Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital.

OBJECTIVES: To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service. MATERIALS AND METHODS: We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed. RESULTS: We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097 €, sig<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality. CONCLUSIONS: We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications.

Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital

Objectives. To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service.Materials and methods. We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed.Results. We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097€, sig.<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality.Conclusions. We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications can improve quality of care and reduce costs (AU)

Objetivos. Analizar la relación entre la presencia de infección nosocomial y el resultado clínico final, la duración de la estancia y el coste del episodio en los pacientes diagnosticados de tumoración cerebral en nuestro servicio.Material y método. Realizamos un estudio retrospectivo incluyendo los pacientes ingresados en el Servicio de Neurocirugía del Hospital Universitario de Cruces con diagnostico de tumoración cerebral en el periodo comprendido entre el 1-1-2007 y el 31-12 del 2007. Recogimos variables demográficas, los microorganismos responsables y la localización de las distintas infecciones, el tiempo de ingreso y los costes de los distintos procedimientos médicos y quirúrgicos realizados.Resultados. Recogimos 139 pacientes, que acumularon un total de 210 episodios. Encontramos la presencia de infecciones nosocomiales en 34 episodios (16,25%). La localización mas frecuente fue la respiratoria, seguida del tracto urinario y la infección de herida quirúrgica. Encontramos unas diferencias significativas en la situación funcional al alta (sig <0.01), el coste medio de los episodios (17097€, sig.<0.01) y en la estancia media (15.45 días, sig.<0.01). No encontramos diferencias significativas con respecto a la mortalidad.Conclusiones. Encontramos asociaciones significativas entre la presencia de infección nosocomial, un peor resultado clínico, un mayor coste y una mayor estancia. Los gérmenes responsables y localizaciones fueron similares a las series previamente publicadas. A pesar de que la variabilidad en el diseño de los estudios recogidos en la literatura dificulta la interpretación y comparación de los resultados, las medidas destinadas a la prevención de esta complicación permiten simultáneamente mejorar la asistencia prestada, asi como reducir los costes generados por la enfermedad (AU)

[Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature]. / Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de la literatura.

INTRODUCTION: Spontaneous cerebrospinal fluid otorrhea is a relatively rare entity and can be easily missed in adults. Every adult older than 50 years with a negative history of otologic disease who has recurrent serous otitis media should be evaluated for this pathology. Meningitis is the most serious complication, so there is no doubt that the condition needs immediate attention and correction. OBJECTIVE: We present two patients who were diagnosed with spontaneous CSF otorrhea and make a review of what is reported about this topic. CONCLUSION: Surgical repair is mandatory to seal these nontraumatic CSF leaks. There are two main surgical approaches, the middle fossa craniotomy and the transmastoid approach. A multilayered closure technique in which autologous and artificial materials are combined is considered to result in the highest rate of success.

[Neuronal tumors: gangliocytoma]. / Tumores neuronales: gangliocitoma.

INTRODUCTION: Gangliocytomas are neuronal tumors of the central nervous system. They tend to appear in children and young adults. These tumors usually appear in the supratentorial compartment in the temporal lobe. Their clinical presentation is frequently as refractory epilepsy. CASE REPORTS: Three gangliocytoma cases in different locations are presented and a review is made. CONCLUSIONS: Immunochemistry is of great value in the pathological study of these lesions, using neuronal markers for the diagnosis. They are usually benign lesions. Therefore, surgical complete removal is the goal to pursue.

[Imidazoline I(2) receptors as a possible marker for malignancy in human glial cell tumours]. / Los receptores para imidazolinas I(2) como posible marcador de malignidad en tumores gliales humanos.

