Postoperative Neurologic Outcome in Patients Undergoing Resective Surgery for Parietal Lobe Epilepsy: A Systematic Review.

BACKGROUND AND OBJECTIVES: Parietal lobe epilepsy (PLE) surgery can be an effective treatment for selected patients with intractable epilepsy but can be associated with the risk of serious neurologic deficits. We performed a systematic review of the literature to obtain a comprehensive summary of the frequency and types of new postoperative neurologic deficits in patients undergoing PLE resective surgery. METHODS: We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published between January 1, 1990, and April 28, 2022. We included studies that reported postoperative neurologic outcome following PLE resective surgery confined to the parietal lobe. We required that studies included ≥5 patients. The data collected included demographic information and specific details of postoperative neurologic deficits. When available, individual patient data were collected. We used the Risk of Bias in Nonrandomized Studies of Interventions tool to assess the risk of bias and Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence. RESULTS: Of the 3,461 articles screened, 33 studies met the inclusion criteria. A total of 370 patients were included. One hundred patients (27.0%) had a new deficit noted postoperatively. Approximately half of the patients with deficits experienced only transient deficits. Motor deficits were the most commonly identified deficit. The rates of motor deficits noted after PLE surgery were 5.7%, 3.2%, and 2.2% for transient, long-term, and duration not specified, respectively. Sensory and visual field deficits were also commonly reported. Gerstmann syndrome was noted postoperatively in 4.9% of patients and was almost always transient. Individual patient data added information on parietal lobe subregion postoperative neurologic outcome. DISCUSSION: Our systematic review provides a comprehensive summary of the frequency and types of neurologic deficits associated with PLE surgery. A significant percentage of postoperative deficits are transient. In addition to the expected sensory and visual deficits, PLE surgery is associated with a notable risk of motor deficits. The available literature has important deficiencies. Our study highlights gaps in the literature and provides recommendations for future directions. TRIAL REGISTRATION INFORMATION: This systematic review was registered on PROSPERO (CRD42022313108, May 26, 2022).

Temporo-Parieto-Occipital Disconnection by Robot-Assisted Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Refractory Epilepsy in a Pediatric Patient: Proof-of-Principle Case Report and Surgical Nuances.

OBJECTIVE: Magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) has been proven safe and effective for the treatment of focal epilepsy of different etiologies. It has also been used to disconnect brain tissue in more extensive or diffuse epilepsy, such as corpus callosotomy and hemispherotomy. METHODS: In this study, we report a case of temporo-parieto-occipital disconnection surgery performed using MRIgLITT assisted by a robotic arm for refractory epilepsy of the posterior quadrant. A highly realistic cadaver simulation was performed before the actual surgery. RESULTS: The patient was a 14-year-old boy whose seizures began at the age of 8. The epilepsy was a result of a left perinatal ischemic event that caused a porencephalic cyst, and despite receiving multiple antiepileptic drugs, the patient continued to experience daily seizures which led to the recommendation of surgery. CONCLUSIONS: A Wada test lateralized language in the right hemisphere. Motor and sensory function was confirmed in the left hemisphere through magnetic resonance imaging functional studies and NexStim. The left MRIgLITT temporo-parieto-occipital disconnection disconnection was achieved using 5 laser fibers. The patient followed an excellent postoperative course and was seizure-free, with no additional neurological deficits 24 months after the surgery.

Non-fatal Bihemispheric Penetrating Brain Injury from a Crossbow Arrow with Good Clinical Outcome: Case Report

Crossbow injuries to the head have seldom been reported in the literature, and they represent a unique type of penetrating brain injury (PBI) in which a low-velocity arrow results in an intracranial fragment larger than most high-velocity projectiles, usually with a lethal outcome.We present the case of a 34-year-oldman who attempted suicide with a self-inflicted cranial injury from a crossbow arrow, with a right parietal point of entry and a palpable subcutaneous tip in the left parietal region. The emergency team reported a Glasgow coma scale (GCS) score of 15, and the patient was brought sedated and intubated. Computed tomography (CT) imaging scans showed that the arrow crossed both parietal lobes, with mild subarachnoid hemorrhage and small cerebral contusions adjacent to its intracranial path. Careful retrograde removal of the penetrating arrow was performed in the CT suite, followed by an immediate CT scan, which excluded procedure-related complications. The patient woke up easily and was discharged 3 days later withmild left hand apraxia and no other neurologic deficits. To the best of our knowledge, there are no similar case reports describing both good clinical outcome and rapid discharge after a bihemispheric PBI. Individualizing the management of each patient is therefore crucial to achieve the best possible outcome as PBI cases still represent a major challenge to practicing neurosurgeons worldwide.

