astrocytomas of the spinal cord have rarely been reported. We examined our experience, treatment and outcome of patients treated during the last four years. MATERIAL AND METHODS: We reviewed the charts from patients treated for this neoplasm in a multidisciplinary team of Granada, Spain. The information was retrospectively obtained from the patients' hospital records. The patients were evaluated with clinical history, physical exam, spinal magnetic resonance (MR), surgery, location and histology, treatment, and follow-up. RESULTS: In the last four years, we have treated 37 astrocytomas, of which only 3 were intramedullary. All patients underwent surgery, radiotherapy and chemotherapy. Two patients died, but one is alive and practically asymptomatic. CONCLUSION: The optimal treatment remains controversial. Radiotherapy should be considered for tumors with high-grade histopathology, clinically progressive and when a substantial resection cannot be achieved. New therapeutic strategies need to be studied to improve survival.