AIM: To present the experimental data that support the hypothesis that the imidazoline I(2) receptors may be assessed as a biological marker to establish diagnosis and grade of human gliomas. DEVELOPMENT: Gliomas constitute the most important group of brain neoplasm in humans. In these tumours accurate histopathologic diagnosis is a first crucial prerequisite for patient treatment. However, current grading schemes are still limited by subjective histologic criteria. Therefore, the search for new molecular and biological markers of gliomas represents a crucial step. In this context, it has been reported a significant increase in I(2) density in human gliomas when compared with normal brain tissue and other intracranial non-glial tumours. Moreover, this increase seems to fit well with the degree of malignancy in human gliomas. Thus, in glioblastomas multiformes the I(2) density is 1.4 times higher than in anaplastic astrocytomas and 2.2 higher than in low-grade astrocytomas. CONCLUSIONS: The present results demonstrate that the measurement of the I(2) density by positron emission tomography techniques could be used in the future for grading and prognosis of human gliomas. This could avoid the current need for tumour biopsies in order to obtain a histopathologic diagnosis.

A prospective study of a series of 356 patients with supratentorial spontaneous intracerebral haematomas treated in a Neurosurgical Department.

BACKGROUND: Spontaneous supratentorial intracerebral haemorrhages (SSIH) carry high morbidity and mortality rates. At present, the proper role of surgery is not clear and data from the International STICH trial have not clarified this challenging question. On the other hand, few prospective studies have measured long term survival regardless of the treatment and clinical condition of the patient. PATIENTS AND METHODS: We prospectively collected data from all SSIH patients (n = 356) admitted at a tertiary reference hospital over a 40-month time period regardless of their clinical condition and treatment received. Among data investigated were preclinical neurological state, GCS on admission, history of systemic hypertension and treatment (surgical or conservative). Clinical factors influencing mortality at 1-year follow-up were analysed statistically by univariable and multivariable methods. FINDINGS: We found that patients in the eighth decade were the most frequent. Hypertension was present in 47% of patients. Based on the prehospitalisation modified Rankin Scale, 305 (86%) patients were independent for activities of daily living (ADL). At 12-months follow-up, 91 (46% of alive patients) remained independent for ADL. The surgical rate was 22%. Although it was not a randomised study, we did not find a significantly different mortality rate according to whether the patient was treated surgically or conservatively. Overall, the mortality rate was 44% (157 patients) with a 79% of deaths taking place in the first 30 days after admission. CONCLUSIONS: This study underscores the high mortality rate of SSIH, especially so in the first month after admission. Among the subgroup of patients clinically independent before the haemorrhagic stroke, only 29.8% remained independent one year after the event. We did not find any statistically significant difference in mortality according to treatment modality received (surgical vs conservative) although treatment assignment was not randomised. Among other clinical factors, pre-ictal functional status, age, level of consciousness on admission and volume of haemorrhage strongly influence mortality as determined at the 1-year follow-up.

Improvement in quality of life in patients with advanced Parkinson's disease following bilateral deep-brain stimulation in subthalamic nucleus.

In this article we investigate the changes observed in the scales that quantify the quality of life (PDQ-39) in patients that have already completed 1 and 2 years of bilateral subthalamic stimulation (DBS-STN). Fourteen patients were evaluated 1 year after DBS-STN; the evaluation was repeated on 11 of them, 2 years after surgery. All of them suffered from Parkinson's disease with a 14.3 (+/-5.7) years history of motor complications. Patients were selected according to CAPSIT criteria. All of them were implanted bilateral electrodes in the subthalamic nucleus. The parameters applied were UPDRS II, UPDRS III, PDQ-39, and the scale of quality of life for caregivers (SQLC). Scorings in motor scales (UPDRS III) improved 45% in relation to the first year, and 48% in relation to the second year (P < 0.001). Patient's quality of life (PDQ-39 summary index) improvement was 62% 2 years after surgery (P < 0.001), and caregivers' quality of life improvement was 68% (P = 0.002) by the same time. DBS-STN is a therapy that efficiently improves the quality of life of selected patients with Parkinson's disease. This improvement is still present 2 years after surgery and has a positive impact on caregivers quality of life.

