Surgical treatment of trigeminal neuralgia in adults.

Trigeminal neuralgia is a painful disorder of the face that negatively affects the functionality of those who suffer from it. Microvascular decompression remains the top choice for its short and long-term outcomes. In those who are not candidates for open surgery, ablative options become valuable, including radiosurgery, and radiofrequency, balloon, and glycerol rhizotomies. Radiosurgery can be useful in cases of trigeminal neuralgia associated with multiple sclerosis. A scheme is proposed to facilitate decision-making considering outcomes, predictors of response and complication rates.

La neuralgia del trigémino es un desorden doloroso de la cara que afecta de forma negativa la funcionalidad de quienes lo padecen. La descompresión microvascular sigue siendo la mejor opción por sus desenlaces a corto y largo plazo. En aquellos no candidatos a cirugía abierta cobran valor las opciones ablativas, entre ellas la radiocirugía, y las rizotomías por radiofrecuencia, balón y glicerol. La radiocirugía puede ser útil en casos de neuralgia del trigémino asociada a esclerosis múltiple. Se propone un esquema para facilitar la toma de decisiones, considerando predictores de respuesta y tasas de complicaciones.

Refractory traumatic intracranial hypertension: the role of decompressive craniectomy.

Traumatic brain injury according to the World Health Organization estimates that by 2020 will be the third leading cause of morbidity and mortality worldwide. Intracranial hypertension refractory to medical management is the cause of increased mortality in neurotrauma. There are various measures to control intracranial hypertension, including surgical. Decompressive craniectomy has been routinely used to treat intracranial hypertension secondary to cerebral infarction, subarachnoid hemorrhage, intracerebral hemorrhage and trauma. We review the literature to describe the mechanisms, types and indications for this procedure.

El trauma craneoencefálico, según la Organización Mundial de la salud, se estima que para el año 2020 será la tercera causa de morbimortalidad en el mundo. La hipertensión intracraneal refractaria al manejo médico es la causante de la mayor mortalidad en esta población de pacientes. Existen diversas medidas para el control de la hipertensión intracraneal, entre ellas las quirúrgicas. La craniectomía descompresiva ha sido utilizada sistemáticamente para tratar la hipertensión intracraneal secundaria al infarto cerebral, la hemorragia subaracnoidea, la hemorragia intracerebral y el trauma. Se hace una revisión de la literatura para describir los mecanismos fisiopatológicos de la lesión cerebral traumática, así como también los tipos y las indicaciones de este procedimiento.

Intradiploic Pterional Epidermoid Tumor: A Case Report and Review of literature.

Intradiploic epidermoid cyst is an uncommonly occurring neoplasm, and only about 200 cases are reported in the form of isolated case report. It is presumed to occur due to ectodermal cells in inclusion in the bone tissue during embryonic life neural tube closure. It commonly remains asymptomatic or rarely presents as a bony lump in the skull bone. Authors report present an interesting case, which presented with swelling, and underwent successful surgical resection. Pertinent literature along with diagnosis and management is briefly reviewed. These lesions can erode the bone and involve the brain parenchyma due to their proximity to the brain. Radiological imaging is very helpful in accurate diagnosis of these lesions and in differentiating intradural from intradiploic varieties of epidermoid. We present an unusual case of this pathology.

Sacroiliac Pain: A Clinical Approach for the Neurosurgeon.

Pain originating from sacroiliac joint may also cause pain in the lumbar and gluteal region in 15% of the population. The clinical manifestation represents a public health problem due to the great implications on the quality of life and health-related costs. However, this is a diagnosis that is usually ignored in the general clinical practice; probably because of the unknown etiology, making harder to rule out the potential etiologies of this pathology, or maybe because the clinical criteria that support this pathology are unknown. By describing several diagnostic techniques, many authors have studied the prevalence of this pathology, finding more positive data than expected; coming to the conclusion that even though there is no diagnostic gold standard yet, an important amount of cases might be detected by properly applying several tests at the physical examination. Thus, it is necessary to have knowledge of the physiopathology and clinical presentation so that diagnosis can be made to those patients that manifest this problem. We present a clinical approach for the neurosurgeon.

[Type I Chiari malformation associated with cerebellar atrophy. Case report]. / Malformación de Chiari Tipo I asociado a atrofia cerebelosa. Reporte de caso.