Reconstrucción inmediata de cuero cabelludo / Immediate scalp reconstruction

Presentamos una serie de casos realizados en el Servicio de Cirugía del Hospital Clínico San Pablo en Coquimbo, Chile, entre Abril de 1998 y Abril de 2005. Se trata de un grupo de estudio de 22 pacientes consecutivos con pérdida traumática o quirúrgica del cuero cabelludo, mayor de 3cm de diámetro. Se empleó para la reconstrucción colgajo semilunar, en espejo o en remolino vascularizados a partir de las ramas principales del cuero cabelludo. Analizamos en cada caso el tamaño del defecto, pérdida de hueso asociada, tipo de cirugía, resultados de la cobertura y complicaciones. La edad media de los pacientes fue de 40.6 años con un rango entre 3 y 71 años. El área anatómica comprometida fue parietal en 11 pacientes (50%), temporal en 7 (31,8%), occipital en 3 (13,6%) y frontal en 1 caso (4,5%). La causa de la pérdida de sustancia fue resección de tumores malignos o benignos en 10 casos, postraumática en 5, postquirúrgica en 4, y por alopecia en 3. El tamaño medio del defecto fue de 147 cm2 con un rango entre 28 y 615 cm2 . El colgajo empleado fue doble en espejo en 10 casos (50%), semilunar de deslizamiento en 9 (36,4%) y en remolino en 3 (13,6%). En 6 pacientes se utilizó un injerto dermo-epidérmico para cerrar un defecto residual del área dadora del colgajo (dos semilunares y dos en espejo). Veintiun pacientes (45%) evolucionaron sin incidencias, con cicatrización del colgajo en un plazo máximo de 21 días. Un paciente con pérdida ósea tras dos craneotomías, presentó necrosis parcial distal del colgajo y falleció por neumonía aspirativa. Comparamos los tres tipos de reparación de acuerdo al tamaño del defecto y a la superficie del mismo. La elección de colgajo doble en espejo, remolino o semilunar, al aplicar la prueba de Kruskal Wallis, no se relacionó con la superficie del defecto, y la elección del colgajo fue atribuible al azar, p > 0.05. La principal razón para escoger uno u otro fue la ubicación del defecto. En conclusión, la estrategia de reconstrucción del cuero cabelludo mediante colgajos arterializados permite el cierre de grandes defectos en una operación fácil y con cicatrices inaparentes que quedan ocultas bajo el cabello. Es por ello que creemos que estos procedimientos son la mejor alternativa de tratamiento y recomendamos su uso por sus resultados fiables cuando se siguen los principios técnicos del manejo de colgajos (AU)

We present sucessive cases performed at Surgery Department of Hospital San Pablo, Coquimbo, Chile, between April1998, and April 2005: Twenty two consecutive patients suffering surgical or postinjury scalp defects, greater than 3 cm of diameter. Semilunar flap, mirror flap, or multiple pinwheel flap arterialized from the main scalp arteries were used for reconstruction. We determinate in every case the large of the defect, asociated bone loss, kind of surgery, end result and complications. Patients’ mean age was 40.6 years with rank between 3 and 71 years old. The involved anatomical area was parietal on 11 patients, (50 %), temporal in 7 cases (31.8 %), occipital in 3 cases (13.6 %) and frontal 1 case, (4.5 %). The origin of scalp loss was malign or benign tumor resection in 10 patients, post injury 5 cases, secondary to neurosurgical procedures in 4 cases, and alopecia or baldness in 3 cases. The mean large of the defect was 147 cm2 with rank between 28 and 615 cms2 . The mirror flap was used in 10 cases (50 %), the sliding semilunar flap in 9 patients (36.4 %), and the multiple pinwheel flap in 3 patients (13.6 %). An aditional dermoepidermal graft was used on 6 patients to cover a small area of flap donor site (two mirror flaps, and two semilunar flaps). Patients’ evolution were without complications in 95 % of cases (21/22). One woman with a temporal bone necrosis after two craniotomies suffered a distal flap necrosis, and finally died due aspirative pneumonia. The three kind of flap were compared according the defect length and defect area. The Kruskal Wallis test shows that the mean length and mean area of three different flap are statistically similars. The choice of one flap or another is no related with the area of the defect, p > 0.05. The main reason for choosing the flap was the site defect. Conclutions: the immediate scalp reconstruction strategie by arterialized flaps allows to close big defects, in one step, by a relatively simple technique with hidden scars under hair. We think this procedure is the best choice for immediate scalp recostruction, and we recommend its usage because this technique has reliable outcome when the surgical team follows the technical principles of flaps handle (AU)

Aportación de la PET en el seguimiento de las metástasis cerebrales del cáncer de pulmón no microcítico. Valoración de un caso clínico / Contribution of PET in the follow-up of cerebral metastases in non-small cell lung cancer. A clinical case valuation

Presentamos el caso clínico de un varón de 44 años diagnosticado de adenocarcinoma pulmonar con metástasis única cerebral tratada con cirugía y radioterapia. Los estudios con PET realizados durante el curso evolutivo de la enfermedad fueron muy útiles y decisivos en la detección primero de radionecrosis, y posteriormente de recidiva de la metástasis cerebral en dos ocasiones que se confirmó por los hallazgos radiológicos (RMN cerebral) y la anatomía patológica tras su extirpación quirúrgica. La PET ofrece una ayuda importante en casos seleccionados de pacientes con metástasis cerebrales de cáncer de pulmón

We report a clinical case of a male 44 years old with lung adenocarcinoma with a single brain metastases treated with surgery and radiotherapy. The different PET studies performed during the evolution of the disease were very useful and crucial, firstly in the detection of radiation necrosis and after that when cerebral metastases recurrent appeared twice. The radiographic technique (Brain MRI) and the histopathology after the surgical removal confirmed the PET results. PET imaging is helpful in selected patients with brain metastases in lung cancer

Empleo del colgajo del sistema músculo-aponeurótico superficial (SMAS) en la cirugía de parótida

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Anaplastic oligodendroglioma with cervical lymphonode metastasis: report of a case

A case of a patient operated on twice for a temporoparietal anaplastic oligondendroglioma, followed by radiotherapy, is reported. Although no intracranial recurrence has happened, a biopsyproven extracranial cervical lymphnode metastasis was diagnosed 15 months later. Surgical manipulation of the primary lesion by lymphatic and/or blood vessel invasion seem to be the main suspected factors in the development of CNS tumors metastasis in the head and neck region.