[Intraabdominal complications in the lumbar disc surgery]. / Complicaciones intra-abdominales de la cirugía de la hernia discal lumbar.

INTRODUCTION: : Removal of a lumbar disc herniation is, at present, the most frequent surgical procedure, related to the spine in Neurosurgical Departments. It carries a very low rates of complications and a short postoperative hospital stay. However, in spite of their rarity, serious adverse intraoperative complications may occur, so we must be aware of its existence in order to make an early diagnosis and treatment to prevent a fatal outcome. It is important to ensure that the patient understand the possible complications and obtaining written consent to avoid later medico-legal problems. CLINICAL CASES: We report two cases with typical lumbociatic pain secondary to lumbar disc herniation operated at our Department, that resulted in intraoperative complications, due to perforation of intraabdominal structures. Initially, the patients underwent planned flavectomy, followed by simple disc removal. However, symptoms of abdominal pain and systemic hypotension in each case, began some hours later. Early diagnosis was achieved using abdominal-pelvic CT scan, showing an intestinal perforation in one patient and a tear of both iliac artery and vein in the other. In both, an urgent laparotomy was performed by colleagues from the Department of General and Vascular Surgery, with surgical repair. The final outcome was good and both are asymptomatic. CONCLUSION: Surgical removal of the lumbar disc herniation is a very effective procedure, but is not free from certain severe though rare complications. Intestinal perforation and vascular tears are two possible complications to suspect if abdominal pain or systemic arterial to suspect if abdominal pain or systemic arterial urgent surgical repair of such complications. It is of vital importance that the patient knows the existence of such complications and so obtain a written consent.

Complicaciones intra-abdominales de la cirugía de la hernia discal lumbar / Intraabdominal complications in the lumbar disc surgery

Introducción. La extirpación de la hernia discal lumbar es actualmente el acto quirúrgico más habitual sobre el raquis en los servicios de Neurocirugía, con un número de complicaciones muy escasas y unas estancias hospitalarias realmente cortas. Sin embargo, y a pesar de la rareza, es posible la aparición de complicaciones intraoperatorias muy graves que son necesarias conocer puesto que un diagnóstico y tratamiento precoces pueden evitar el fallecimiento del paciente. Es importante involucrar a éste en el conocimiento de estas posibles complicaciones y obtener un consentimiento informado por escrito para evitar problemas médicolegales posteriores. Casos clínicos. Presentamos dos casos de lumbociática típica secundaria a hernia discal lumbar intervenidos en el Servicio de Neurocirugía de Cruces que se complicaron con la perforación intraoperatoria de estructuras intraabdominales. En ambos casos se realizó una fiavectomía y extirpación discal simple de forma habitual. La sintomatología comenzó algunas horas después de la cirugía con dolor abdominal e hipotensión en uno y otro caso. El diagnóstico precoz se realizó mediante TAC abdomino-pélvico. Posteriormente, y de forma urgente los Servicios de Cirugía General y Cirugía Vascular realizaron sendas laparotomías, posibilitando la reparación de una perforación intestinal en un paciente y de un desgarro de la arteria y vena iliacas en el otro, evitando así fatales consecuencias. Actualmente ambos están asintomáticos. Conclusión. La cirugía de la hernia discal lumbar, en la gran mayoría de los casos muy agradecida en cuanto a la desaparición del dolor, no está exenta de complicaciones tan raras como graves. La perforación intestinal y el desgarro vascular son dos ejemplos que hay que conocer y sospechar ante la aparición de dolor abdominal o hipotensión arterial sistémica en el postoperatorio, a pesar de que la extirpación discal discurra sin incidencias. El diagnóstico precoz mediante TAC abdomino-pélvico dirigirá la actitud hacia un tratamiento quirúrgico urgente de dichas lesiones. Es de máxima importancia que el paciente conozca la existencia de las posibles complicaciones de la cirugía de la hernia discal y obtener su consentimiento por escrito (AU)

Imidazoline I(2) receptor density increases with the malignancy of human gliomas.