Chiari malformation is characterized by caudal displacement of the cerebellar tonsils that penetrate into the spinal canal through the foramen magnum, achieving reach the atlas or axis. trunk and any drop of the fourth ventricle is observed. Typically is seen in young adults. In some cases scoliosis and Syringomyelic cavities may occur. The authors present (as far as they know) the first case in the literature with long term follow-up, of a caucasian woman with an unusual form of cerebellar atrophy and Chiari Type I malformation, suffering from weakness in his upper and lower extremities with rapidly progression. The patient was successfully treated with suboccipital decompression and C1 laminectomy.

La malformación de Chiari se caracteriza por un desplazamiento caudal de las amígdalas cerebelosas que penetran hacia el canal raquídeo por el foramen mágnum, logrando llegar hasta el atlas o el axis. No hay descenso del tronco y tampoco del cuarto ventrículo. Típicamente se observa en adultos jóvenes. En algunos casos hay escoliosis y cavidades siringomiélicas. Los autores presentan lo que a su conocimiento es el primer caso de la literatura con seguimiento a largo plazo de una mujer de raza blanca con una forma inusual de atrofia cerebelosa y malformación de Chiari tipo I, que sufre de debilidad en sus extremidades superiores e inferiores rápida y progresivamente. La paciente fue tratada con éxito mediante descompresión suboccipital y laminectomia C1.

Concurrencia de meningioma y astrocitoma: breve reporte de caso / Concurrence of meningioma and astrocytoma: brief case report

Las neoplasias intracraneales múltiples son infrecuentes, representan alrededor del 4 por ciento de todos los tumores cerebrales. Estas lesiones se observan ocasionalmente en pacientes con neurofibromatosis y en tratados con radioterapia. Presentamos el caso de un paciente portador de meningioma y una lesión de estirpe glial manejado en nuestro servicio de neurocirugía.

Multiple intracranial neoplasms are rare, representing about 4 percent of all brain tumors. These lesions are occasionaly observed in patients with neurofibromatosis and in patients treated with radiotherapy. We report the case of a patient with a meningioma and a glial lineage lesion , handled in our service of neurosurgery, University of Cartagena, Colombia.

Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring.

Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.

Symptomatic Chiari Malformation with Syringomyelia after Severe Traumatic Brain Injury: Case Report.

Chiari malformation Type I (CM-I) is a congenital disorder, which is basically a tonsillar herniation (≥ 5 mm) below the foramen magnum with or without syringomyelia. The real cause behind this malformation is still unknown. Patients may remain asymptomatic until they engender a deteriorating situation, such as cervical trauma. The objective of this case report is to give a broad perspective on CM-I from the clinical findings obtained in a patient with asymptomatic non-communicating syringomyelia associated with a CM-I exacerbated within 2 years of a TBI, and to discuss issues related to that condition.

Retinitis y fiebre por chikunguña: reporte de caso / Chikunguya fever and retinitis. Case report

Contexto: La enfermedad por Chikunguña es una infección viral, que ha sido un problema importante de salud en el mundo, recientemente asociado con manifestaciones oculares. Actualmente, no existe ningún tratamiento o vacuna para la fiebre por Chikunguña. Esta revisión se concentra en las manifestaciones de la retina de esta enfermedad viral a través de un caso clínico. La importancia de publicar este reporte es facilitar un diagnóstico precoz, basados en la poca evidencia que existe y así no sea una enfermedad subdiagnosticada. Presentación del caso: Paciente de sexo masculino de 46 años de edad, con antecedentes de trastorno bipolar tipo 2 quien experimenta fiebre, artralgias, rash cutáneo severo y edema en miembros inferiores, durante el brote de fiebre por Chikunguña, asociado con manifestaciones visuales: disminución de la agudeza visual, visión borrosa y escotoma en su ojo izquierdo. La Tomografía de coherencia óptica y la Angiografía fluoresceínica evidencian retinitis, y desprendimiento de vítreo posterior. Conclusiones: Los cambios oculares asociados con Chikunguña deben ser considerados en las regiones epidémicas. Existe la necesidad de dar importancia clínica, no sólo por el compromiso de esta enfermedad viral sistémica, sino también la presentación de manifestaciones oculares, y disminuir los casos de morbilidad y mortalidad

Background: Chikungunya is a viral infection that has been a major health world problem, recently associated with ocular manifestations. Currently, there is no treatment or vaccine for Chikungunya fever. In this work, we focus on the retinal manifestations of this viral disease, reporting a single clinical case. The importance of publish this report is to facilitate on early diagnosis, based on the lack of evidence and misdiagnosed. Case presentation: A 46 years old male, with history of bipolar II disorder, experienced fever, joint pain, severe rash and lower limb edema, during the outbreak of Chikungunya fever, associated with visual manifestations: decrease visual acuity, blurred vision and scotoma on his left eye; coherence tomography and fl uorescein angiography supports retinitis, and posterior vitreous detachment. Conclusions: Chikungunya associated ocular changes should be considered in epidemic regions. It is necessary to considered not only systemic manifestations but ocular, to reduce morbidity and mortality cases.

