Dosage of intrathecal baclofen maintenance therapy in the spastic syndromes.

Twenty-three patients affected with severe spasticity as a result of several clinical pathologies were treated with intrathecal Baclofen and administered at a lumbar level by means of an implantable infusion system. The system allows programming of any drug dosage in a continuous infusion fashion in the subarachnoid space. The appropriate patients were selected using specific criteria and the patients were regularly reviewed regarding the level of the spasticity and functional capacity. The required daily doses were determined using a specific detailed system. The doses needed varied according to the pathologic or clinical diagnosis. The doses administered by the global method at the beginning of the treatment were 91.96 microg/day and 137.81 microg/day in the final phase. These doses were higher in patients with medullary traumatic lesion, diffuse cerebral lesion and spastic idiopathic paraparesis. Relatively mild side effects were produced by the therapeutic doses used.

PET/RMN en paciente con hidrocefalia y metástasis cerebrales tratadas con radiocirugía / PET/RMN in patients with hydrocephalia and brain metastases treated with radiosurgery

Propósito: Las metástasis cerebrales constituyen el tipo más común de tumor cerebral en adultos, causando un incremento de morbilidad y mortalidad en pacientes con cáncer. En la actualidad el tratamiento electivo en la mayoría de los casos es la radiocirugía.• Material y métodos: Presentamos la valoración de la respuesta a la radiocirugía mediante tomografía por emisión de positrones (PET) y resonancia magnética nuclear (RMN) en un paciente con hidrocefalia y metástasis cerebrales (circunstancia excepcional en la práctica asistencial diaria). • Resultados: Ambas exploraciones PET-FDG y RMN identificaron las lesiones metastásicas cerebrales, detectándose mediante PET la afectación multiorgánica del carcinoma de pulmón. La respuesta a la radiocirugía, en este caso la viabilidad tumoral persistente, fue valorada correctamente por PET- FDG. • Conclusiones: Creemos que es necesario una utilización conjunta de la PET y de la RMN como método óptimo y complementarios para estimar con mayor exactitud el grado de respuesta a la radiocirugía en el tratamiento de las metástasis cerebrales. (AU)

Gamma Knife radiosurgery of the glomus jugulare tumour - early multicentre experience.

Leksell Gamma Knife was used to treat 66 patients with glomus jugulare tumour at 6 European sites between 1992-1998. The age of the patients ranged between 18-80 years (median 54 years). Gamma Knife radiosurgery was a primary treatment in 30 patients (45. 5%). Open surgery preceded radiosurgery in 24 patients (36.4%), embolisation in 14 patients (21.2%) and fractionated radiotherapy in 5 patients (7.6%). The volume of the tumour ranged 0.5-27 cm(3) (median 5,7 cm(3)). The minimal dose to the tumour margin ranged between 10-30 Gy (median 16.5 Gy). After radiosurgery 52 patients were followed, the follow up period was 3-70 months (median 24 months). Neurological deficit improved in 15 patients (29%) and deteriorated in 3 patients (5,8%), one transient and two persistant. Neuroradiological follow up using MRI or CT was performed in 47 patients 4-70 months (median 24 months) after radiosurgery. Tumour size decreased in 19 patients (40%) while in the remaining 28 patients (60%) no change in the tumour volume was observed. None of the tumours increased in volume during the observation period. Control angiography was performed in 6 patients. Pathological vascularisation completely disappeared in one patient, reduced in two and there was no change in the remaining three. Radiosurgery proves to be a safe treatment for glomus jugulare tumour with no mortality and no acute morbidity. Because of its naturally slow growth rate, up to 10 years of follow up will be necessary to establish a cure rate after radiosurgery for these lesions.

Spontaneous carotid-cavernous fistula in osteogenesis imperfecta.

A case of spontaneous carotid-cavernous fistula is presented in a patient suffering from osteogenesis imperfecta tarda type I. The patient was operated on under local anesthesia by intraluminal occlusion of the cavernous carotid artery with a Fogarty catheter, in accordance with Prolo's technique, with total remission except for homolateral loss of vision due to postglaucoma atrophy. the pathogenetic phenomena described in the literature are reviewed, with the suggestion that osteogenesis imperfecta be included with Ehlers-Danlos disease, Marfan's syndrome, and pseudoxanthoma elasticum, as a connective tissue disease with increased weakness of vessel walls that can produce a spontaneous carotid-cavernous fistula. Reports of cases operated on by intraluminal occlusion with various types of balloon-tipped catheters are also reviewed. The good results obtained place this technique among the elective ones for the treatment of carotid-cavernous fistula.