BACKGROUND: Current glioma grading schemes are limited by subjective histological criteria. Imidazoline I(2) receptors are principally expressed on glial cells. OBJECTIVE: To investigate the feasibility of using the measurement of imidazoline I(2) receptor expression to differentiate glial tumours from other types of brain tumours and for grading the different gliomas. METHODS: The specific binding of [(3)H]idazoxan to imidazoline I(2) receptors was measured in homogenates from human gliomas of different grades. RESULTS: The density of imidazoline I(2) receptors was significantly greater in the three types of malignant glial tumours than in postmortem control brain or non-glial tumours. The increase in density correlated with the malignancy grade of the gliomas. No significant differences in affinity values were observed. CONCLUSION: These results suggest that the density of imidazoline I(2) receptors may be a useful radioligand parameter for the differentiation of glial tumours from other types of brain tumours and for grading the different gliomas.

[Bilateral subthalamic nucleus deep-brain stimulation (STN-DBS) in Parkinson's disease: initial experience in Cruces Hospital]. / Estimulación bilateral del núcelo subtalámico en la enfermedad de Parkinson. Experiencia inicial en el Hospital de Cruces.

INTRODUCTION: Clinical outcomes of Parkinson's disease patients treated for 12 months with STN-DBS were analyzed. PATIENTS ADN METHODS: Twelve patients were selected using the CAPSIT protocol criteria and placement of electrodes in the appropriate target was performed according to results of fusion image techniques and intraoperative microrecording. RESULTS: A reduction in motor UPDRS (44 %) and activities of daily living (58 %) scores during <> phases were observed. <> time with dyskinesias was reduced (86 %), while severe dyskinesias disappeared. Levodopa dosage was also lowered (44 %). Patients and caregivers showed a clear-cut benefit on quality of life (58 % and 61 % respectively). No cognitive deterioration was observed and morbidity was in the same range as that published by other teams. CONCLUSION: Bilateral STN-DBS is an effective symptomatic therapy for complicated Parkinsons disease patients. It improves the quality of life of patients and their caregivers and allows a reduction of levodopa dosage.

Estimulación bilateral del núcleo subtalámico en la enfermedad de Parkinson. Experiencia inicial en el Hospital de Cruces / Bilateral subthalamic nucleus deep-brain stimulation (STN-DBS) in Parkinson's disease: initial experience in Cruces Hospital

Introducción: Se presentan los resultados clínicos tras 1 año de evolución en 12 pacientes con enfermedad de Parkinson tratados con estimulación bilateral de núcleo subtalámico. Pacientes y métodos: Los pacientes han sido seleccionados y estudiados de acuerdo con el protocolo CAPSIT y la colocación de los electrodos se ha realizado con el apoyo de técnicas de fusión de imagen y microrregistro intraoperatorio. Resultados: Se ha observado una mejoría clínica significativa en la intensidad del off, tanto en actividades de la vida diaria (58 por ciento) como en el aspecto motor (44 por ciento), ha disminuido el tiempo de discinesias (86 por ciento), con desaparición total de las discinesias graves, y se ha reducido en un 44 por ciento la dosis equivalente de levodopa del tratamiento médico. Se ha observado también una mejoría del 58 por ciento en la calidad de vida de los pacientes, así como un beneficio de un 61 por ciento en la calidad de vida de los cuidadores. No se ha observado deterioro cognitivo y la morbilidad ha sido similar a la de otros equipos quirúrgicos. Conclusión: La estimulación bilateral del núcleo subtalámico en la enfermedad de Parkinson evolucionada es una terapia eficaz que mejora la calidad de vida de los pacientes y de sus cuidadores y permite la reducción de dosis de levodopa (AU)

[Neuropsychological changes and bilateral subthalamic deep brain stimulation in Parkinson's disease]. / Efectos cognitivos de la estimulación cerebral profunda sobre el núcleo subtalámico en la enfermedad de Parkinson.