Trauma craneoencefálico severo: atención prehospitalaria, manejo quirúrgico y monitoreo multomodal / Severe cranioencephalic trauma: prehospital care, surgical management and multimodal monitoring

El trauma craneoencefálico severo representa por lo menos la mitad de las muertes relacionadas con trauma, la patofisiología celular y clínica esta extensamente estudiada y documentada, las opciones de monitorización y tratamiento constituyen los paradigmas actualmente para la el progreso en la sobrevida disminuyendo la probabilidad de secuelas, junto con los principios de manejo general que incluyen entre otros el control de la temperatura, tensión arterial, sedación, ventilación, nutrición hacen posible la calidad en la atención de nuestros pacientes.

Severe brain trauma accounts for at least half of the deaths related to trauma, cellular pathophysiology and clinic it is extensively studied and documented , the monitoring and treatment options are currently paradigms for progress in decreasing the likelihood of survival sequels along with general management principles which include among others the temperature control, blood pressure, sedation, ventilation, nutrition enables quality care for our patients.

Odontogenic Pain as the Principal Presentation of Vertebral Artery Pseudoaneurysm; a Case Report.

Dissection of the vertebral artery is an important but rare cause of cerebrovascular accidents. Here we report a 48-year-old man with toothache since 4 days before who presented to the emergency department with neck pain and final diagnosis of dissecting right vertebral artery pseudoaneurysm. To our knowledge, this maybe the first report of odontogenic pain as the first manifestation of vertebral artery pseudoaneurysm in the literatures.

Iniencephaly: Case Report.

The iniencephaly involves a variable defect in the occipital bone, resulting in a large foramen magnum, partial or total absence of the cervical and thoracic vertebrae, accompanied by incomplete closure of arcs and/or vertebral bodies, significant shortening of the spinal column and hyperextension of the malformed cervicothoracic spine; the individual's face is deviated upward, the mandibular skin is directly continuous with anterior thorax due to the absence of neck. Its incidence is about 1:1000-1:2000 births, so this is a pretty rare neural tube defect. We present a case of iniencephaly in association with cardiovascular, spinal cord, and intracranial malformations that ended demonstrating the low survival of patients affected with this condition.

Absceso cerebral en pacientes pediatricos / Brain abscess in pediatric patients

El absceso cerebral se constituye como un área central supurativa dentro del parénquima cerebral, dentro de una envoltura ampliamente vascularizada. Los patógenos ampliamente aislados en la patogénesis de esta entidad en niños son los Streptococos spp. A pesar del avance en la terapia antimicrobiana, las técnicas neuroquirúrgicas e imagenológicas, que permiten su diagnóstico y ubicación oportuna, el absceso cerebral aún se considera un problema de salud pública, con una importante incidencia, morbilidad y mortalidad en países en vía de desarrollo. Para el manejo de este tipo de infección del SNC, se requerirá de un abordaje multidisciplinario que involucre terapia médico quirúrgica. El objetivo de esta revisión es hacer un abordaje amplio sobre la patobiología del absceso cerebral relacionada con la labor concerniente al neurocirujano.

Brain abscess is formed as a central suppurativa area within the brain parenchyma, within an envelope extensively vascularized. Microorganisms largely isolated in the pathogenesis of this condition in children are Streptococos spp. Despite the progress in antimicrobial therapy, neurosurgical techniques and imagenologic support, which enabling timely diagnosis and location, brain abscess is still considered a public health problem and has an important incidence, morbidity and mortality in developing countries. To handle this type of CNS infection, will require a multidisciplinary approach involving surgical medical therapy. The aim of this review is to make a comprehensive approach on the pathobiology of brain abscess related to the work concerning the neurosurgeon.

