New contributions on chronic low back pain: disc infection or contaminated cultures?

There is controversy about the likely infectious origin of chronic low back pain, because it has been suggested the possibility of a relationship with infection by Cutibacterium acnes (C. acnes). The aim of this study is to compare four methods to determine the presence of a likely infection caused by C. acnes in surgical disc samples. This work is a cross-sectional observational study in which there are included 23 patients with microdiscectomy indication. Disc samples were taken during surgery and analysis was done by culture, Sanger sequencing, next-generation sequencing (NGS), and real-time PCR (qPCR). Furthermore, clinical data collection was conducted, and it was analyzed the presence of the Modic-like changes on the magnetic resonance imaging. In 5 of the samples from among the 23 patients (21.7%), C. acnes was isolated by culture. However, in none of the samples could its genome be detected through Sanger sequencing, the less sensitive method. Only the qPCR and NGS were able to detect very few copies of the genome of this microorganism in all the samples, with no significant quantitative differences being observed between the patients in whom isolation of the microorganism by culture was evident or not. Furthermore, there were no significant relationships identified between the clinical variables, including Modic alterations and positive cultures. The most sensitive methods to the detect C. acnes were NGS and qPCR. The data obtained do not suggest association between the presence of C. acnes and the clinical process and support the hypothesis that C. acnes is found in these samples only because it is a contamination from the skin microbiome.

¿Existen diferencias en el manejo neuroquirúrgico de las lesiones intracraneales en la paciente gestante? Resultados de nuestra experiencia y revisión de la literatura / No disponible

Objetivo El objetivo principal de nuestro trabajo es revisar nuestra experiencia neuroquirúrgica en la paciente gestante y realizar una revisión de la literatura para optimizar el manejo neuroquirúrgico en este tipo de pacientes. Método Estudio retrospectivo entre agosto de 1993 y junio de 2010. Se incluyen aquellas pacientes que se encontraban en período de gestación y presentaban alguna entidad neuroquirúrgica craneal o raquídea. Resultados Fueron documentadas 12 pacientes con edades comprendidas entre 17 y 37 años, con una media de edad de 28,8 años. La media de semanas de gestación fue de 24,17, encontrándose el 50% de las pacientes en el tercer trimestre de embarazo en el momento del diagnóstico, el 25% en el segundo trimestre y el otro 25% en el primer trimestre. El seguimiento medio de las pacientes fue de 84 meses. Cuatro de las 12 pacientes presentaron patología vascular cerebral, cinco presentaron lesiones tumorales cerebrales, una paciente (..) (AU)

[Do differences exist in the neurosurgical handling of intracranial lesions of pregnant patient? Outcomes of our experience and literature review]. / ¿Existen diferencias en el manejo neuroquirúrgico de las lesiones intracraneales en la paciente gestante? Resultados de nuestra experiencia y revisión de la literatura.

OBJECTIVE: The main objective of our work is to revise our neurosurgical experience in pregnant patient and to carry out a revision of the related literature in order to optimize the neurosurgical handling of these kind of patients. METHOD: Retrospective study between august 1993 and June 2010. We included patients who were pregnant at the time and who presented any trace of cranial neurosurgical or spinal disease. RESULTS: The research includes the cases of 12 patients aged between 17 and 37 years old with an average age of 28.8 years old. The average gestation period was of 24.17 weeks, finding 50% of the patients within their third three-month period of pregnancy at the moment of diagnosis, 25% in their second three-month period and the remaining 25% in their first three-month period. The mean follow-up duration for this series was 84 months. 4 of them presented brain vascular lesions, 5 presented brain tumor lesions, 1 of them presented Chiari malformation, one lumbar disc herniation and 1 patient suffered from traumatic intracraneal hemorrhage. 8 of the 12 patients were subjected to neurosurgical procedures under general anesthetic, 2 for aneurysm embolizations and 2 for conservative treatments. Between the neurosurgical procedures 6 craniotomies were done, of wich 4 were to resection of the tumor and 2 for aneurysm clippings. There were done a transesfenoidal approach and a lumbar microdiscectomy. 2 of the 6 patients given craniotomies required external ventricular drainage before the operation. 5 elective cesareans were done in the group of patients given the craniotomies whilst of the rest the pregnancy was allowed to bring to term for reasons of pulmonary maturity. In our patients there were no cases of therapeutic abortion. There was found no morbidity no mortality neither in the mother nor in the fetus related to surgery. CONCLUSIONS: In our experience with pregnant patients who suffered from neurosurgical lesion and in the experience we got from the revision of the related literature, the surgery of intracranial lesions is well tolerated by the mothers and the fetus. It must though be considered, the possibility of labor through cesarean depending on the fetus' lung maturity.