INTRODUCTION: To investigate neuropsychiatric changes in Parkinson's disease (PD) patients after 12 months of bilateral subthalamic deep brain stimulation (DBS-STN). SUBJECTS: Nine out of 23 patients with PD subjected to DBS-STN were included. The mean follow-up of this cohort was 12 months, mean disease duration 14.2 5.5 years and mean UPDRS motor score in <> 43.2 13.7. METHODS: Patients were selected on the basis of CAPSIT criteria. They underwent bilateral implant of stimulators in STN under stereotactic conditions. Quality of life scale (PDQ 39), depression scale (Brev-Cet), frontal function test (Stroop, Wisconsin, verbal fluency) and memory evaluation (Barcelona test) were monitored at baseline in <> medication and after 12 months in <> medication/<> stimulation. RESULTS: The patients' motor scores improved on an average of 40.2 % (p = 0.0002) in <> medication situation and 58 % in quality of life scores. We observed a benefit in depression scores (52 %, p = 0.003). Immediate verbal memory improved as well, 25 % (p = 0.04) in recall memory and 14 % (p = 0.02) in recognition memory. No changes were observed in visual memory, verbal fluency and/or global cognitive tests. CONCLUSION: DBS-STN in PD patients seems to be an effective tool for improving their quality of life, due to its benefits on motor function, verbal memory and mood. Bilateral DBS-STN did not affect either verbal fluency or executive functions in our patients. Neuropsychological assessment is a good tool for selection and study of the operated patients.

Efectos cognitivos de la estimulación cerebral profunda sobre el núcleo subtalámico en la enfermedad de Parkinson / Neuropsychological changes and bilateral subthalamic deep brain stimulation in Parkinson's disease

Introducción: Se investigan cambios en la esfera cognitiva en pacientes con enfermedad de Parkinson (EP) tras 12 meses de estimulación cerebral profunda en el núcleo subtalámico (ECP NS). Pacientes: La serie recoge nueve de 23 pacientes con EP sometidos a ECP NS, con 12 meses de seguimiento. La duración media de la enfermedad era 14,2 ñ 5,5 años y la puntuación de UPDRS III en situación off de 43,2 ñ 13,7. Métodos: Se utilizaron los criterios CAPSIT para la inclusión de pacientes. Se les implantaron electrodos (bilateralmente) mediante cirugía estereotáctica. Se monitorizaron en situación basal (on medicación) y al año (on medicación, on estimulación) los siguientes parámetros: calidad de vida (PDQ 39), depresión (Brev-Cet), funciones frontales subcorticales (Stroop, Wisconsin, fluencia verbal) y valoración de la memoria (test de Barcelona). Resultados: Las puntuaciones en escalas motoras mejoraron un 40,2 por ciento (p = 0,0002) en off/on y un 58 por ciento en calidad de vida. Se observó una mejoría del 52 por ciento en escalas de depresión (p = 0,003). La memoria verbal inmediata también mejoró, un 25 por ciento en evocación (p = 0,04) y un 14 por ciento en reconocimiento (p = 0,02). No se observaron modificaciones en memoria visual, fluencia verbal y parámetros cognitivos globales. Conclusiones: La ECP NS es un tratamiento eficaz para mejorar la calidad de vida de enfermos parkinsonianos avanzados, debido a la mejoría que se produce en síntomas motores, depresivos y memoria verbal. En nuestra serie no hemos detectado cambios en las funciones ejecutivas ni en la fluencia verbal. El estudio neuropsicológico ayuda a una mejor selección y estudio de los pacientes intervenidos (AU)

Prognostic factors in a series of 185 consecutive spontaneous supratentorial intracerebral haematomas.