Heridas por proyectil de arma de fuego en cráneo: revisión de la literatura / Firearm projectile wounds on skull: literature review

El trauma craneoencefálico es una de las principales causas de muerte en el mundo, y gran parte de estos se asocian a heridas por arma de fuego en cráneo. Conocer el manejo, las características y fisiopatología de la lesión nos permitirá saber abordar estos casos cuando se presenten a los diferentes centros asistenciales, al tiempo que nos permitirá tener en cuenta las posibles complicaciones, para evitar su aparición y así buscar mejorar la morbilidad por esta causa. Siempre acompañado de un manejo integral que permita abarcar todas las dimensiones afectadas.

Traumatic brain injury is a of the leading causes of death in the world, and many of these are associated with gunshot wounds in the skull. To know management the characteristics and pathophysiology of the lesion will tell as deal with these cases when presented to medical centers, while enabling us to take into account of possible complications, to prevent its occurrence and so try to improve morbidity from this cause. Always accompanied by an integrated management that can encompass all affected dimensions.

Hipotermia terapéutica en la lesión traumática cerebral / Therapeutic hypothermia in traumatic brain injury

El trauma craneoencefálico severo es una causa importante de mortalidad en pacientes jóvenes a nivel internacional. La hipertensión intracraneal es la causa de más del 80 por ciento de los pacientes con lesión traumática cerebral. Al presentar una traumática secundaria, se inician una seria de mecanismos metabólicos que incrementan la lesión al tejido cerebral, la inducción de hipotermia ha demostrado que puede alterar el curso natural del proceso patológico. Los fundamentos biológicos apuntan a que la hipotermia puede tener un potencial beneficio, aunque algunas publicaciones no han demostrado mejoría, es claro que en un grupo de pacientes principalmente jóvenes, la hipotermia temprana puede ser beneficiosa. Presentamos una práctica revisión de la literatura sobre esta temática.

The severe head trauma is a major cause of mortality in young patients worldwide. Intracranial hypertension is the cause of more than 80 percent of patients with traumatic brain injury. When a traumatic secondary presenter, begin a series of mechanisms that increase metabolic injury to brain tissue, induction of hypothermia has been shown to alter the natural course of the disease process. The biological foundations suggest that hypothermia may have a potential benefit, although some publications have not shown improvement, it is clear that in a group of mostly young patients, early hypothermia may be beneficial. We present a practical review of the literature on this subject.

Effects of sexed semen and interactive effects on commercial in vitro embryo production when oocytes are collected from cows of Bos indicus, and Bos taurus breeding and crossbred cows of these subspecies.

A large scale commercial in vitro embryo production and in vitro fertilization record is reported when there was use of oocytes from Bos taurus (BT), Bos indicus (BI), and Bos Taurus/indicus (BT/BI) crossbred subspecies fertilized with sexed (SS) and conventional (CS) semen. The aim of the study was to analyze the impacts of use SS in a commercial embryo production center in Colombia. Non-pregnant (n=800), healthy, and estrous cycling BT, BI, and BI/BT crossbred cows were selected to be used as oocyte donors. Viable oocytes from 733 ovum pick up sessions in cows of the BT (4663) and BI (7305), BT/BI (3605) groups were matured and fertilized with frozen thawed semen from commercial sires. Of all cultured oocytes (n=15,573), 52.3% of the embryos (n=8607) underwent cleavage while 3062 (19.7%) developed to the blastocyst stage. For cows of the BT, SS and CS groups, there were similar cleavage rates; however, use of SS decreased blastocyst formation (15.6% versus 18.9%). In the BI group, use of SS increased cleavage rates (59.1% versus 53%, respectively) although there was no effect on blastocyst rate development (22.9% versus 21.9). In the BI/BT groups, use of SS decreased cleavage (44.4% versus 57.1%, respectively) and blastocyst rate development compared with the CS group (15.3% versus 20.1%, respectively). Data from this study indicate embryos from cows of the BT purebred or BI/BT crossbred had less in vitro developmental capacity compared to embryos derived from oocytes of cows that were purebred BI in tropical-subtropical regions.

Management of Craniocerebral Gunshot Injuries: A Review.

Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive.

Sacroiliac screw fixation: A mini review of surgical technique.

The sacral percutaneous fixation has many advantages but can be associated with a significant exposure to X-ray radiation. Currently, sacroiliac screw fixation represents the only minimally invasive technique to stabilize the posterior pelvic ring. It is a technique that should be used by experienced surgeons. We present a practical review of important aspects of this technique.