Estudio volumétrico por resonancia magnética de la fosa posterior y sus componentes en la neuralgia del trigémino idiopática / Volumetric measurement of the posterior fossa and its components using magnetic resonance imaging in idiopathic trigeminal neuralgia

Introducción. El conflicto neurovascular se considera hoy día un dogma indiscutible en la fisiopatología de la neuralgia del trigémino idiopática (NTI). Sin embargo, son cada vez más los trabajos que aportan información acerca de otros factores que favorecen dicho conflicto o la neuralgia por sí misma. Objetivos. Medir el volumen de los espacios y subestructuras de la fosa posterior en pacientes con NTI y controles e investigar la asociación entre un espacio reducido de dichas estructuras y la incidencia de NTI. Sujetos y métodos. Se realizan resonancias magnéticas de alta resolución (1,5 T) a 20 pacientes diagnosticados de NTI y a 20 controles sanos y se obtienen secuencias coronales y axiales (1 mm de espesor) potenciadas en T2 para realizar un estudio volumétrico de las cisternas pontomesencefálicas, el cavum de Meckel y el tronco principal del nervio trigémino. Resultados. Considerando la mitad de la cisterna pontomesencefálica a cada lado de la línea media, el volumen de la hemicisterna del lado afectado era significativamente menor que el del lado sano en pacientes con NTI (p = 0,004) y también al compararla con las hemicisternas de los controles. No se encontraron diferencias significativas con el cavum de Meckel ni con el propio nervio trigémino. Se buscó también la presencia de conflicto neurovascular y en un 10% de los pacientes no se identificó dicho fenómeno en el lado afectado. Conclusiones. Los datos obtenidos en nuestro trabajo apoyan la teoría de que un espacio reducido de las cisternas de la fosa posterior que contienen el nervio trigémino podría favorecer la incidencia de NT (AU)

Introduction. The neurovascular conflict is now considered an unquestionable dogma in the pathophysiology of idiopathic trigeminal neuralgia (ITN). However, there are more and more papers that provide information about other factors that promote such conflict or neuralgia itself. Aims. To measure the volume of the substructures of the posterior fossa in patients with ITN and controls and to investigate the association between a reduced volume of these structures and the incidence of ITN. Subjects and methods. In 20 patients with unilateral ITN and 20 healthy participants, high resolution 1.5 T magnetic resonance imaging scans including axial and coronal sequences T2-weighted with a slice thickness of 1 mm were performed with the aim of a volumetric study of pontomesencephalic cistern, Meckel’s cave and trigeminal nerve. Results. Measuring the pontomesencephalic cistern on each side of the midline, the volume of the affected side cistern was significantly lower than the healthy side one in patients with ITN (p = 0.004) and also when compared with controls hemicisterns. No significant differences in the Meckel’s cave nor the trigeminal nerve were found. The incidence of neurovascular conflict was also studied resulting in 10% of patients with ITN where the conflict was not identified. Conclusions. Our data support the theory that a small volume of the posterior fossa cisterns containing the trigeminal nerve may increase the incidence of ITN (AU)

[Volumetric measurement of the posterior fossa and its components using magnetic resonance imaging in idiopathic trigeminal neuralgia]. / Estudio volumetrico por resonancia magnetica de la fosa posterior y sus componentes en la neuralgia del trigemino idiopatica.

INTRODUCTION: The neurovascular conflict is now considered an unquestionable dogma in the pathophysiology of idiopathic trigeminal neuralgia (ITN). However, there are more and more papers that provide information about other factors that promote such conflict or neuralgia itself. AIMS. To measure the volume of the substructures of the posterior fossa in patients with ITN and controls and to investigate the association between a reduced volume of these structures and the incidence of ITN. SUBJECTS AND METHODS: In 20 patients with unilateral ITN and 20 healthy participants, high resolution 1.5 T magnetic resonance imaging scans including axial and coronal sequences T2-weighted with a slice thickness of 1 mm were performed with the aim of a volumetric study of pontomesencephalic cistern, Meckel's cave and trigeminal nerve. RESULTS: Measuring the pontomesencephalic cistern on each side of the midline, the volume of the affected side cistern was significantly lower than the healthy side one in patients with ITN (p = 0.004) and also when compared with controls hemicisterns. No significant differences in the Meckel's cave nor the trigeminal nerve were found. The incidence of neurovascular conflict was also studied resulting in 10% of patients with ITN where the conflict was not identified. CONCLUSIONS: Our data support the theory that a small volume of the posterior fossa cisterns containing the trigeminal nerve may increase the incidence of ITN.