We report a retrospective observational study of 185 cases with spontaneous supratentorial intracerebral haemorrhage, in which, by univariate and multivariate analysis, the main clinical and CT findings influencing patient outcome were studied. Forty (22%) patients died and 77 (41%) remained in a very disabled state. Using logistic regression analysis we found that the volume of the haematoma, its deep location, surgical treatment and the preictal status in relation to activities of daily living (ADL) were independent factors for patient outcome measured with the Modified Rankin Scale. Similarly, GCS at presentation, preictal status in relation to ADL and age were directly correlated with mortality at 6 months follow-up. We also observed that age, GCS at admission and the volume of the haematoma, were the main factors influencing the neurosurgeon's decision regarding surgical treatment.

Giant pituitary adenomas: clinical characteristics and surgical results.

Although most pituitary neoplasms are benign, some grow rapidly, spreading to extrasellar tissues. Definition of these 'giant' pituitary adenomas (PAs) is not clear. In order to clarify this question, we studied all pituitary macroadenomas operated in our hospital during the last 20 years, differentiating those with diameter > or = 3 cm (n = 43) and attempting to identify their typical features and prognosis. The reason for consultation was local in 58.3% of giant PAs, hormonal in 22.9% and tumour recurrence in 16.7%. Surgery was performed via a trans-sphenoidal approach in 92.5% of cases and succeeded in completely removing the tumour in only 27% of cases. In conclusion, we found that giant PAs are not a special type but the extreme case in the gradient of invasiveness of tumours of adenohypophyseal origin. They are characterized by a higher frequency of neuro-ophthalmological symptoms and hormonal deficits, and poorer response to surgical treatment.

[Prophylactic antiepileptic treatment of cerebral aggressions]. / Tratamiento antiepiléptico profiláctico de las agresiones cerebrales.

OBJECTIVE: On the occasion of the First Congress of the Spanish Anti Epilepsy League we had reviewed the use of antiepileptic drugs for preventing postoperative and posttraumatic seizures. DEVELOPMENT: Two specific causes of epilepsy are particularly relevant to neurosurgical practice; postoperative and posttraumatic epilepsy. After reviewing the seizures arising after craniotomy for supratentorial conditions such as vascular malformations (aneurysms and arteriovenous malformations), cerebral tumours and supratentorial abscesses and empyemas, we discuss the different types of posttraumatic epilepsy and the risk factors. The pathogenesis of tumour associated epilepsy and the pathophysiological events initiating posttraumatic epilepsy are described. The use of prophylactic antiepileptic drugs is only justified in cases with several risk factors capable to develop seizures. CONCLUSION: As no treatments have yet been shown to be effective in preventing the development of epileptic seizures, additional trials are likely to be necessary.

[Lumbar root compression secondary to juxtafacet cysts: review of 10 cases]. / Compresión radicular lumbar secundaria a quistes yuxtafacetarios: revisión de 10 casos.

OBJECT: We report a series of 10 patients with 11 juxtafacet cysts of the lumbar spine treated in our center from 1994 to 2000. METHODS: The clinical histories, radiographic images, surgical protocols and pathological records of the 10 patients diagnosed of lumbar juxtafacet cyst have been analyzed. RESULTS: Six patients were women and four were men. The average age of presentation was 54 years. The most frequent clinical presentation was radicular pain, and motor or sensitive deficits were not very common. Computed tomography and magnetic resonance are essential in establishing the diagnosis. The cysts were located at L4-L5 in eight patients, at L2-L3 in one patient, and at L3-L4 in other patient. Eight patients were treated by means of decompressive laminectomy and excision of the cyst, and the remaining two underwent conservative treatment. Degenerative phenomena adjacent to the juxtafacet cysts are easy to evidence. All the patients were improved of their radicular pain. CONCLUSIONS: Analysing our series, we conclude that the juxtafacet cysts appear more frequently at L4-L5 level in people of advanced age, and produce commonly low back pain and radiculopathy. Although they can be treated initially in a conservative way, in the presence of a progressive sciatic syndrome, surgical management is preferable.

Compresión radicular lumbar secundaria a quistes yuxtafacetarios: revisión de 10 casos / Lumbar radicular compression secondary to juxtafacet cysts: report of ten cases

Objetivo: Se presenta una revisión de la clínica, estudios radiológicos, y hallazgos; operatorios e histológicos de 10 pacientes con 11 quistes yuxtafacetarios de la columna lumbar tratados en nuestro centro desde 1994 al 2000.Métodos: Se han analizado las historias clínicas, imágenes radiológicas, protocolos quirúrgicos e informes histopatológicos de los 10 pacientes diagnosticados de quiste yuxtafacetario lumbar (11). Resultados: Seis pacientes eran mujeres y cuatro hombres. La edad media de presentación fue de 54 años. La clínica de más frecuente presentación fue la de dolor radicular, siendo poco común el déficit motor o sensitivo. La tomografía computerizada y la resonancia magnética son esenciales para establecer el diagnóstico. Los quistes estaban localizados a nivel L4-L5 en ocho pacientes ä nivel L2-L3 - en un paciente y L3-L4 en otro paciente. Ocho pacientes se trataron mediante laminectomía descompresiva y resección del quiste, y los dos restantes recibieron tratamiento conservador. Fenómenos degenerativos adyacentes a los quistes yuxtafacetarios son fáciles de evidenciar. Todos los pacientes han presentado mejoría de su dolor radicular. Conclusiones: Analizando nuestra casuística, concluimos que los quistes yuxtafacetarios aparecen más frecuentemente a nivel L4-L5, sobre todo en personas de edad avanzada, y producen habitualmente lumbalgia y radiculopatía. Aunque pueden tratarse de forma inicialmente conservadora, ante un síndrome ciático progresivo, es preferible optar por un tratamiento quirúrgico (AU)

Nuestra experiencia con la válvula Codman-Medos programable:revisión de 125 derivaciones / Our experience with the programmable codman-medos valve: a review of 125 shunts

Introducción. Las válvulas programables pueden ser una solución para los problemas de hiperdrenaje o hipodrenaje. Objetivo. Aportar nuestra experiencia con estas derivaciones programables y aclarar conceptos. Pacientes y métodos. Hemos colocado 125 derivaciones Codman-Medos programables a 118 pacientes. La indicación más frecuente ha sido la hidrocefalia secundaria (sobre todo obstructiva tumoral) y primaria, pero también para hipertensión intracraneal benigna (HICB), fístulas de LCR y quistes aracnoideos. La mayoría se han colocado frontalmente, y con profilaxis antibiótica. Resultados. Excluidos los pacientes con seguimiento menor a tres meses, el seguimiento medio es de 14,63ñ9,07 meses, mejorando clínicamente el 80 por ciento. La mortalidad relacionada con la cirugía es del 0 por ciento. La presión inicial media es de 121,84ñ24,74 mmH2O y tras 52 reprogramaciones realizadas a 36 (30 por ciento) pacientes, la presión final media es de 124,96ñ30,58 mmH2O. La reprogramación se ha utilizado para el manejo de síntomas y para evitar higromas subdurales. No hemos obtenido evidencia clínica de desprogramación. Las complicaciones han sido 29, en 7 casos se han solucionado con reprogramación y el resto quirúrgicamente. Conclusiones. Recomendamos su colocación frontal y con catéter peritoneal largo, principalmente en pacientes con hidrocefalias secundarias a estenosis del acueducto de Silvio, HICB, post-TCE y Arnold-Chiari. La presión inicial es difícil de determinar pero tendemos a que ésta sea media-alta. Las reprogramaciones son especialmente útiles en el tratamiento de los higromas subdurales. No hemos tenido evidencia clínica de desprogramación. Las complicaciones en su mayoría son debidas a la técnica quirúrgica y no al shunt utilizado (AU)